Deacon A J, Melhuishi N S, Terblanche N C S
Department of Anaesthesia and Pain Medicine, Calvary Hospital, Australian Capital Territory.
Anaesth Intensive Care. 2014 Jul;42(4):480-6. doi: 10.1177/0310057X1404200409.
Spinal ultrasonography is a promising aid for epidural insertion. We aimed to determine the learning curve of spinal ultrasonography tasks and the number of training scans required to reach competency after undergoing standardised step-wise teaching. Trainees were required to complete a minimum of 60 assessed scans on selected non-pregnant models following attendance at two training sessions, with feedback from an expert after each scan. Learning curves were plotted using the non-risk cumulative summation technique and an acceptable failure rate of 20%. Five trainees completed between 65 and 75 scans each. All trainees were competent at identifying a randomly assigned intervertebral space after a median of five scans (range one to nine) and at measuring the depth from skin to the posterior complex after a median of 10 scans (range 1 to 42). Two trainees were competent at marking an ideal needle insertion point after 55 scans, while three trainees did not attain competency. All trainees were competent after 60 scans if the tolerance was changed from five to eight millimetre for marking the needle insertion point. The average time taken to complete a scan was 163 seconds. Our study showed that after a standardised educational intervention, anaesthetic trainees are able to identify a lumbar interlaminar space easily and can measure the depth to the posterior complex after a reasonable number of additional practice scans, but experienced difficulty accurately marking the needle insertion point whilst using spinal ultrasonography. We confirmed that it was hard to achieve competency in all aspects of spinal ultrasonography, based on assessment using our predefined competency criteria.
脊柱超声检查是一种很有前景的硬膜外穿刺辅助手段。我们旨在确定脊柱超声检查任务的学习曲线以及在接受标准化逐步教学后达到胜任水平所需的训练扫描次数。在参加两次培训课程后，要求学员在选定的非妊娠模型上至少完成60次评估扫描，每次扫描后由专家提供反馈。使用非风险累积求和技术绘制学习曲线，并设定可接受的失败率为20%。五名学员每人完成了65至75次扫描。所有学员在中位数为5次扫描（范围为1至9次）后能够胜任识别随机分配的椎间隙，在中位数为10次扫描（范围为1至42次）后能够胜任测量从皮肤到后复合体的深度。两名学员在55次扫描后能够胜任标记理想的进针点，而三名学员未达到胜任水平。如果将标记进针点的公差从5毫米改为8毫米，所有学员在60次扫描后都能胜任。完成一次扫描的平均时间为163秒。我们的研究表明，经过标准化的教育干预后，麻醉学员能够轻松识别腰椎椎间隙，并且在经过合理数量的额外练习扫描后能够测量到后复合体的深度，但在使用脊柱超声检查时准确标记进针点存在困难。基于使用我们预先定义的胜任标准进行的评估，我们证实很难在脊柱超声检查的所有方面都达到胜任水平。
