Abstract
BackgroundIn preparing novice anesthesiologists to perform their first ultrasound-guided axillary brachial plexus blockade, we hypothesized that virtual reality simulation-based training offers an additional learning benefit over standard training. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial.MethodsWe planned to recruit 20 anesthesiologists who had no experience of performing ultrasound-guided regional anesthesia. Initial standardized training, reflecting current best available practice was provided to all participating trainees. Trainees were randomized into one of two groups; (i) to undertake additional simulation-based training or (ii) no further training. On completion of their assigned training, trainees attempted their first ultrasound-guided axillary brachial plexus blockade. Two experts, blinded to the trainees’ group allocation, assessed the performance of trainees using validated tools.ResultsThis study was discontinued following a planned interim analysis, having recruited 10 trainees. This occurred because it became clear that the functionality of the available simulator was insufficient to meet our training requirements. There were no statistically significant difference in clinical performance, as assessed using the sum of a Global Rating Score and a checklist score, between simulation-based training [mean 32.9 (standard deviation 11.1)] and control trainees [31.5 (4.2)] (p = 0.885).ConclusionsWe have described a methodology for assessing the effectiveness of a simulator, during its development, by means of a randomized controlled trial. We believe that the learning acquired will be useful if performing future trials on learning efficacy associated with simulation based training in procedural skills.Trial registrationClinicalTrials.gov identifier: NCT01965314. Registered October 17th 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2253-14-110) contains supplementary material, which is available to authorized users.
Highlights
In preparing novice anesthesiologists to perform their first ultrasound-guided axillary brachial plexus blockade, we hypothesized that virtual reality simulation-based training offers an additional learning benefit over standard training
In the context of ultrasoundguided axillary brachial plexus blockade (USgABPB), we have demonstrated that anesthesiologists in Ireland perceive a lack of learning opportunity as being the most important impediment to procedural skill development [1]
Ten trainee anesthesiologists were recruited from a university affiliated teaching hospital (Cork University Hospital) in July 2010, 4 to the Simulation group and 6 to the Control group Recruitment was discontinued because, it became clear that the functionality of the available simulator was insufficient to meet our training requirements
Summary
In preparing novice anesthesiologists to perform their first ultrasound-guided axillary brachial plexus blockade, we hypothesized that virtual reality simulation-based training offers an additional learning benefit over standard training. The learning environment in which resident anesthesiologists acquire procedural skills has fundamentally changed. Training programmes are shorter and afford fewer training opportunities. Institutional and regulatory expectations limit acceptance of trainees acquiring skills. It is indisputable that simulation will play in an increasingly important part in the training and assessment of procedural skills [2]. Simulation offers trainees an opportunity to hone skills in a risk-free environment. A recent meta-analysis demonstrated that technology-enhanced simulation-based training is associated with large positive effects on knowledge, skills, and behaviors, and moderate effects on patient based outcomes [5]
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