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The Effect of Bench Model Fidelity on Fluoroscopy-Guided Transforaminal Epidural Injection Training: A Randomized Control Study
  1. Alan Gonzalez-Cota, MD*,,
  2. Srinivas Chiravuri, MD,
  3. R. Brent Stansfield, PhD,§,
  4. Chad M. Brummett, MD and
  5. Stanley J. Hamstra, PhD,§
  1. *Comprehensive Spine Center, Interventional Pain Medicine Division, Lewes Beach, DE; †Graduate Medical Education Scholars Program, Department of Medical Education, ‡Department of Anesthesiology, Division of Pain Medicine, and §Department of Medical Education, University of Michigan, Ann Arbor, MI; and ∥Academy for Innovation in Medical Education, University of Ottawa Skills and Simulation Centre, Ottawa, Ontario, Canada.
  1. Address correspondence to: Stanley J. Hamstra, PhD, AIME, 2034 RGN, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, Canada K1H 8M5 (e-mail: shamstra{at}


Background and Objectives The purpose of this study was to determine whether high-fidelity simulators provide greater benefit than low-fidelity models in training fluoroscopy-guided transforaminal epidural injection.

Methods This educational study was a single-center, prospective, randomized 3-arm pretest-posttest design with a control arm. Eighteen anesthesia and physical medicine and rehabilitation residents were instructed how to perform a fluoroscopy-guided transforaminal epidural injection and assessed by experts on a reusable injectable phantom cadaver. The high- and low-fidelity groups received 30 minutes of supervised hands-on practice according to group assignment, and the control group received 30 minutes of didactic instruction from an expert.

Results We found no differences at posttest between the high- and low-fidelity groups on global ratings of performance (P = 0.17) or checklist scores (P = 0.81). Participants who received either form of hands-on training significantly outperformed the control group on both the global rating of performance (control vs low-fidelity, P = 0.0048; control vs high-fidelity, P = 0.0047) and the checklist (control vs low-fidelity, P = 0.0047; control vs high-fidelity, P = 0.0047).

Conclusions Training an epidural procedure using a low-fidelity model may be equally effective as training on a high-fidelity model. These results are consistent with previous research on a variety of interventional procedures and further demonstrate the potential impact of simple, low-fidelity training models.

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  • Financial support was received from the Department of Anesthesiology, University of Michigan, Ann Arbor, MI (subject compensation, research staff support, faculty support), and St Jude Medical, St Paul, MN (high-fidelity simulator).

    Dr Chiravuri is a consultant for St Jude Medical, St Paul, MN.

    The present original work was presented and awarded Best Scientific Poster at the Society for Education in Anesthesia Spring Meeting 2011 in San Antonio, TX, on June 5, 2011.

    Research Institution: Department of Anesthesiology, Division of Pain Medicine, University of Michigan, Ann Arbor, MI.

    Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (