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Clinical Impact of Epidural Anesthesia Simulation on Short- and Long-term Learning Curve: High- Versus Low-fidelity Model Training
  1. Zeev Friedman, MD*,
  2. Naveed Siddiqui, MD*,
  3. Rita Katznelson, MD,
  4. Isabella Devito, MD, FRCPC*,
  5. Matthew D. Bould, MB, ChB, MRCP, FRCA and
  6. Viren Naik, MD, MEd, FRCPC
  1. From the *Department of Anesthesia and Pain Management, Mount Sinai Hospital,
  2. Department of Anesthesia, Toronto General Hospital, and
  3. Department of Anesthesia, St Michael's Hospital, University of Toronto, Ontario, Canada.
  1. Address correspondence to: Zeev Friedman, MD, Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto M5G1X5, ON, Canada (e-mail: zeevfriedman{at}


Background and Objectives: Epidural anesthesia is a technically challenging regional anesthetic technique that can be difficult to teach to novices. Epidural simulators are now available to allow realistic training within a safe and controlled environment before attempting the procedure on patients. Potentially, this may improve skill acquisition by novice residents. The purpose of this study was to examine the effect of a high-fidelity epidural anesthesia simulator on residents' ability to perform their first labor epidurals and on their learning curve compared with a group having training with a low-fidelity model.

Methods: Second-year anesthesia residents were recruited. Subjects were randomized into 2 groups and practiced epidural needle insertion on a high-fidelity epidural simulator or on a low-fidelity model. Subjects were then repeatedly videotaped performing epidural anesthesia over a 6-month period. Two blinded examiners graded each session, using a previously validated Global Rating Scale and Manual Skill Checklist to judge the skill level.

Results: Seventy-two sessions performed by 24 residents were recorded. Manual Skill Checklist and Global Rating Scale total scores were compared across the 2 study groups at baseline (first epidural), middle (31-90 epidurals) and late (>90 epidurals) time points using independent-samples t tests. No significant differences in scores were detected at either one of these time points.

Conclusion: Our study shows that a simple model can be as useful for learning how to place an epidural catheter as an expensive anatomically correct simulator. New and more technologically advanced simulators should be compared against lower fidelity models to establish their utility and cost-effectiveness.

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  • The work should be attributed to the Departments of Anesthesia, Mount Sinai Hospital and St Michael's Hospital, University of Toronto.