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Standardised training program in spinal ultrasound for epidural insertion: protocol driven versus non-protocol driven teaching approach


Terblanche, NCS and Arzola, C and Wills, KE and Lawson, R and Blackford, D and Balki, M, Standardised training program in spinal ultrasound for epidural insertion: protocol driven versus non-protocol driven teaching approach, Anaesthesia and Intensive Care, 42, (4) pp. 460-466. ISSN 0310-057X (2014) [Refereed Article]

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Copyright 2014 Australian Society of Anaesthetists

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DOI: doi:10.1177/0310057X1404200406


Spinal ultrasonography provides guidance for epidural insertion in obstetric patients. The primary objective of the study was to develop a training program in spinal ultrasound for anaesthetists and to determine its effect on the skill acquisition of anaesthetists with no prior spinal ultrasound experience. Eighteen anaesthetists underwent two structured workshops (one week apart), each followed by a practice session and videorecorded assessments. Participants were randomised to a protocol-driven or non-protocol driven spinal ultrasound teaching program. Two experts rated each individual's performance using a global rating scale (GRS), checklist and image quality scale. The primary outcome was the mean difference in GRS score between the two workshops, analysed using linear mixed models. Intraclass correlation coefficients were calculated to assess agreement between assessors' ratings. A total of 108 ultrasound scans were performed on five pregnant volunteers during the assessment periods. After adjusting for confounders, GRS scores increased on all three rating scales at the second workshop, this increase being 6.01 points (95% confidence interval 4.56 to 7.46, P<0.001) from a mean score of 28.4 (95% confidence interval 24.8 to 32.0). There was no significant difference in the scores between the two teaching groups (difference in GRS scores=1.36 points, 95% confidence interval -0.77 to 3.50, P=0.211). Intraclass correlation coefficients showed substantial assessor agreement for all three assessment methods (range 0.59 to 0.89). The results demonstrate that programmed spinal ultrasound training sessions involving practice with guidance and feedback from an expert, whether protocol-based or non-protocol based, lead to improved performance.

Item Details

Item Type:Refereed Article
Keywords:anaesthesia education, lumbar vertebrae, ultrasonography, feedback, learning curves
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Anaesthesiology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Terblanche, NCS (Dr Nico Terblanche)
UTAS Author:Wills, KE (Dr Karen Wills)
ID Code:93681
Year Published:2014
Web of Science® Times Cited:3
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-08-13
Last Modified:2017-11-02

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