The effect of simulation-based training on initial performance of ultrasound-guided axillary brachial plexus blockade in a clinical setting – a pilot study

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.

Ultrasound-Guided Regional Anesthesia Simulation Training

“…Subsequently, 12 studies met the inclusion criteria and were included in this systematic review. [16][17][18][19][20][21][22][23][24][25][26][27] …”

“…Eleven studies used a combination of didactic and simulation training approaches in teaching UGRA principles, [16][17][18][19][20][22][23][24][25][26][27] and 1 study used only simulation to evaluate the effect of a needle guidance system on UGRA skills of novices. 21 …”

“…One study investigated Kirkpatrick levels 2, 3, and 4 by measuring the knowledge and skills (level 2), performance in the workplace (level 3), and patient outcome (level 4). 23 A second study also investigated Kirkpatrick levels 2 and 4. 22 The remaining 10 studies investigated Kirkpatrick level 2 only.…”

“…Eight studies were found to be high risk in blinding participants and personnel (performance bias). 17,[20][21][22][23][25][26][27] Five studies were found to be high risk for blinding of outcome assessment (detection bias). 16,21,22,25,27 Also, 4 studies were found to be high risk in incomplete outcome data (attrition bias).…”

“…16,21,22,25,27 Also, 4 studies were found to be high risk in incomplete outcome data (attrition bias). 17,22,23,25 Figure 2 shows a risk of bias summary for the 12 included studies using the Effective Practice and Organisation of Care (EPOC) tool.…”