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Resident Competency and Proficiency in Combined Spinal–Epidural Catheter Placement Is Improved Using a Computer-Enhanced Visual Learning Program

A Randomized Controlled Trial

Nixon, Heather C., MD*; Stariha, Jillian, BA; Farrer, Jason, MD; Wong, Cynthia A., MD§; Maisels, Max, MD; Toledo, Paloma, MD, MPH

doi: 10.1213/ANE.0000000000003816
Medical Education: Original Clinical Research Report

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

From the *Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois

Rosalind Franklin Medical School, Chicago, Illinois

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

§Department of Anesthesiology, University of Iowa Carver School of Medicine, Iowa City, Iowa

Department of Urology, Northwestern Feinberg School of Medicine and Lurie Children’s Hospital, Chicago, Illinois.

Published ahead of print 22 August 2018.

Accepted for publication August 22, 2018.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Heather C. Nixon, MD, Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, 1740 W Taylor Ave, Suite 3200, Chicago, IL 60612. Address e-mail to

© 2019 International Anesthesia Research Society
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