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Assessment and training on a new epidural simulator

Thursday, 22 May, 2014 - 11:25
Board 3

Poster Presenter: Vincent Hamlynvincent.hamlyn@doctors.org.uk
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Original Research

Assessment and training on a new epidural simulator
VG Hamlyn†, D Bruynseels†, J Clark*, JE Hall*, RE Collis†
University Hospital of Wales, Cardiff, UK
Proficiency at neuraxial procedures, especially epidural placement, requires a great deal of training and can be difficult to teach [1]. To date training aids, although know to be useful [2], have not been widely used for this purpose partly because it has been difficult to design realistic models. 
A novel, low fidelity five-layered silicon model in a box has been developed (figure 1) based on extensive local testing and expert opinion, with the aim of bringing a small, practical and durable product to delivery suite††. The aim of this study was to assess the model for realism and as a teaching and training aid.
Development and testing had ethics and R&D approval. The model was set up in a delivery suite room (figure 2) in order to maximise the fidelity of the simulation. Each participant was provided with an information leaflet and given opportunity to ask questions. After giving verbal consent, anaesthetists with a range of experience performed an epidural using their usual technique. The insertion was video recorded from two angles (figure 3). After each epidural insertion, the video was reviewed on a large screen with the participant with some discussion, and feedback was given by the authors on their performance. Participants were then asked to give their own feedback on realism and usefulness as a training device, using visual analogue scale (VAS) scores from 0-100mm.
Figure 1. Design of the model          Figure 2. Setup in a delivery suite room            Figure 3. Edited two-angle view 
Thirteen operators from CT2 to consultant performed an epidural using the model. Table 1 shows the results of the VAS questionnaire.
Overall, participants thought that the model provided a moderately realistic representation of the soft tissues          encountered during epidural insertion, but thought that it could be a very useful training tool. Some participants felt that the model was made less realistic by the absence of bony structures. Most found the model was useful in identifying their strengths and weaknesses, and the majority were confident the model allowed them to duplicate their real life clinical performance. The use of video feedback from ubiquitous hand-held devices in a non-threatening environment added positively to the experience. The new model was highly portable, easy and quick to set up, and was used when time allowed. We feel it could be used both as a training device for novices and as an assessment tool for the more experienced anaesthetist in a labour ward environment.
1. Konrad C, Schupfer G, Wietlisbach M, Gerber H. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesthesia  and  Analgesia 1998; 86: 635 –9.
2. Domuracki KJ, Moule CJ, Owen H, Kostandoff G, Plummer JL. Learning on a simulator does transfer to clinical practice. Resuscitation 2009; 80: 346 –9.
† Department of Anaesthetics, University Hospital of Wales, Cardiff, UK, *Academic Department of Anaesthesia, Cardiff University, Cardiff, UK.
†† The model was developed in collaboration with Technovent Ltd, with an i-4-i NIHR grant, MBI Wales.