Evaluation of a Simulation Based Workshop in an Anesthesia Residency Program
Condition: Cerebrospinal Fluid Drainage Catheter
MeSH terms: Cerebrospinal Fluid Leak
Study type: Interventional

Summary: 
      The study aim is to determine whether simulation based learning would improve senior
      anesthesiology residents' patient care performance during the insertion and management of
      cerebrospinal fluid drainage catheters when compared to interactive problem based learning
      (PBL) using the Anesthetist's Nontechnical Skills Global rating scale
    

Detailed description: 
      This prospective randomized trial allocates anesthesia residents into two educational groups
      and compares resident's performance on the the composite score (Anesthetist's Nontechnical
      Skills Global Rating Scale) assigned by supervising anesthesiologists after the insertion and
      management of cerebrospinal fluid drainage catheter during resident's vascular rotation.

      The senior residents (CA-3 and CA-2) rotating through the vascular rotation at the Cleveland
      Clinic main campus starting December 2014 are randomly allocated to simulation based learning
      versus problem based learning using computer generated randomization. Randomization occurs
      prior to the start of the vascular rotation. The randomization is designed to allocate all
      residents (usually one or 2 residents) rotating through the vascular rotation each month (4
      week rotation) to either simulation or problem based learning. The learning activity (whether
      simulation based or problem based) is scheduled to occur in the first week of the vascular
      rotation and the content of the educational activities (simulation based and problem based)
      is designed to cover the same educational material. Two of the authors of the study moderate
      all educational activities interchangeably (simulation and problem based). Simulation based
      learning required advanced scheduling of activities with our simulation center to ensure
      space and equipment availability and is a key factor in the decision to perform the
      randomization in 4 month intervals rather than month to month.

      The primary outcome is the composite score (Anesthetist's Nontechnical Skills Global Rating
      Scale) received by participating residents during their first CSF drainage catheter insertion
      and management as evaluated by their supervising cardiothoracic anesthesiologists. Evaluating
      staff anesthesiologists is blinded to the residents' allocation group and were not involved
      in the study.

      Baseline and outcomes data are prospectively collected on participating residents and
      respective patients undergoing thoracic aortic vascular procedures requiring CSF drainage
      catheters at the Cleveland Clinic main campus during the study period. Complications of CSF
      drainage catheters is also collected by looking into the EPIC of all the patients who had CSF
      drainage catheters handled by the residents in the study. Patients are followed up till they
      leave the hospital to evaluate if they developed any complications like paraplegia,
      infection, retained fragments. This will be a secondary descriptive outcome.

      The simulation scenario consists of a patient requiring perioperative CSF drainage prior to
      undergoing thoracic aortic aneurysm surgery. The simulation involves step-by-step
      instructions on insertion of the CSF drainage catheter including aseptic technique, position
      of patient (lateral vs. sitting), site of insertion. The simulation training is done on a
      mannequin to simulate actual conditions. We plan to use a simulation model, which is
      basically a torso with the ability to palpate the back and spinous processes and use the
      epidural needle with loss of resistance technique with haptic feedback. The trainees would be
      able to actually perform the procedure on the manikin.

      Various commercial CSF drainage kits are available. We will use the Medtronic lumbar drainage
      kit, which is available in the OR. Sterile technique, including chlorhexidine prep, full
      gown, sterile drape, sterile gloves, mask, hat. Insertion is typically at L3-L4 or L4-L5.The
      Tuohy needle will be inserted with the bevel facing cephalad in incremental fashion with loss
      of resistance technique until the epidural space is reached and then inserted further till a
      distinct pop is felt and the subarachnoid space entered. This will be confirmed by free flow
      of CSF from the Tuohy needle. The CSF catheter will then be inserted through the Tuohy
      needle, taking care to avoid marked seepage of CSF by minimizing the duration between trocar
      withdrawal and catheter introduction. The technique of using wire reinforced catheters as
      opposed to ordinary catheters will be demonstrated ( available on Integra CSF drainage
      catheters). The catheter will be threaded approximately 5 to 7 cm past the needle into the
      intrathecal space, the needle will be gently removed and the catheter secured with a clear
      occlusive dressing. Confirmation of free CSF drainage is obtained prior to dressing. The
      simulation would continue needing assembly and attachment of the catheter to the monitor
      through a transducer and learning how to drain the CSF at a particular preset value.

      The residents allocated to the non simulation group (problem based learning) receives
      standard educational teaching in the form of a problem based learning discussion during the
      first week of rotation.
    

Intervention name(s): Simulation-based learning; interactive problem based learning
Intervention type(s): Other; Other
Intervention description(s): Simulation-based teaching involves using done on a mannequin to simulate actual conditions; Standard teaching (problem based learning discussion) during cardiac/vascular rotation
Other intervention name(s): Simulation; PBL
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Prospective randomized educational trial
Masking: Single (Outcomes Assessor)
Primary purpose: Other