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

Autor:	Nixon HC; From the Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois., Stariha J; Rosalind Franklin Medical School, Chicago, Illinois., Farrer J; Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Wong CA; Department of Anesthesiology, University of Iowa Carver School of Medicine, Iowa City, Iowa., Maisels M; Department of Urology, Northwestern Feinberg School of Medicine and Lurie Children's Hospital, Chicago, Illinois., Toledo P; Rosalind Franklin Medical School, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2019 May; Vol. 128 (5), pp. 999-1004.
DOI:	10.1213/ANE.0000000000003816
Abstrakt:	Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Databáze:	MEDLINE
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