Teaching Novices Ultrasound-Assisted Neuraxial Procedures Using Simulation-Based Courses: A Proof of Concept.

Background: Ultrasonography (US) provides valuable information for neuraxial procedures in patients with elevated body mass index (BMI). However, it is challenging to systematically teach US-assisted techniques to novices in clinical settings due to time constraints and patient factors. Simulator-based training may improve the learning experience while minimizing patient discomfort. Methods: With institutional review board approval, 24 learners were randomized into 2 courses, conventional (C) and experimental (E). Course C used human models for the US-assisted technique and simulators to practice intrathecal access with a spinal needle, an approach commonly used in procedural workshops. Course E used simulators that featured a 3D visualization function and incorporated the principles of deliberate practice without using human models. Results: Course C learners correctly identified an average of 74% of the sonoanatomy on a written test and marked an average of 5.8 out of 8 test targets during a lumbar sonography assessment, whereas course E learners scored 73% and marked 6.8. Ten learners in course C (83%) and 11 in course E (92%) successfully achieved dural punctures within 10 minutes on a high-BMI lumbar simulator. Additionally, 75% of course E learners followed the assessment steps before needle insertion compared with only 16.7% in course C. Conclusions: The fundamental US-assisted technique for neuraxial procedures can be effectively taught using simulator-based courses without human models. Course E, which incorporated 3D visualization and the principles of deliberate practice, was more effective in shaping stepwise approaches for the procedure.