Deliberate Practice With Validated Metrics Improves Skill Acquisition in Performance of Ultrasound Guided Peripheral Nerve Block in a Simulated Setting

Safe performance of ultrasound-guided peripheral nerve blocks (PNB) requires competence across a range of technical and nontechnical skills. Correct placement of a needle close to a nerve or plexus is critical to safe and successful procedure performance. Failure to maintain needle visibility while in forward motion may cause iatrogenic injury to nerves and surrounding structures, and is a "quality compromising" behavior in the early part of novice learning curve. Skills related to needle guidance are difficult to learn, as they require integration of multiple cognitive and psychomotor elements.

The objective of this study was to compare the effects of expert supervised deliberate practice with validated metrics vs. self-guided practice on novice needling skill acquisition as evaluated by the number of steps completed and errors made.

Methods

Having obtained informed written consent from each, eighteen 3rd and 4th year medical students with no previous experience of ultrasound-guided procedures were recruited. Each student provided demographic information on his or her age, gender and handedness. All subjects will attend a didactic lecture (learning phase) delivered in standard fashion by one investigator. This included outlines of ultrasound physics, scanning and practical techniques.

Subsequently, subjects will be randomly allocated using computer generated random numbers to one of two groups; self-guided practice (SP) and deliberate practice (DP). Approximately 24 hours after completion of the learning phase each subject will attempt to perform the following set of tasks (baseline assessment).