title: A Randomized Controlled Trial Evaluating the See, Tilt, Align, and Rotate (STAR) Maneuver on Skill Acquisition for Simulated Ultrasound-Guided Interventional Procedures.
abstract: OBJECTIVE
  Achieving the best view of the needle and target anatomy when performing ultrasound-guided interventional procedures requires technical skill, which novices may find difficult to learn. We hypothesized that teaching novice performers to use 4 sequential steps (see, tilt, align, and rotate [STAR] method) to identify the needle under ultrasound guidance is more efficient than training with the commonly described probe movements of align, rotate, and tilt (ART).
  
  
  METHODS
  This study compared 2 instructional methods for transducer manipulation including alignment of a probe and needle by novices during a simulated ultrasound-guided nerve block. Right-handed volunteers between the ages of 18 and 55 years who had no previous ultrasound experience were recruited and randomized to 1 of 2 groups; one group was trained to troubleshoot misalignment with the ART method, and the other was trained with the new STAR maneuver. Participants performed the task, consisting of directing a needle in plane to 3 targets in a standardized gelatin phantom 3 times. The performance assessor and data analyst were blinded to group assignment.
  
  
  RESULTS
  Thirty-five participants were recruited. The STAR group was able to complete the task more quickly (P < .001) and visualized the needle in a greater proportion of the procedure time (P = .004) compared to the ART group. All STAR participants were able to complete the task, whereas 41% of ART participants abandoned the task (P = .003).
  
  
  CONCLUSIONS
  Novices are able to complete a simulated ultrasound-guided nerve block more quickly and efficiently when trained with the 4-step STAR maneuver compared to the ART method.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.).
authors.forename: Nicholas C K
authors.initials: NC
authors.lastname: Lam
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.).
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fishburn
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.).
authors.forename: Angie R
authors.initials: AR
authors.lastname: Hammer
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.).
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Petersen
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.).
authors.forename: Neal S
authors.initials: NS
authors.lastname: Gerstein
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.). emariano@stanford.edu.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
mesh_terms: D000765:Anesthesia, Conduction; D002983:Clinical Competence; D004311:Double-Blind Method; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009339:Needles; D011871:Radiology / Q000193:education*; D000066908:Simulation Training; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: regional anesthesia; training; ultrasound; ultrasound education; ultrasound-guided regional anesthesia