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Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists’ Acquisition of Ultrasound-Guided Regional Anesthesia Skills
  1. Ankeet Deepak Udani, MD, MSEd*,,
  2. T. Kyle Harrison, MD,,
  3. Edward R. Mariano, MD, MAS,,
  4. Ryan Derby, MD,
  5. Jack Kan, MD§,
  6. Toni Ganaway, BA,
  7. Cynthia Shum, RN, BSN, MSEd,
  8. David M. Gaba, MD,,
  9. Pedro Tanaka, MD, PhD,
  10. Alex Kou, BS and
  11. Steven K. Howard, MD,
  1. From the *Duke University School of Medicine, Durham, NC; and †Stanford University School of Medicine, Stanford; ‡Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; and §Newport Harbor Anesthesia Consultants, Newport Beach, CA
  1. Address correspondence to: Ankeet Deepak Udani, MD, MSEd, Duke University School of Medicine, DUMC Box 3094, Durham, NC 27710 (e-mail: Ankeet.Udani{at}duke.edu).

Abstract

Background and Objectives Simulation-based education strategies to teach regional anesthesia have been described, but their efficacy largely has been assumed. We designed this study to determine whether residents trained using the simulation-based strategy of deliberate practice show greater improvement of ultrasound-guided regional anesthesia (UGRA) skills than residents trained using self-guided practice in simulation.

Methods Anesthesiology residents new to UGRA were randomized to participate in either simulation-based deliberate practice (intervention) or self-guided practice (control). Participants were recorded and assessed while performing simulated peripheral nerve blocks at baseline, immediately after the experimental condition, and 3 months after enrollment. Subject performance was scored from video by 2 blinded reviewers using a composite tool. The amount of time each participant spent in deliberate or self-guided practice was recorded.

Results Twenty-eight participants completed the study. Both groups showed within-group improvement from baseline scores immediately after the curriculum and 3 months following study enrollment. There was no difference between groups in changed composite scores immediately after the curriculum (P = 0.461) and 3 months following study enrollment (P = 0.927) from baseline. The average time in minutes that subjects spent in simulation practice was 6.8 minutes for the control group compared with 48.5 minutes for the intervention group (P < 0.001).

Conclusions In this comparative effectiveness study, there was no difference in acquisition and retention of skills in UGRA for novice residents taught by either simulation-based deliberate practice or self-guided practice. Both methods increased skill from baseline; however, self-guided practice required less time and faculty resources.

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Footnotes

  • Author contributions: A.D.U.: conception, study design, data acquisition, analysis, drafting manuscript, and final approval of version to be published; T.K.H.: conception, study design, data acquisition, and final approval of version to be published; E.R.M.: conception, study design, data analysis, drafting manuscript, and final approval of version to be published; R.D.: data analysis and final approval of version to be published; J.K.: data analysis and final approval of version to be published; T.G.: data acquisition and final approval of version to be published; C.S.: study design, data acquisition, drafting manuscript, and final approval of version to be published; D.M.G.: conception, study design, and final approval of version to be published; P.T.: conception, study design, and final approval of version to be published; A.K.: data analysis, drafting manuscript, and final approval of version to be published; S.K.H.: conception, study design, data acquisition, analysis, drafting manuscript, and final approval of version to be published.

    This study is attributed to Duke University School of Medicine, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System.

    Funding was provided by the Foundation for Anesthesia Education and Research, Research Fellowship Grant.

    This work was presented in part at the Society for Education in Anesthesia 30th Spring Meeting, April 24 to 26, 2015, in Seattle, WA.

    E.R.M. reports that he has received unrestricted educational program funding paid to his institution from Halyard Health, Alpharetta, GA (formerly I-Flow/Kimberly-Clark, Lake Forest, CA) and B. Braun (Bethlehem, PA). The other authors declare no conflict of interest.

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