Low-Fidelity Haptic Simulation Versus Mental Imagery Training for Epidural Anesthesia Technical Achievement in Novice Anesthesiology Residents: A Randomized Comparative Study

Abstract

Background There are many teaching methods for epidural anesthesia skills. Previous work suggests that there is no difference in skill acquisition whether novice learners engage in low-fidelity versus high-fidelity haptic simulation for epidural anesthesia. However, no study has compared the effect of low-fidelity haptic simulation for epidural anesthesia versus mental imagery training in which no physical practice is attempted. We tested the hypothesis that mental imagery training is superior to low-fidelity haptic simulation training for epidural anesthesia skill acquisition. Methods Twenty PGY-2 anesthesiology residents were tested at the beginning of the training year. After a didactic lecture on epidural anesthesia, they were randomized into two groups. Group LF had low-fidelity simulation training for epidural anesthesia using a previously described banana simulation technique. Group MI had guided, scripted mental imagery training in which they were initially oriented to the epidural kit components and epidural anesthesia was described in stepwise detail, followed by individual mental rehearsal; no physical practice was undertaken. Each resident then individually performed epidural anesthesia on a partial-human task trainer on three consecutive occasions under the direct observation of skilled evaluators who were blinded to group assignment. Technical achievement was assessed using a modified validated skills checklist. Scores (0–21) and duration to task completion (minutes) were recorded. A linear mixed-effects model analysis was performed to determine differences in scores and duration between groups and over time. Results There was no statistical difference between the two groups for scores and duration to task completion. Both groups showed similarly significant increases (P = 0.0015) in scores over time (estimated mean score [standard error]: Group MI: 15.9 [0.55] to 17.4 [0.55] to 18.6 [0.55]; Group LF: 16.2 [0.55] to 17.7 [0.55] to 18.9 [0.55]). Time to complete the procedure decreased similarly and significantly (P = 0.032) for both groups after the first attempt (estimated mean time [standard error]: Group MI: 16.0 [1.04] minutes to 13.7 [1.04] minutes to 13.3 [1.04] minutes; Group LF: 15.8 [1.04] minutes to 13.4 [1.04] minutes to 13.1 [1.04] minutes). Conclusions Mental imagery is not different from low-fidelity simulation training for epidural anesthesia skill acquisition. Education in epidural anesthesia with structured didactics and continual mental imagery training may suffice to prepare novice learners prior to an attempt on human subjects.

Improving Dental Students Fine Motor Skills by Visualization and Mental Imagery: A Pilot Randomized Clinical Trial

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Infection prevention in the operating room anesthesia work area

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Adapting Motor Imagery Training Protocols to Surgical Education: A Systematic Review and Meta-Analysis

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