• Preliminary evaluation of a virtual reality-based simulator for learning spinal anesthesia.

      Kulcsár, Zsuzsanna; O'Mahony, Emer; Lövquist, Erik; Aboulafia, Annette; Sabova, Daša; Ghori, Kamran; Iohom, Gabriella; Shorten, George; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland. Electronic address: zsuzsanna.kulcsar@gmail.com. (2012-12-27)
      STUDY OBJECTIVE: To evaluate the influence of a simulation-based program on the initial performance of dural puncture by medical interns, and to refine the design of simulator-based teaching and competence assessment. DESIGN: Prospective interventional study. SETTING: Academic medical center. SUBJECTS: 27 medical interns inexperienced in the technique of spinal anesthesia or dural puncture and within 12 months of graduating from medical school, were randomly assigned to a conventional or a simulator-based teaching course of spinal anesthesia: 13 were recruited to the Conventional Group (CG) and 14 to the Simulator Group (SG). MEASUREMENTS: A SenseGraphic Immersive workbench and a modified Phantom desktop with shutter glasses were used to create a teaching environment. Outcomes of teaching were assessed in two phases within three weeks of the teaching course: Phase I consisted of a written examination followed by assessment on the simulator. A global rating scale and a task-specific checklist were used. Phase II (for those participants for whom a suitable opportunity arose to perform spinal anesthesia under supervision within three wks of the teaching course) consisted of structured observation of clinical performance of the procedure in the operating room. Participants were assessed by independent, study-blinded experts. Student's two-tailed impaired t-tests were used to compare the parametric outcomes (P < 0.05 was considered significant). MAIN RESULTS: All participants completed the written test successfully with no difference between groups. Ten participants from CG and 13 from SG completed the simulator-based testing performing similarly in terms of the global rating scale. Five participants in CG and 6 in SG proceeded to clinical testing. On the global rating scale, interns in SG scored higher than those in CG. They performed similarly according to the task-specific checklist. CONCLUSIONS: Overall, no difference was measured between those taught with traditional methods and those, by a simulator based program in regard to the performance of spinal anesthesia.
    • Proactive error analysis of ultrasound-guided axillary brachial plexus block performance.

      O'Sullivan, Owen; Aboulafia, Annette; Iohom, Gabriella; O'Donnell, Brian D; Shorten, George D; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton, Ireland. onavillus@gmail.com (2012-07-13)
      Detailed description of the tasks anesthetists undertake during the performance of a complex procedure, such as ultrasound-guided peripheral nerve blockade, allows elements that are vulnerable to human error to be identified. We have applied 3 task analysis tools to one such procedure, namely, ultrasound-guided axillary brachial plexus blockade, with the intention that the results may form a basis to enhance training and performance of the procedure.
    • Teaching and learning spinal anaesthesia: anaesthetists' attitudes.

      Breen, Dorothy; Shorten, George; Bogar, Lajos; Aboulafia, Annette; Department of Anaesthesia and Intensive Care, Cork University Hospital, Ireland. dorothybreen@financialcontroller.ie (2010-12)
      To identify the determinants of learning for one medical procedural skill, spinal anaesthesia, by eliciting the opinions of anaesthetists in Ireland and Hungary. This objective is one component of a research project, Medical Competence Assessment Procedure (MedCAP) funded by the EU Leonardo da Vinci Lifelong Learning Programme.
    • Testing haptic sensations for spinal anesthesia.

      Kulcsár, Zsuzsanna M; Lövquist, Erik; Fitzgerald, Anthony P; Aboulafia, Annette; Shorten, George D; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton, Cork, Ireland. zsuzsanna.kulcsar@gmail.com (2011-01)
      Having identified key determinants of teaching and learning spinal anesthesia, it was necessary to characterize and render the haptic sensations (feeling of touch) associated with needle insertion in the lower back. The approach used is to match recreated sensations (eg, "pop" through skin or dura mater) with experts' perceptions of the equivalent clinical events.