title: Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists' Acquisition of Ultrasound-Guided Regional Anesthesia Skills.
abstract: OBJECTIVE
  Simulation-based education strategies to teach regional anesthesia have been described, but their efficacy largely has been assumed. We designed this study to determine whether residents trained using the simulation-based strategy of deliberate practice show greater improvement of ultrasound-guided regional anesthesia (UGRA) skills than residents trained using self-guided practice in simulation.
  
  
  METHODS
  Anesthesiology residents new to UGRA were randomized to participate in either simulation-based deliberate practice (intervention) or self-guided practice (control). Participants were recorded and assessed while performing simulated peripheral nerve blocks at baseline, immediately after the experimental condition, and 3 months after enrollment. Subject performance was scored from video by 2 blinded reviewers using a composite tool. The amount of time each participant spent in deliberate or self-guided practice was recorded.
  
  
  RESULTS
  Twenty-eight participants completed the study. Both groups showed within-group improvement from baseline scores immediately after the curriculum and 3 months following study enrollment. There was no difference between groups in changed composite scores immediately after the curriculum (P = 0.461) and 3 months following study enrollment (P = 0.927) from baseline. The average time in minutes that subjects spent in simulation practice was 6.8 minutes for the control group compared with 48.5 minutes for the intervention group (P < 0.001).
  
  
  CONCLUSIONS
  In this comparative effectiveness study, there was no difference in acquisition and retention of skills in UGRA for novice residents taught by either simulation-based deliberate practice or self-guided practice. Both methods increased skill from baseline; however, self-guided practice required less time and faculty resources.
authors: From the *Duke University School of Medicine, Durham, NC; and †Stanford University School of Medicine, Stanford; ‡Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; and §Newport Harbor Anesthesia Consultants, Newport Beach, CA.
authors: Ankeet Deepak
authors: AD
authors: Udani
authors: T Kyle
authors: TK
authors: Harrison
authors: Edward R
authors: ER
authors: Mariano
authors: Ryan
authors: R
authors: Derby
authors: Jack
authors: J
authors: Kan
authors: Toni
authors: T
authors: Ganaway
authors: Cynthia
authors: C
authors: Shum
authors: David M
authors: DM
authors: Gaba
authors: Pedro
authors: P
authors: Tanaka
authors: Alex
authors: A
authors: Kou
authors: Steven K
authors: SK
authors: Howard
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods* / Q000592:standards; D000776:Anesthesiology / Q000193:education / Q000379:methods* / Q000592:standards; D002983:Clinical Competence; D003198:Computer Simulation / Q000592:standards; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D008297:Male; D016037:Single-Blind Method; D018084:Ultrasonography, Interventional / Q000379:methods* / Q000592:standards