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A Randomized Controlled Study to Evaluate the Effects of a Computer-Enhanced Visual Learning (CEVL Neuraxial) Tool to Teach Anesthesiology Residents to Perform Combined Spinal Epidural Placements in Obstetric Patients
Abstract Number: F-48
Abstract Type: Original Research
Objectives: In obstetric anesthesiology, educators must balance resident procedural education with clinical time pressures as well as patient safety and comfort. Therefore alternative educational strategies, including E-learning tools, may be beneficial to orient novice learners to new procedures. In this blinded randomized controlled study, we examine whether a two week exposure to an e-learning tool (CEVL neuraxial) improved resident procedural performance and self-confidence.
Methods: A total of 24 CA-1 and CA-2 anesthesiology residents from the University of Illinois at Chicago and Northwestern University were enrolled in the study three weeks prior to their first obstetric anesthesiology rotation. Residents were randomized to receive either on-line access to the neuraxial module (CEVL group) or no access (Control) two weeks prior to the rotation. Subjects were instructed to use the module as they desired and not discuss their group assignment during the rotation. On the first day of the rotation, residents completed a neuraxial self-confidence scale and were observed, by blinded raters, performing combined spinal epidural catheter techniques on laboring patients with BMIs less than 35kg/m2 and no known anatomic spine abnormalities. Raters recorded both performance on a procedural checklist (divided into technical, sterility and needle safety items) and the time to placement (kit opening to dressing placement). Results were characterized by descriptive statistics with t-tests to compare groups.
Results: The CEVL group had significantly shorter placement times compared to the No CEVL group 22.5 ±4.88 vs. 39.5 min ± 7.07 (p<0.001) and had higher scores on the overall neuraxial performance checklist 36.4± 6.63 vs. 28.8 2±7.11 (p=0.012). The CEVL group had higher scores on the checklist for sterility items 7.91±1.78 vs. 6.58±1.31( p=0.048) and technical items 26.83±5.45 vs 20.25±6.36 (p=0.012). Self-confidence scores for gathering equipment, assembling the kit, positioning, LOR technique, LOR recognition, threading the catheter, calculations of depth, needle safety and applying dressing were not statistically different between groups.
Conclusions: CEVL is a novel teaching tool that can enhance the traditional teaching of neuraxial procedures in obstetric anesthesiology. The group of residents with access to CEVL neuraxial prior to their rotation had a shorter combined spinal epidural catheter placement time and higher scores on procedural checklists during their first neuraxial placement on their obstetric anesthesiology rotation. Performance of checklist items related to both sterility and technique were higher in the CEVL group. Self-confidence ratings at the beginning of the rotation did not appear to differ however. Future research could examine whether the use of such tools for resident education impact provider long term performance or patient outcomes.