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Low-fidelity haptic simulation versus "mental imagery" training for epidural anesthesia technical achievement in novice anesthesiology residents: a randomized comparative study
Abstract Number: T-37
Abstract Type: Original Research
Introduction: Epidural anesthesia (EA) is rated among the most difficult technical skills to acquire. Many teaching methods for EA exist, ranging from low fidelity (LF) haptic to high fidelity (HF) haptic simulation. Previous work indicates that there is no difference in skill acquisition when novice learners engage in HF versus LF simulation for EA. However, to our knowledge, no study has compared the effect of LF haptic simulation versus "mental imagery" training (or "non-haptic" simulation) for EA. We hypothesized that LF haptic simulation training for EA would be more effective in achieving technical skills among novice trainees, compared to "mental imagery" training in which no physical practice is attempted.
Methods: In this IRB approved single-center randomized comparative study, 20 PGY-2 anesthesiology residents were tested at the beginning of the training year. Baseline skills and demographic data were collected. Group 1 had 60 minutes of LF simulation training for EA using a banana.[2,3] Group 2 had 60 minutes of "mental imagery" training: they were oriented to the parts of the epidural kit, EA was described in detail, but no physical practice was undertaken. Each resident then individually performed EA on a partial-human task trainer on three consecutive occasions under the direct observation of skilled evaluators, who were blinded to group assignment and who assessed technical achievement using a modified validated skills checklist. Scores (0 –21) and duration (minutes) to task completion were recorded. A mixed model analysis was performed to determine differences in scores and duration to task completion between groups and over time.
Results: Baseline characteristics between the groups were not significantly different. There was no statistically significant difference in scores between the two groups (16.5±1.8 vs. 15.5±2.0, 17.2±2.9 vs. 17.8±1.8, 19.0±1.6 vs. 18.5±2.6, P = 0.58) (Figure 1A). Both groups showed a similar increase in scores over time (Group 1: 16.2 to 17.7 to 18.9; Group 2: 15.9 to 17.4 to 18.6, P = 0.0015). Time to complete the procedure decreased similarly for both groups after the first attempt (Group 1: 15.8 to 13.4 to 13.1; Group 2: 16.0 to 13.7 to 13.3, P = 0.032) (Figure 1B).
Conclusion: Our results suggest that utilization of LF haptic simulation is not superior to "mental imagery" training for technical performance of EA. Education on EA with structured didactics and "mental imagery" training may be adequately preparative for novice learners prior to an attempt on human subjects.
1. Friedman Z. RAPM. 2009;34
2. Leighton BL. Anesthesiology. 1989;70
3. Raj D. EurJAnesth. 2013;30
4. Friedman Z. RAPM. 2006;31