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Technology for Teaching and Learning Regional Anesthesia

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By the end of this session, learners will be able to discuss:
1. The "learning curve" for regional anesthesia;
2. Technology for teaching and learning; and
3. Technology for assessment.

Published in: Education
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Technology for Teaching and Learning Regional Anesthesia

  1. 1. @@EMARIANOMD Technology for Teaching and Learning Regional Anesthesia Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative & Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System
  2. 2. @EMARIANOMD Financial Disclosures • Halyard Health, B Braun – Unrestricted educational program funding paid to my institution The contents of the following presentation are solely the responsibility of the speaker without input from any of the above companies.
  3. 3. @EMARIANOMD Overview • The “learning curve” • Technology for teaching and learning • Technology for assessment
  4. 4. @EMARIANOMD Overview • The “learning curve” • Technology for teaching and learning • Technology for assessment
  5. 5. @EMARIANOMD How Hard Can It Be? NYSORA.COM -
  6. 6. @EMARIANOMD The “10,000 Hours Rule”
  7. 7. @EMARIANOMD Deliberate Practice Ericsson. Acad Emerg Med 2008;15:988
  8. 8. @EMARIANOMD Regional Anesthesia “Learning Curve” Reg Anesth. 1996;21:182
  9. 9. @EMARIANOMD Learning Curve for UGRA RAPM 2004;29:544
  10. 10. @EMARIANOMD Novice Behavior • 520 ultrasound-guided nerve block captured on video and reviewed – 7 errors: needle not visualized, inadequate equipment preparation, poor ergonomics, target malpositioning on screen, unintentional probe movement, awkward hand position on needle, and excessive visual focus on hands • By the 60th block, still 2.8 errors per block Sites, et al. RAPM 2007;32:107
  11. 11. @EMARIANOMD Barrington, et al. RAPM 2012;37:334
  12. 12. @EMARIANOMD Udani & Mariano, et al. RAPM 2016;41:151 Avg 7 (2–22 min) for the control group vs. 48 (29–65 min) for the DP group (p<0.001). No other differences!
  13. 13. @EMARIANOMD Predictors of Learning UGRA Shafqat, et al. Anesth 2015;123:1188
  14. 14. @EMARIANOMD Predictors of Learning UGRA Shafqat, et al. Anesth 2015;123:1188 Maybe we are not all the same!
  15. 15. @EMARIANOMD Overview • The “learning curve” • Technology for teaching and learning • Technology for assessment
  16. 16. @EMARIANOMD Udani & Mariano, et al. Local Reg Anesth 2015;8:33
  17. 17. @EMARIANOMD What Is “Simulation”? 79 articles involving simulation were reviewed: 1. Simulation-based educational interventions (14) 2. Novel simulator design (18) 3. Use of a simulated environment as an experimental setting (11) 4. Other/outside scope of review (36) Udani & Mariano, et al. Local Reg Anesth 2015;8:33
  18. 18. @EMARIANOMD Udani & Mariano, et al. Local Reg Anesth 2015;8:33 Studies of Simulation Interventions
  19. 19. @EMARIANOMD Udani & Mariano, et al. Local Reg Anesth 2015;8:33 Studies of Simulator Design
  20. 20. @EMARIANOMD Udani & Mariano, et al. Local Reg Anesth 2015;8:33 Inorganic Simulator
  21. 21. @EMARIANOMD Udani & Mariano, et al. Local Reg Anesth 2015;8:33 Organic Simulator
  22. 22. @EMARIANOMD “Hybrid” Simulator Udani & Mariano, et al. Local Reg Anesth 2015;8:33
  23. 23. @EMARIANOMD Ramlogan R, et al. RAPM 2017;42: 217 http://www.pie.med.utoronto.ca/VSpine/index.htm
  24. 24. @EMARIANOMD Udani & Mariano, et al. Local Reg Anesth 2015;8:33 Studies Using a Simulation Setting
  25. 25. @EMARIANOMD Anesthesiology- Directed Advanced Procedural Training
