Simulation Training Clinical Trial
Official title:
Effects of Metric-based Feedback Training on Acquisition of Sonographic Skills Relevant to Performance of Ultrasound Guided Axillary Brachial Plexus Block
The investigators hypothesized that feedback based on previously developed and validated
metrics will improve novices' learning of procedural skills.
The objective of this study was to determine the effect of a structured, objective and
terminal feedback on novices' performance skills of ultrasonography part of
ultrasound-guided axillary brachial plexus block.
The use of ultrasound guidance during performance of peripheral nerve blocks improves
success rate, shortens performance time and reduces the risk of inadvertent vascular
puncture. Safe and effective procedure performance requires the operator to make a series of
real-time, high stakes decisions relevant to interpretation of sonographic anatomy and
subsequent nerve visualization, needle-to-nerve guidance, needle-to-nerves approximation and
local anesthetic deposition. Teaching novices to perform ultrasound-guided nerve blocks
should include rendering and assessment of its component skills such as interpretation of
sonographic anatomy, consistent needle imaging and correct placement of local anesthetics.
Learning and teaching ultrasound-related motor skills is challenging within the current
landscape of medical and training education. Simulated learning has been advocated as it can
facilitate deliberate practice as opposed to repeated practice. Simulation and e-learning
are flexible training modalities, which facilitate procedural skills rehearsal in a safe
environment, free from risk to patients, and permitting real time feedback. Deliberate
practice with feedback in a simulated environment may accelerate the rate of skill
acquisition. Feedback is a predictor of effective learning and a useful tool for novices
learning new skill. However summative feedback is superior to concurrent feedback for
procedural skill acquisition during simulated but not clinical training and for skill
retention. The characteristics of feedback, which influence its effect on learning, include
timing, content, who initiates (elicits) it and the format and motivation applied to its
delivery. Feedback positively influences skill acquisition by novice learners. How trainees
adopt objective versus subjective feedback remained largely undetermined. The investigators
hypothesize that feedback based on previously developed and validated metrics will improve
novices' learning of procedural skills.
The objective of this study was to determine the effect of a structured, objective and
terminal feedback on novices' performance skills of ultrasonography part of
ultrasound-guided axillary brachial plexus block.
Methods:
With institutional ethical approval and having obtained written informed consent from each,
12 anesthesia trainees will be invited to participate in this prospective, randomized and
blinded study.
Inclusion criteria:
i. trainees in the Irish national anesthesia training program allocated to Cork teaching
hospital (CUH) ii. have performed no more than 5 ultrasound-guided peripheral nerve blocks
at the time of participation.
Each participant will answer tests to ascertain visuospatial and perceptual abilities (card
rotation, cube comparisons and map planning tests).
Each participant will provide baseline information prior to participation i) age ii) gender
iii) handedness iv) Years since graduating from medical school v) number or estimated number
of previously performed ultrasound-guided interventional procedures including securing
vascular access vi) courses/workshops in ultrasound-guided procedural interventions.
All participants will receive a standard learning in the form of i) a one hour didactic
lecture delivered by a single investigator which outlines basic sonographic anatomy,
ultrasound physics and anatomy relevant to performing ultrasound-guided axillary brachial
plexus block.
Within 24 hours of completing the learning phase, participants will be asked to perform
ultrasonography of left axilla of a volunteer. This will be followed by either feedback A or
feedback B (based on random allocation). Feedback will terminal, summative and commence five
minutes after each participant completed the tasks.
Task description:
1. Participant perform ultrasonography of left axilla and adjacent upper limb as if
preparing to perform ultrasound-guided axillary brachial plexus block
2. Participant identify the four terminal branches of the brachial plexus; identify each
on the screen by using the pointer provided (or freeze image and use arrow on the
screen) and name each verbally.
3. Participant identify the adjacent structures/vessels relevant to the block by
indicating them individually using the pointer provided (or freeze image and use arrow
on the screen) and name each verbally.
4. Once participant have obtained an optimal ultrasound image, participant is requested to
indicate the intended needle insertion point on the skin using the pointer provided.
Participants will be provided with an opportunity to practice performing the tasks for up to
30 minutes. Within one hour of completing the feedback session, participants will be asked
to attempt the same tasks again. Performance before and after feedback delivered will be
video-recorded according to a predefined protocol by a trained investigator. Imaging will be
obtained by an investigator using a handheld camera. Concurrent ultrasound video images will
be recorded using the Digital Video Recorder (DVR) feature of the Ultrasonics Tablet (Sonix
Design Centre, B.K Ultrasound, Richmond, Canada). All video recordings will be edited using
a video editing software (Apple Movie, version 10.0.5, Apple Computer Inc. USA) to present
the procedure together with the ultrasound output on one screen
Types of Feedback:
i. Feedback A: Standard feedback; a consultant anesthetists will be asked to give feedback
as would normally give during performance of such a task in a clinical situation.
ii. Feedback B: Structured feedback; a trained investigator will give feedback according to
a set of metrics and errors previously developed and validated. Trainees will undergo
deliberate practice on the volunteer until they demonstrate adequate and objective
performance as assessed by the set of metrics and errors provided.
Video assessment and scoring:
Two trained, independent and blinded assessors will score the video recordings for a set of
metrics and errors previously developed and validated. The number of steps completed and
errors committed will be compared for i) Group defined by preceding type of feedback, ii)
Pre versus post for each feedback session
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