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Regional anaesthesia is the performance of spinal, epidural or peripheral nerve blocks to allow patients to undergo surgery awake and to provide post-operative pain relief. Anaesthetists inject local anaesthetic using specialist needles close to nerves to prevent transmission of pain. Hand-held ultrasound is often used by anaesthetists to direct these needles to the correct position i.e. close to, but not in the nerve itself. If the needle is not adequately seen using the hand-held ultrasound it may pierce the nerve causing permanent nerve damage and significant patient harm.
Within the time and resource constraints of postgraduate medical training, it would be advantageous to optimise expertise acquisition of practical skills with a cheap, self-directed educational intervention. Therefore, the aim of this study is to determine whether gaze training is associated with improved performance of an ultrasound-guided needle task. The investigators hypothesise that improved gaze control will translate to better technical performance of an ultrasound-guided regional anaesthesia task.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group Gaze | Experimental | The gaze-trained group will be shown a video, derived from the eye tracker, of an expert's visual control whilst performing the ultrasound task. Participants will be made aware of the target-focused gaze strategy (lengthy and stable fixations on the needling target), and the manner in which the gaze shifted from target to tools (hands, needle and transducer) in a fast, smooth fashion. They will then be advised to try to mimic the gaze strategy of the expert while undertaking the needling task as their first training task. After completion of this training task, participants will be shown their own video data, as captured by the eye tracker. Participants will be asked to comment on differences between their own video and the expert video they had previously seen. This feedback process will be replicated a further four training task attempts. Participants in this group will therefore undergo a total of five training attempts of the needling task. |
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| Group Discovery | Active Comparator | The discovery learning group will be given no video feedback and will be instructed to perform five training attempts at the needling task without further training or feedback. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Gaze training | Other | A training module in gaze training for peripheral nerve blockade |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Composite Error Score | Objective error scoring of performance at needling task | Undertaken during ultrasound assessment 1 (before training intervention) and during ultrasound assessment 2 (which will occur 10 minutes after the training intervention was undertaken). Each assessment will be 15 minutes in duration. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Global Rating Scale | Objective performance scoring of needling task, scored from 0-35, higher scores indicating better task performance. | Undertaken during ultrasound assessment 1 (before training intervention) and during ultrasound assessment 2 (which will occur 10 minutes after the training intervention). Each assessment will be 15 minutes in duration. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Task completion time | Time taken to finish needling task | Undertaken during ultrasound assessment 1 (before training intervention) and during ultrasound assessment 2 (which will occur 10 minutes after the training intervention was undertaken). Each assessment will be 15 minutes in duration. |
| Change in Fixation durations |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| David W Hewson, MBBS | Contact | 01159249924 | 61195 | David.hewson@nottingham.ac.uk |
| Name | Affiliation | Role |
|---|---|---|
| David W Hewson, MBBS | University of Nottingham | Principal Investigator |
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| Discovery learning |
| Other |
A phase of discovery learning guided by novice operators themselves |
|
The total duration in seconds during the task that the participant spends engaging fixation visual behaviour in pre-defined areas of interest during the needling task |
| Undertaken during ultrasound assessment 1 (before training intervention) and during ultrasound assessment 2 (which will occur 10 minutes after the training intervention was undertaken). Each assessment will be 15 minutes in duration. |