Original Contribution
Preliminary evaluation of a virtual reality-based simulator for learning spinal anesthesia

https://doi.org/10.1016/j.jclinane.2012.06.015Get rights and content

Abstract

Study Objective

To evaluate the influence of a simulation-based program on the initial performance of dural puncture by medical interns, and to refine the design of simulator-based teaching and competence assessment.

Design

Prospective interventional study.

Setting

Academic medical center.

Subjects

27 medical interns inexperienced in the technique of spinal anesthesia or dural puncture and within 12 months of graduating from medical school, were randomly assigned to a conventional or a simulator-based teaching course of spinal anesthesia: 13 were recruited to the Conventional Group (CG) and 14 to the Simulator Group (SG).

Measurements

A SenseGraphic Immersive workbench and a modified Phantom desktop with shutter glasses were used to create a teaching environment. Outcomes of teaching were assessed in two phases within three weeks of the teaching course: Phase I consisted of a written examination followed by assessment on the simulator. A global rating scale and a task-specific checklist were used. Phase II (for those participants for whom a suitable opportunity arose to perform spinal anesthesia under supervision within three wks of the teaching course) consisted of structured observation of clinical performance of the procedure in the operating room. Participants were assessed by independent, study-blinded experts. Student's two-tailed impaired t-tests were used to compare the parametric outcomes (P < 0.05 was considered significant).

Main Results

All participants completed the written test successfully with no difference between groups. Ten participants from CG and 13 from SG completed the simulator-based testing performing similarly in terms of the global rating scale. Five participants in CG and 6 in SG proceeded to clinical testing. On the global rating scale, interns in SG scored higher than those in CG. They performed similarly according to the task-specific checklist.

Conclusions

Overall, no difference was measured between those taught with traditional methods and those, by a simulator based program in regard to the performance of spinal anesthesia.

Introduction

Traditionally, an “apprenticeship model” has been universally used in medical education requiring residents and medical students to acquire their skills by practicing on real patients [1]. In our experience, postgraduate medical trainees have expressed dissatisfaction with the formal and informal training and learning opportunities available to them. Simulation has become an important part of the teaching in anesthesia. However, a majority of these simulations are mannequin-based. A significant part of manual (procedural) skills training is still performed on patients.

Recently we examined key determinants of teaching and learning of spinal anesthesia using preliminary and focused questionnaires and focus group interviews with experts and trainees [2]. One important determinant identified was the acquisition of knowledge or recognition of certain characteristic “feels” as the procedure is performed. Both experts and trainees agreed that acquiring the ability to recognize these “feels” was a very important element of learning spinal anesthesia. Several respondents stated definitively that the only way to acquire this ability was by recurrently performing (or practicing) the procedure on patients. Another important determinant identified in that study was the need for the learner to visualize the procedure.

We hypothesized that visuo-haptic computer technology may be used to create an effective teaching tool for the technique of spinal anesthesia. This procedure was selected because it “contains” essential elements common to many other, more complex medical procedures. These include knowledge and visual, tactile, psychomotor elements applied in a setting to which human factors and communication are relevant.

The aim of the study was to evaluate the influence of a simulation-based preparatory program on the initial performance of dural puncture by medical interns and to further improve the design of simulator-based teaching and competence assessment.

Section snippets

Subjects

With Cork University Hospital Institutional Ethical Approval and written, informed consent from all participants, 27 interns were recruited. Inclusion criteria were: temporary registration with the Irish Medical Council and within 12 months of graduating from medical school. The exclusion criterion was having performed more than 10 spinal anesthetics or lumbar punctures prior to the study.

Study design

This prospective interventional study compared traditional clinical training with and without supplementary

Results

A total of 27 interns participated in the study, 14 of whom were randomly assigned to the Simulator Group and 13 to the Conventional Group. A majority had not performed the procedure prior to the study. Four of 27 had performed a lumbar puncture once, one of 27 had done so three times, one of 27 had 4 exposures, and one of 27 had done so on 8 occasions.

All participants completed the written test, successfully scoring 70% or higher, with no difference noted between the groups.

A total of 23

Discussion

We designed this study to evaluate the effect of simulator-based preparatory teaching on acquisition of the procedural skill of spinal anesthesia, which was assessed both in a simulated and clinical environment. To decrease the risk of performance bias, we designed training sessions in which participants received the same amount of training time following predefined teaching goals. Evaluation of performance employed the OSATS approach, currently the “gold standard” in assessment of procedural

Acknowledgments

The authors wish to thank Ms. Emer O'Shea, Cork University Hospital, for her contribution, advice, and commentary on the manuscript.

References (22)

  • D.J. Doyle

    Simulation in medical education: focus on anaesthesiology

    Med Educ Online

    (2005)
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    Funded by Health Service Executive Design Based Medical Training project, Naas, Co. Kildare, Ireland. Supported in part by the Irish Health Service Executive, Dublin, Ireland.

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