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Resident Competency and Proficiency in Combined Spinal-Epidural Catheter Placement Is Improved Using a Computer-Enhanced Visual Learning Program: A Randomized Controlled Trial
Journal article   Open access   Peer reviewed

Resident Competency and Proficiency in Combined Spinal-Epidural Catheter Placement Is Improved Using a Computer-Enhanced Visual Learning Program: A Randomized Controlled Trial

Heather C Nixon, Jillian Stariha, Jason Farrer, Cynthia A Wong, Max Maisels and Paloma Toledo
Anesthesia and analgesia, Vol.128(5), pp.999-1004
05/2019
DOI: 10.1213/ANE.0000000000003816
PMID: 30286007
url
https://doi.org/10.1213/ANE.0000000000003816View
Published (Version of record) Open Access

Abstract

Physician educators must balance the need for resident procedural education with clinical time pressures as well as patient safety and comfort. Alternative educational strategies, including e-learning tools, may be beneficial to orient novice learners to new procedures and speed proficiency. We created an e-learning tool (computer-enhanced visual learning [CEVL] neuraxial) to enhance trainee proficiency in combined spinal-epidural catheter placement in obstetric patients and performed a randomized controlled 2-center trial to test the hypothesis that use of the tool improved the initial procedure performed by the anesthesiology residents. Anesthesiology residents completing their first obstetric anesthesiology rotation were randomized to receive online access to the neuraxial module (CEVL group) or no access (control) 2 weeks before the rotation. On the first day of the rotation, residents completed a neuraxial procedure self-confidence scale and an open-ended medical knowledge test. Blinded raters observed residents performing combined spinal-epidural catheter techniques in laboring parturients using a procedural checklist (0-49 pts); the time required to perform the procedure was recorded. The primary outcome was the duration of the procedure. The CEVL group had significantly shorter mean (±standard deviation) procedure time compared to the control group 22.5 ± 4.9 vs 39.5 ± 7.1 minutes (P < .001) and had higher scores on the overall performance checklist 36.4 ± 6.6 vs 28.8 ± 7.1 (P = .012). The intervention group also had higher scores on the open-ended medical knowledge test (27.83 ± 3.07 vs 22.25 ± 4.67; P = .002), but self-confidence scores were not different between groups (P = .64). CEVL neuraxial is a novel prerotation teaching tool that may enhance the traditional initial teaching of combined spinal-epidural procedures in obstetric anesthesiology. Future research should examine whether the use of web-based learning tools impacts long-term provider performance or patient outcomes.
 Anesthesia, Epidural - methods Anesthesiology - education Anesthesia, Spinal - methods Anesthesiology - methods Humans Male Anesthesia, Obstetrical - methods Anesthesia, Epidural - instrumentation Labor, Obstetric Anesthesia, Obstetrical - standards Female Clinical Competence Catheterization Internship and Residency Treatment Outcome Obstetrics Catheters Pregnancy Self Concept Computer-Assisted Instruction - methods Checklist Software Internet Anesthesiology - standards Anesthesia, Spinal - instrumentation

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