Characterizing Novice Behavior Associated With Learning Ultrasound-Guided Peripheral Regional Anesthesia

Sites, Brian D.; Spence, Brian C.; Gallagher, John D.; Wiley, Christopher W.; Bertrand, Marc L.; Blike, George T.

doi:10.1016/j.rapm.2006.11.006

Cited by 173 publications

(120 citation statements)

References 14 publications

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“…3 In a clinical study of USG peripheral nerve blockade, Sites and colleagues found long learning curves and a consistent pattern of errors, including unintentional probe movement, awkward needle holding, and most importantly, poor needle tip visualization. 22 We observed a similar pattern of errors early in training, and believe this was also reflected in the baseline and early HMA metrics. The deliberate practice stations were therefore modified to include drills that required precise localization of the tip of the needle (Table 3).…”

Section: Discussionsupporting

confidence: 71%

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

McGraw

Chaplin

McKaigney

et al. 2016

CJEM

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Objective: To develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency. Methods: Ten post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale. Results: None of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently. Conclusion: We successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks. RÉSUMÉObjectifs: L'étude visait à élaborer un programme de formation axé sur la simulation et conçu à l'intention des résidents en vue de l'apprentissage de la mise en place échoguidée de cathéters veineux centraux (CVC), et à déterminer le nombre et le type d'exercices pratiques permettant d'en arriver à la compétence technique. Méthode: Dix résidents, en deuxième année d'études de cycles supérieurs, en médecine d'urgence et en anesthésie ont participé à quatre séances de formation de deux heures chacune, tenues à deux semaines d'intervalle, dans le cadre d'un programme structuré de pratique intentionnelle sur simulateur, en vue de l'acquisition des compétences de base dans la mise en place échoguidée de CVC. Les progrès réalisés durant la formation ont été suivis de près à l'aide d'un outil régulier de mesure, l'Hand Motion Analysis (HMA), et les valeurs de référence ont été déterminées par l'HMA des experts locaux. À la fin des séances de formation, les compétences techniques enregistrées sur bande vidéo ont fait l'objet d'une évaluation à l'insu par des experts, sur une échelle globale de notation (EGN). Résultats: Au départ, aucun des résidents n'atteignait l'une ou l'autre des valeurs de référence. Au fil de la formation, les mesures de l'HMA des résidents ont révélé une amélioration constante et i...

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Section: Discussionsupporting

confidence: 71%

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

McGraw

Chaplin

McKaigney

et al. 2016

CJEM

View full text Add to dashboard Cite

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“…Even after correct target identification, available studies have observed that even experienced practitioners (with > 100 ultrasound-guided nerve blocks) persistently failed to maintain the needle tip in view [15]. A recent cadaveric study reported a 50% incidence of unintentional intraneural (sub epineurium) injection during simulated ultrasound-guided interscalene block [8].…”

Section: ó 2011 the Authorsmentioning

confidence: 99%

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Liu

YaDeau

Shaw³

et al. 2011

Anaesthesia

138

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SummaryIt is proposed that ultrasound guidance decreases the risk of intraneural injection and associated postoperative neurological complications. However, the incidence of unintentional intraneural injection with ultrasound is unknown. Two hundred and fifty-seven patients were enrolled in a prospective, single-blind observational study. All patients underwent a pre-operative neurological examination before ambulatory shoulder arthroscopy with sedation and ultrasound-guided interscalene or supraclavicular block. Patients were followed up at 1 week and at 4-6 weeks postoperatively. Two blinded anaesthesiologists viewed the same video of the ultrasound image during the block offline to determine intraneural trespass. Intraneural injection occurred in 42 patients (17%; 95% CI 12-22%). No patient suffered from postoperative neurological complications (0%; 95% CI 0-1.6%) at follow-up.

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“…Ultrasound, Kinect, Simulation, Needle, Volumetric Slicing, OpenGL, OpenCV want to incorporate US into their regional anesthesia practice [5]. Traditionally, this skill set is acquired during anesthesia training through performance of these procedures on patients under supervision.…”

Section: Keywordmentioning

confidence: 99%

Ultrasound Guided Regional Anesthesia Training Simulator Using Microsoft Kinect

Sairam¹

2014

Int J Anesthetic Anesthesiol

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We present a system for the interactive simulation of ultrasound guided peripheral nerve blocks using a Microsoft Kinect®. The system performs motion tracking of both the ultrasound probe and the nerve block needle. Software generates synthetic ultrasound images from previously captured ultrasound images. Details of the software elements in the system are described. Some of the current challenges and future work in this research are discussed.

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Characterizing Novice Behavior Associated With Learning Ultrasound-Guided Peripheral Regional Anesthesia

Abstract: Based on the analysis of the committed errors and the identification of quality-compromising behaviors, we are able to recommend important targets for learning in future training and simulation programs.

Cited by 173 publications

References 14 publications

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Ultrasound Guided Regional Anesthesia Training Simulator Using Microsoft Kinect

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