From the Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois.
Rosalind Franklin Medical School, Chicago, Illinois.
Anesth Analg. 2019 May;128(5):999-1004. doi: 10.1213/ANE.0000000000003816.
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.
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.
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).
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.
医师教育者必须在住院医师程序教育的需求与临床时间压力以及患者安全和舒适之间取得平衡。替代教育策略，包括电子学习工具，可能有助于向新手学习者介绍新程序并提高熟练度。我们创建了一个电子学习工具（计算机增强视觉学习 [CEVL] 神经轴），以提高受训者在产科患者中进行联合脊髓-硬膜外导管放置的熟练度，并进行了一项随机对照的 2 中心试验，以检验使用该工具可提高麻醉住院医师首次进行的程序的假设。
正在完成其第一个产科麻醉旋转的麻醉住院医师被随机分配为在旋转前 2 周接受在线访问神经轴模块（CEVL 组）或无访问（对照）。在旋转的第一天，住院医师完成了神经轴程序自信量表和开放式医学知识测试。盲法评估者使用程序检查表（0-49 分）观察在分娩产妇中进行联合脊髓-硬膜外导管技术的住院医师；记录执行程序所需的时间。主要结果是程序的持续时间。
CEVL 组的平均（±标准差）程序时间明显短于对照组 22.5 ± 4.9 对 39.5 ± 7.1 分钟（P <.001），并且整体表现检查表的得分更高 36.4 ± 6.6 对 28.8 ± 7.1（P =.012）。干预组在开放式医学知识测试中的得分也更高（27.83 ± 3.07 对 22.25 ± 4.67；P =.002），但两组的自信心评分无差异（P =.64）。
CEVL 神经轴是一种新颖的旋转前教学工具，可能会增强产科麻醉中联合脊髓-硬膜外程序的传统初始教学。未来的研究应检查使用基于网络的学习工具是否会影响提供者的长期表现或患者结局。
