From Confusion to Confidence:

One Hour of Simulation, Weeks of Growth

Accelerating Neuraxial Skills with Targeted Training

Katherine Redfield Chan, MD

Noor Raheel, MBChB, MPH

Michaela K. Farber, MD, MS

Brigham and Women’s HospitalThe Issue The Innovation

The Issue: Variations & Limitations Inconsistent Exposure

• Case volume & difficulty vary, rarely use US1

• Advanced learners given greater challenges

Practice Utility Limited

• Co-learners often present ‘easy’ exams

• Patients frequently challenging

The Innovation: Simulation Jacket

1 Provenzano SM et al Adv Med Educ Pract 2025 Targeted Deliberate Practice

• Realistic challenges, no coordination required

• Early experience in vital skills2

Standardizes Early Experience

• Does not depend on case load

• All learners get ‘difficult’ cases

2 Nielsen MS et al Br J Anaesth 2025Adjustable Depth With Real, Live Anatomy

Building A Sim Jacket

Real Images - Same Person:

Using A Sim Jacket

Without Jacket With Jacket

• Simulates challenges in palpation & ultrasound

• Titratable depth for progressive difficulty

• Enables rapid-cycle deliberate practice

• Easy to build one yourself (links later)Results: All Trainee Levels Build US Skills

US Confidence Before/After 1 Hour Session

Minimal (<10) Many (>20)

Large Effect Size

d = 1.25

Cohen’s d

(Intervention vs Baseline)

Statistically Significant

With Jacket p = 0.005

All Experience Groups

(Intervention vs Baseline)

Confidence Boost

23% 88%

Reporting Confidence ≥ 5

(Intervention vs Baseline)

Prior ExperienceFast-Track Novices: Comparable to 2 Weeks

Acceleration & Normalization Of Growth

Without Jacket

Start (+1 Hr) Mid-Month Start (+1 Hr) Mid-Month Start (+1 Hr) Mid-Month

Palpation

Positioning Landmarks

“I feel prepared to use

palpation to guide successful

neuraxial placement”

“I am confident in coaching

positioning to optimize

neuraxial placement”

“I am able to identify

landmarks across different

body habitus”Impact, Persistence, and Invitation – Try It!

Confidence Trajectory

Enduring Skills

• Accelerates Early Learning: scores after

intervention mimic two-weeks training

• Consistent Broad Exposure:multiple exams,

varying difficulty for everyone

• Skills Persist:immediate, sustained gains

Easy to Implement and Scale

• Low Resource Requirement:built with low-cost

OTC products without special training or facility

• Broad Applications: can be used as adjunct to

static training models, adaptable to non-OB

• Efficient:1-hour session, immediate results

Composite Scores of Early Learners

(+1 Hr)

Start Mid-Month Without Jacket With Jacket

End

Ask me to try it

Supplies & How-To