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Teaching ultrasound-guided regional anesthesia using remote immersive virtual reality: a randomized controlled trial
Aneurin Moorthy1, Fahad Alam1,2, Stephen Choi1,2
1Department of Anesthesiology and Pain Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Purpose:
Effective education in ultrasound-guided regional anesthesia is an essential component of anesthesiologists' training. Telesimulation is a viable alternative to in-person training, allowing an instructor to guide a distant learner through technical skills in real time. Here, we sought to compare remote teaching of ultrasound-guided nerve blocks by 2D telesimulation vs 3D telesimulation remote immersive virtual reality (RIVR). We hypothesized that 3D RIVR would be the superior teaching modality.
Methods:
We recruited 24 medical students without prior exposure to ultrasound-guided procedures into a single-centre randomized controlled assessor-blinded trial. After providing written consent, we randomized participants to receive instruction on how to perform an ultrasound-guided nerve block on a porcine simulation model, where the instructor provided remote teaching either via 2D telesimulation or 3D RIVR. The primary outcome was pretest to posttest improvement, assessed using scores on a validated checklist. The secondary outcome was student and instructor satisfaction with learning via the 3D RIVR compared with the 2D teaching modality, assessed via a satisfaction questionnaire after each session.
Results:
Participants randomized to 2D telesimulation showed a mean improvement of 36.7 (95% confidence interval [CI], 30.6 to 42.8; P < 0.001). Participants randomized to 3D RIVR telesimulation showed a mean improvement of 28.8 (95% CI, 22.1 to 35.4; P < 0.001). The magnitude of the improvement was not significantly different between groups (mean difference, 7.9; 95% CI, -0.6 to 16.4; P = 0.06). Satisfaction questionnaires showed that both instructors and students responded more positively to the 2D teaching, likely owing to the limitations of the existing 3D RIVR technology.
Conclusion:
The 3D RIVR telesimulation was comparable to 2D telesimulation for training novices in procedural skills for ultrasound-guided regional anesthesia. The 2D telesimulation was preferred by both instructors and learners. Nevertheless, with the advancement of technology, remote teaching via virtual reality may supersede this method soon.
Study Registration:
ClinicalTrials.gov ( NCT05755724 ); registered 11 February 2023.
