Simulation-based training in ultrasound-guided regional anaesthesia for emergency physicians: insights from an Italian pre/post intervention study.

Autor: Resta F; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Barcella B; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.; Program in Experimental Medicine, University of Pavia, Pavia, Italy., Angeli V; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Lago E; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Santaniello A; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Dedato AS; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Centurioni CE; Emergency Medicine Postgraduate Training Program, Vita-Salute San Raffaele University, Milan, Italy., Regeni E; Emergency Medicine Postgraduate Training Program, Università degli Studi di Trieste, Trieste, Italy., Savastano S; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Baldi E; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Contri E; AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Maffeis R; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Denti P; Medical Graduate, University of Pavia, Pavia, Italy., Musella V; Unit of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Schicchi A; Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.; Program in Experimental Medicine, University of Pavia, Pavia, Italy., Lonati D; Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy., Salinaro F; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Perlini S; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy., Di Pietro S; Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. santi.dipietro@unipv.it.; Program in Experimental Medicine, University of Pavia, Pavia, Italy. santi.dipietro@unipv.it.
Jazyk: angličtina
Zdroj: BMC medical education [BMC Med Educ] 2024 Dec 20; Vol. 24 (1), pp. 1510. Date of Electronic Publication: 2024 Dec 20.
DOI: 10.1186/s12909-024-06500-0
Abstrakt: Background: Despite the importance of Ultrasound-guided Regional Anaesthesia (UGRA) in Emergency Medicine (EM), there is significant variability in UGRA training among emergency physicians. We recently developed a one-day (8 h), simulation-based UGRA course, specifically tailored to help emergency physicians to integrate these skills into their clinical practice.
Methods: In this pre/post intervention study, emergency physicians attended a course consisting of a 4-hour teaching on background knowledge and a practical part structured as follows: a scanning session on a healthy individual; a needling station with an ex-vivo model (turkey thighs); a simulation-based learning experience on local anaesthetic toxicity (LAST); a session on the UGRA simulator BlockSim™. Participants rated their level of knowledge across several domains of UGRA practice; for this purpose, we used a 5-points Likert scale (from 0 to 4). Participants also rated the perceived utility of the practical sessions. We extrapolated baseline characteristics of participants, and we paired the answers of pre- and post-course questionnaires using Wilcoxon signed-rank test.
Results: Seventy-four emergency physicians across ten Italian regions and Switzerland completed the pre-and post- course questionnaire. Most of them were EM residents (75.68%) who had never performed UGRA. Median self-reported knowledge significantly improved from 1 to 3 in the following domains of UGRA indications: Knowledge of contraindications and UGRA techniques [pre-course 1 (IQR 1-2), post-course 3 (IQR 2-3)]; Equipment and drugs [pre-course 1(IQR 1-1), post-course 3 (IQR2-3)]; LAST recognition [pre-course 1 (IQR 1-2), post-course 3 (IQR 2-4)]; LAST management [pre-course 1 (IQR 1-1,75), post-course 3 (IQR 2-3)] (p < 0.001). A smaller improvement was observed in the domain Knowledge of "sonoanatomy" (from 1 to 2; p < 0.001); this might be due to the fact that a one-hour scanning session on a single healthy volunteer may be insufficient for learners to gain confidence with the relevant sonoanatomy. Most participants rated positively the utility of practical stations (100% for the scanning session; 100% for the ex-vivo station with turkey thigh; 91.8% for the BlockSim™).
Limitations: The main limitation of this study is that measurements are limited to learners' reaction to learning and self-assessment outcomes. We did not measure the impact of our course on participants' performance in simulated settings, or on their behavior in the clinical setting, or on patient outcomes. The sample size of participants was relatively small, although larger than most published similar studies.
Conclusions: This one-day simulation-based, UGRA course tailored for emergency physicians led to improved participants' self-reported knowledge across several domains of UGRA practice. The course represents an effective educational strategy and can be replicated in other settings for the initial training of emergency physicians in UGRA.
Competing Interests: Declarations. Ethical approval: The study was granted exempt status by the local institutional review board (Comitato Etico Territoriale Lombardia 6). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent to participate: All subjects participated voluntarily in the course. Informed consent to participate was obtained from all of the participants in the study. Consent to publish: Informed consent was obtained from all individual participants included in the study. Written informed consent for publication of identifying images or other personal or clinical details was obtained from all of the participants. Data sharing statement: The data that support the findings of this study are available from the corresponding author (SDP), upon reasonable request. Clinical trial number: Not applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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