使用虚拟现实技术教授超声引导下区域麻醉针刺技术：一项随机对照试验。

Using Virtual Reality to teach ultrasound-guided needling skills for regional anaesthesia: A randomised controlled trial.

机构信息

South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Department of Anaesthesia, Liverpool Hospital, Sydney, Australia.

MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia.

出版信息

J Clin Anesth. 2024 Oct;97:111535. doi: 10.1016/j.jclinane.2024.111535. Epub 2024 Jun 17.

DOI:10.1016/j.jclinane.2024.111535

Abstract

STUDY OBJECTIVE

We previously designed and validated a virtual reality-based simulator to help train novices in ultrasound-guided needling skills necessary for safe and competent ultrasound-guided regional anaesthesia. This study was designed to compare the performance and error rates of novices trained by a human faculty aided with the assistance of this virtual reality simulator (virtual reality-assisted training), versus novices trained wholly by humans (conventional training).

DESIGN, SETTING, AND PARTICIPANTS: In this single centre, randomised controlled study, we used a standardised teaching protocol, rigorous blinding, iterative training of assessors, and validated global rating scale and composite error score checklists to assess skills learning of novice participants.

MAIN RESULTS

We recruited 45 novices and scored 270 assessments of performance and error rates. Inter-rater correlation coefficient of reliability of scoring between assessors for the global rating scale was 0.84 (95%CI 0.68-0.92) and for the composite error score checklist was 0.87 (95%CI 0.73-0.93). After adjustment for age, sex, Depression, Anxiety and Stress-21, and baseline score, there was no statistical difference for virtual reality-assisted training compared to conventional training in final global rating score (average treatment effect -3.30 (95%CI-13.07-6.48), p = 0.51) or in the final composite error score (average treatment effect 1.14 (95%CI -0.60-2.88), p = 0.20). Realism in the virtual reality simulator was similar to real-life when measured by the Presence Questionnaire, all components p > 0.79; and task workload assessed by the NASA-Task Load Index was not statistically different between groups, average treatment effect 5.02 (95%CI -3.51-13.54), p = 0.25. Results were achieved in the virtual reality-assisted group with half the human faculty involvement.

CONCLUSION

Novices trained using a hybrid, virtual reality-assisted teaching program showed no superiority to novices trained using a conventional teaching program, but with less burden on teaching resources.

摘要

研究目的

我们之前设计并验证了一种基于虚拟现实的模拟器，以帮助培训新手进行安全且熟练的超声引导区域麻醉所需的超声引导下穿刺技能。本研究旨在比较新手在虚拟现实模拟器辅助（虚拟现实辅助培训）和完全由人类辅助（传统培训）下的表现和错误率。

设计、地点和参与者：在这项单中心、随机对照研究中，我们使用标准化教学方案、严格的盲法、评估员的迭代培训以及经过验证的总体评分量表和综合错误评分检查表来评估新手参与者的技能学习情况。

主要结果

我们招募了 45 名新手，并对 270 项表现和错误率评估进行了评分。评估员之间评分的可靠性的组内相关系数对于总体评分量表为 0.84（95%CI 0.68-0.92），对于综合错误评分检查表为 0.87（95%CI 0.73-0.93）。在调整年龄、性别、抑郁、焦虑和压力 21 量表、基线评分后，虚拟现实辅助培训与传统培训在最终总体评分（平均治疗效果-3.30（95%CI-13.07-6.48））或最终综合错误评分（平均治疗效果 1.14（95%CI-0.60-2.88））方面没有统计学差异，p=0.51）。通过存在问卷测量，虚拟现实模拟器的逼真度与现实生活相似，所有组成部分 p＞0.79；而通过 NASA 任务负荷指数评估的任务工作量在组间没有统计学差异，平均治疗效果 5.02（95%CI-3.51-13.54），p=0.25。在虚拟现实辅助组中，仅需一半的师资即可实现结果。