Annette Aboulafia

Proactive error analysis of ultrasound-guided axillary brachial plexus block performance.

Background: 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. Methods: A hierarchical task analysis of the procedure was performed with subsequent analysis using systematic human error reduction and prediction approach (SHERPA). Failure modes, effects, and criticality analysis was applied to the output of our SHERPA analysis to provide a definitive hierarchy to the error analysis. Results: Hierarchical task analysis identified 256 tasks associated with the performance of ultrasound-guided axillary brachial plexus blockade. Two hundred twelve proposed errors were analyzed using SHERPA. Failure modes, effects, and criticality analysis methodology was applied to the output of SHERPA analysis to prioritize 20 errors. Conclusions: This study presents a formal analysis of (i) the specific tasks that might be associated with the safe and effective performance of the procedure and (ii) the most critical errors likely to occur as trainees learn to perform the procedure. Potential applications of these data include curricular development and the design of tools to teach and assess block performance.

Virtual reality-based medical training and assessment: The multidisciplinary relationship between clinicians, educators and developers

Background: The current focus on patient safety and evidence-based medical education has led to an increased interest in utilising virtual reality (VR) for medical training. The development of VR-based systems require experts from different disciplines to collaborate with shared and agreed objectives throughout a systems development process. Both the development of technology as well as the incorporation and evaluation of relevant training have to be given the appropriate attention. Aim: The aim of this article is to illustrate how constructive relationships can be established between stakeholders to develop useful and usable VR-based medical training systems. Methods: This article reports a case study of two research projects that developed and evaluated a VR-based training system for spinal anaesthesia. Results: The case study illustrates how close relationships can be established by champion clinicians leading research in this area and by closely engaging clinicians and educators in iterative prototype design throughout a systems development process. Conclusion: Clinicians and educators have to strive to get more involved (ideally as champions of innovation) and actively guide the development of VR-based training and assessment systems. System developers have to strive to ensure that clinicians and educators are participating constructively in the developments of such systems.

Novel Technology for Learning in Medicine

In this chapter we will present some medical educational approaches together with their links to different learning objectives and learning situations. We will also present various forms of computer-based technology, which aim to enhance the teaching and learning capabilities of doctors, mostly in the form of 3D visua- lisation, simulation and haptic technology. We will focus on research conducted in the areas of spinal anaesthesia, surgery and emergency. Finally, we will emphasise some challenges of our domain which are related to the interaction between medical education, technological and computer factors.

Determinants of learning ultrasound-guided axillary brachial plexus blockade.

Background and objectives:  Training in medical procedural skills is currently undergoing important change. We set out to identify those factors, perceived by trainers and trainees, to be important determinants of learning ultrasound‐guided axillary brachial plexus blockade (USgABPB).

Defining a competency map for a practical skill.

In recent years there has been a move towards a competency‐based model for assessing the performance of practical procedures in clinical medicine rather than the traditional assumption that competency is achieved with increasing experience. For such an assessment to be valid, the necessary competencies comprising that skill must be identified. Our aim was to map the individual competencies necessary to perform a given procedural skill using spinal anaesthesia as the example, and to explore the relationship of individual competencies with each other.

Discussion: Understanding work units and activities - A perspective from general psychsology

González (2006) proposes a novel conceptual contribution to a general psychological framework concerning activity commonly, if somewhat inappropriately, termed in English, ‘activity theory’. González argues for this extension to the general framework based on a set of empirical studies outlined in his dissertation. While aspects of these observations are indeed of interest, they will not be discussed further here, as the focus of this commentary is on the claims being put forward concerning the need for a new conceptual level in the activity system. This commentary will take issue with a number of the González’s arguments concerning this enterprise, and raises some questions as to the status of the proposed new level of ‘working spheres’ or ‘engagements’. The argumentation that follows may appear somewhat recondite for an article in a general HCI journal such as Interacting with Computers, but given the popularity of ‘activity theory’ recently in HCI, perhaps it is now necessary to become more involved in the genesis of this approach and its theoretical implications. In González (2006), A.N. Leontjev’s general structure of activity is applied both as an explanatory principle and as a subject of investigation in itself. As a point of reference, the dissertation shows that actions are clustered in ‘themes’, which correspond to Leontjev’s ‘series of actions’. But in addition, it is claimed that the general structure of activity needs to be modified in order to fit these findings. It is argued that there is a conceptual gulf

A qualitative approach to defining learning determinants of spinal anaesthesia: 15AP2-3

Anesthesiology, University Hospital Bern, Inselspital, Bern, Switzerland Background: Cricothyroidotomy (CrT), a rarely used life saving emergency skill, needs special training on manikins or cadavers. Anaesthetists are thought to perform the skill on a competent level after the training. Knowledge about the retention of skill performance over time has an impact on CME-program organization. We assessed retention of skill performance 1, 3 and 6 months after a CrT-training to determine the appropriate time for refresher training. Methods: With IRB approval and informed consent anaesthesia personnel performed CrT after 1, 3 and 6 months of an airway workshop in which CrT was performed 5x on prepared pig larynxes. Performance time was measured from skin palpation until tracheal ventilation. Results: Of the 64 airway course participants only 48 participated after 1 month of the training, 40 after 3 and 6 months. Only the 36 participants who attended all the training were analyzed. See table for duration of different attempts in the original training and the follow up.

A design based approach to development of a mixed interface simulator for learning spinal anaesthesia: 15AP2-6

nurses (N = 47), 58.0% of the physicians (N = 29) and 73.0% of the patients (N = 73). The nurses were more positive towards scales Measurement of pain (scale mean 4.19 vs. 3.66, 95% CI 0.02–1.04, p 0.05) and Encouragement (scale mean 3.80 vs. 3.06, 95% CI 0.31–1.17, p 0.001) than the physicians. The physicians were less concerned about Problems with analgesics than the nurses (scale mean 3.05 vs. 2.32, 95% CI 0.23–1.25, p 0.01). The patients agreed more with items “It is easier to suffer from pain than the side effects” [F2,133) = 17.823, p\lt;0.001], “Pain complaint might distract the doctor from my real problem” [(F 2,134) = 5.505, p\lt;0.01], “Analgesics should be given only when pain is unbearable” [F(2,134) = 9.481, p 0.001] than the nurses and the physicians. Conclusions: The ED personnel need education about measurement of pain and pain medication. Pain history affects the patients’ willingness to report their pain and their attitudes towards pain medication. The patients should be encouraged to talk about their pain. Reference: 1 Stalnikowicz R, Mahamid R, Kaspi S, Brezis M. Int J Qual Health Care 2005; 17: 173–176.