The Effects of the STAR Maneuver on UGRA Training
Condition: Simulator-based Training of Ultrasound-guided Regional Anesthesia
Study type: Interventional

Summary: 
      Volunteers will watch a training video demonstrating how to place a needle in the correct
      position while keeping it visible. Later the volunteers will be placed in front of a set up
      identical to the video, and asked to demonstrate how to direct an 80 mm echogenic Pajunk
      needle into 3 targets in a standardized homemade phantom a total of three times.
    

Detailed description: 
      After watching the training video, each volunteer will be placed in front of a set up
      identical to the video seen. Adjacent to this set up, a single fellowship trained regional
      anesthesiologist known as the assessor is situated with a screen that allows real time
      viewing of the ultrasound screen seen by the volunteer. The assessor is blinded to the
      assignment of the volunteer. Also, the assessor does not have any visualization of the
      volunteer. This prevents visualizing hand or body movement that may cause a bias. The same
      assessor is used for the whole study to provide consistent assessment of the task.

      The task involves the volunteer directing an 80 mm echogenic Pajunk needle into 3 targets in
      a standardized homemade phantom. The targets simulate the nerve roots commonly found in the
      interscalene block. Thus, they are arranged diagonally to simulate the nerve root position
      commonly seen. Also, they are arranged on a tilt relative to the flat surface of the phantom
      to simulate the direction the nerve travels. This is important as the tilt of the target
      requires the volunteer to tilt the probe so that their incidental ultrasound wave is
      perpendicular to the target for the brightest reflection to occur. This phenomenon is known
      as anisotropy. This increases the realism of the task that cannot be imitated by commercially
      available phantoms.

      There are 3 goals that the volunteer must fulfill in performing their task. Firstly, they
      must direct the needle to the 12 o'clock position of the 3 targets. Secondly, they must
      achieve maximal ultrasound image brightness of the 3 targets at all times. Thirdly, the
      entire needle must be visualized at all times.

      If the needle is not in the correct position, the assessor will verbally inform the volunteer
      to redirect it to the correct position. If the target images are not at their brightest, the
      assessor will verbally inform the volunteer not to manipulate the needle towards the target
      until the targets are at their brightest. Clinically, this functions to prevent the needle
      being inserted inside the nerve as the targets are not clearly seen. Thirdly, if the needle
      is visualized entirely, the volunteer will be told to stop manipulating the needle towards
      the target until the needle is fully visualized by manipulating the probe. A timer records
      the cumulative time the needle is not in full visualization. Clinically, this functions to
      prevent the needle being inserted into a nerve or structure that it should not.

      After all 3 targets have been completed, the volunteer repeats the task a total of 3 times.
    

Intervention name(s): STAR; ART
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Health Services Research