Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2010 Feb;57(2):120-6. doi: 10.1007/s12630-009-9219-2. Epub 2009 Dec 30.
Ultrasound assessment of the lumbar spine to facilitate neuraxial anesthesia has recently received much attention. The transfer of knowledge pertaining to this skill has never been studied. The purpose of this study was to determine the amount of teaching needed to achieve competence in spinal ultrasound.
Participants were given reading material and a link to a video presentation on spinal ultrasound. As well, they attended a 45-min lecture followed by a 30-min hands-on workshop. They were then assessed individually 1-2 weeks later. The assessment was performed on a live model using a low frequency curved ultrasound probe (2-5 mHz). Participants were asked to determine, at random lumbar spinal levels, the optimal insertion point and the depth to the ligamentum flavum-dura mater unit (up to 20 trials, 2 min per trial). Feedback was provided by an expert for each incorrect task. The learning curves were constructed, using the cumulative sum method, by comparing the participants' results with those of a benchmark established by experts. Statistical analysis was performed using STATA 9.2 for Macintosh (College Station, TX, USA).
A total of 308 anesthesiologists were approached and 18 anesthesiologists participated in the study. Only five of the 18 participants (27%) achieved competence in determining the interspace, with a median number of 11 attempts (range 8-18). None of the participants achieved competence in determining either the insertion point or the depth to the ligamentum flavum-dura mater unit.
Under the study conditions, 20 supervised trials plus teaching sessions were not enough for the participants to achieve competence in different aspects of ultrasound assessment of the lumbar spine. These results may well be considered when planning teaching sessions and workshops in the future.
最近，腰椎超声评估在辅助椎管内麻醉方面受到了广泛关注。但针对该技能的知识转移尚未得到研究。本研究旨在确定掌握脊柱超声所需的教学量。
参与者接受了脊柱超声的阅读材料和视频演示链接，以及 45 分钟的讲座和 30 分钟的实践工作坊。然后，他们在 1-2 周后进行了单独评估。评估在一个活模特上使用低频弯曲超声探头（2-5 MHz）进行。参与者被要求随机确定腰椎脊柱水平，确定最佳插入点和黄韧带-硬脑膜单位的深度（最多 20 次尝试，每次尝试 2 分钟）。专家为每个错误任务提供反馈。使用累积和方法构建学习曲线，通过将参与者的结果与专家确定的基准进行比较。统计分析使用 STATA 9.2 for Macintosh（美国德克萨斯州学院站）进行。
共联系了 308 名麻醉师，18 名麻醉师参加了研究。在 18 名参与者中，只有 5 名（27%）在确定椎间空间方面达到了能力水平，中位数为 11 次尝试（范围 8-18）。没有参与者在确定插入点或黄韧带-硬脑膜单位的深度方面达到能力水平。
在研究条件下，20 次监督试验加教学课程不足以使参与者在腰椎超声评估的不同方面达到能力水平。在未来规划教学课程和研讨会时，应考虑这些结果。