  26. 26. @EMARIANOMD Lectures, Scanning Iterative Practice, Simulation 8 Hour Program Mariano, et al. JUM 2015;34:1883
  27. 27. @EMARIANOMD Mariano, et al. JUM 2015;34:1883
  28. 28. @EMARIANOMD Echogenic Technology Mariano, et al. JUM 2014;33:905 Moy & Mariano, et al. JUM 2017 epub
  29. 29. @EMARIANOMD Needle Guidance Systems McVicar, et al. RAPM 2015;40:150
  30. 30. @EMARIANOMD Overview • The “learning curve” • Technology for teaching and learning • Technology for assessment
  31. 31. @EMARIANOMD Simulation (Dr. David Gaba) #CAS_SCA2017 June 24, 2017
  32. 32. @EMARIANOMD Video Recording and Review
  33. 33. @EMARIANOMD Assessment Category Description Points Procedural Time (min) Starting when US probe touches skin and ending when placement needle is removed 2 (≤5 min) 1 (6-10 min) 0 (>10 min) Needle Passes (#) Withdrawal of the placement needle >1 cm with readvancement 2 (1) 1 (2) 0 (>2) Procedural Performance Needle visualization during advancement 2 (All the time) 1 (Part of the time) 0 (None of the time) Equipment preparation (e.g., probe selection, machine settings) 2 (Excellent) 1 (Good) 0 (Poor) Target positioning (eg, able to see target and feasible needle trajectory) 2 (All the time) 1 (Part of the time) 0 (None of the time) Probe stability (eg, no unintentional movement) 2 (All the time) 1 (Part of the time) 0 (None of the time) Needle manipulation (eg, comfortable grip on needle and catheter) 2 (All the time) 1 (Part of the time) 0 (None of the time) Visual focus (eg, appropriately focused on machine and not hands during procedure) 2 (All the time) 1 (Part of the time) 0 (None of the time) Confirmation of proper injectate spread 2 (Excellent) 1 (Good) 0 (Poor) Confirmation of proper catheter tip position 2 (Excellent) 1 (Good) 0 (Poor) Ergonomic Factors Positioning of ultrasound machine 2 (Excellent) 1 (Good) 0 (Poor) No thoracolumbar flexion (≥45) 2 (All the time) 1 (Part of the time) 0 (None of the time) No head/neck rotation (≥45) 2 (All the time) 1 (Part of the time) 0 (None of the time) No lateral shoulder tilt (≥30) 2 (All the time) 1 (Part of the time) 0 (None of the time) No crossing sterile field to non-dominant side 2 (All the time) 1 (Part of the time) 0 (None of the time) Mariano, et al. JUM 2015;34:1883
  34. 34. @EMARIANOMD DOPS Wragg, et al. Clin Med 2003;3:131 Watson, et al. Anaesth 2014;69:604 Chuan, et al. Anaesth Int Care 2016;44:2
  35. 35. @EMARIANOMD DOPS Wragg, et al. Clin Med 2003;3:131 Watson, et al. Anaesth 2014;69:604 Chuan, et al. Anaesth Int Care 2016;44:2
  36. 36. @EMARIANOMD Global Rating Scale Cheung, et al. RAPM 2012;37: 329 Wong, et al. RAPM 2014;39:399
  37. 37. @EMARIANOMD Hand Motion Analysis Chin, et al. RAPM 2011;36:213
  38. 38. @EMARIANOMD Eye Tracking Harrison & Mariano, et al. J Anesth 2015;30:530 The Expert 94 sec 1.85 fixations/sec The Novice 257 sec 0.86 fixations/sec
  39. 39. @EMARIANOMD J Anesth 2015;30:530 How Does Expertise Look? Can We Quantify It?
  40. 40. @EMARIANOMD Borg & Mariano, et al. In press.
  41. 41. @EMARIANOMD Summary We discussed: • The “learning curve” • Technology for teaching and learning • Technology for assessment
  42. 42. @EMARIANOMD “Regional anesthesia is a vital skill for any anesthesiologist and ultrasound-guided techniques have enhanced our ability to achieve effective and consistent blocks. It is important that we ensure our graduating residents have the requisite skills to perform basic regional techniques in a safe and effective manner in order to disseminate the benefits of regional anesthesia to the broader surgical population.” McCartney & Mariano. RAPM 2016;41:663.

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