Effects of Metric-based Feedback Training on Acquisition of Sonographic Skills Relevant to Performance of Ultrasound Guided Axillary Brachial Plexus Block

The use of ultrasound guidance during performance of peripheral nerve blocks improves success rate, shortens performance time and reduces the risk of inadvertent vascular puncture. Safe and effective procedure performance requires the operator to make a series of real-time, high stakes decisions relevant to interpretation of sonographic anatomy and subsequent nerve visualization, needle-to-nerve guidance, needle-to-nerves approximation and local anesthetic deposition. Teaching novices to perform ultrasound-guided nerve blocks should include rendering and assessment of its component skills such as interpretation of sonographic anatomy, consistent needle imaging and correct placement of local anesthetics. Learning and teaching ultrasound-related motor skills is challenging within the current landscape of medical and training education. Simulated learning has been advocated as it can facilitate deliberate practice as opposed to repeated practice. Simulation and e-learning are flexible training modalities, which facilitate procedural skills rehearsal in a safe environment, free from risk to patients, and permitting real time feedback. Deliberate practice with feedback in a simulated environment may accelerate the rate of skill acquisition. Feedback is a predictor of effective learning and a useful tool for novices learning new skill. However summative feedback is superior to concurrent feedback for procedural skill acquisition during simulated but not clinical training and for skill retention. The characteristics of feedback, which influence its effect on learning, include timing, content, who initiates (elicits) it and the format and motivation applied to its delivery. Feedback positively influences skill acquisition by novice learners. How trainees adopt objective versus subjective feedback remained largely undetermined. The investigators hypothesize that feedback based on previously developed and validated metrics will improve novices' learning of procedural skills.

The objective of this study was to determine the effect of a structured, objective and terminal feedback on novices' performance skills of ultrasonography part of ultrasound-guided axillary brachial plexus block.

Methods:

With institutional ethical approval and having obtained written informed consent from each, 12 anesthesia trainees will be invited to participate in this prospective, randomized and blinded study.

Inclusion criteria: