title: Low-Fidelity Haptic Simulation Versus Mental Imagery Training for Epidural Anesthesia Technical Achievement in Novice Anesthesiology Residents: A Randomized Comparative Study.
abstract: BACKGROUND
  There are many teaching methods for epidural anesthesia skill acquisition. Previous work suggests that there is no difference in skill acquisition whether novice learners engage in low-fidelity (LF) versus high-fidelity haptic simulation for epidural anesthesia. No study, however, has compared the effect of LF haptic simulation for epidural anesthesia versus mental imagery (MI) training in which no physical practice is attempted. We tested the hypothesis that MI training is superior to LF haptic simulation training for epidural anesthesia skill acquisition.
  
  
  METHODS
  Twenty Post-Graduate Year 2 (PGY-2) anesthesiology residents were tested at the beginning of the training year. After a didactic lecture on epidural anesthesia, they were randomized into 2 groups. Group LF had LF simulation training for epidural anesthesia using a previously described banana simulation technique. Group MI had guided, scripted MI training in which they initially were oriented to the epidural kit components and epidural anesthesia was described stepwise in detail, followed by individual mental rehearsal; no physical practice was undertaken. Each resident then individually performed epidural anesthesia on a partial-human task trainer on 3 consecutive occasions under the direct observation of skilled evaluators who were blinded to group assignment. Technical achievement was assessed with the use of a modified validated skills checklist. Scores (0-21) and duration to task completion (minutes) were recorded. A linear mixed-effects model analysis was performed to determine the differences in scores and duration between groups and over time.
  
  
  RESULTS
  There was no statistical difference between the 2 groups for scores and duration to task completion. Both groups showed similarly significant increases (P = 0.0015) in scores over time (estimated mean score [SE]: group MI, 15.9 [0.55] to 17.4 [0.55] to 18.6 [0.55]; group LF, 16.2 [0.55] to 17.7 [0.55] to 18.9 [0.55]). Time to complete the procedure decreased similarly and significantly (P = 0.032) for both groups after the first attempt (estimated mean time [SE]: group MI, 16.0 [1.04] minutes to 13.7 [1.04] minutes to 13.3 [1.04] minutes; group LF: 15.8 [1.04] minutes to 13.4 [1.04] minutes to 13.1 [1.04] minutes).
  
  
  CONCLUSIONS
  MI is not different from LF simulation training for epidural anesthesia skill acquisition. Education in epidural anesthesia with structured didactics and continual MI training may suffice to prepare novice learners before an attempt on human subjects.
authors.affiliation: From the *Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; †Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; and ‡Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Grace
authors.initials: G
authors.lastname: Lim
authors.forename: Robert G
authors.initials: RG
authors.lastname: Krohner
authors.forename: David G
authors.initials: DG
authors.lastname: Metro
authors.forename: Bedda L
authors.initials: BL
authors.lastname: Rosario
authors.forename: Jong-Hyeon
authors.initials: JH
authors.lastname: Jeong
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007092:Imagination; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D008953:Models, Anatomic; D009048:Motor Skills; D010414:Pennsylvania; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods*; D013997:Time Factors