title: The Effects of Real-Time Computerized Needle Tip Location Feedback on State Anxiety and Immediate Performance of Simulated Ultrasound-Guided Regional Anesthesia
Creators: name: Janakes, Joseph
Publisher: name: University of Nevada, Las Vegas
Year: 2021

description: Background: Complications of ultrasound-guided regional anesthesia (UGRA) in the clinical setting are severe and frequently related to improper needle tip placement, which is a challenging skill for novice student learners. Accordingly, anesthesia education programs are incorporating simulation-based teaching methods that use expensive procedural task trainers to aid in UGRA training. However, it was unknown if the task trainers with real-time computerized needle tip location feedback affect student anxiety and immediate simulated UGRA performance, leaving educators wondering if the cost was justified.Aims: The purpose of the study was to examine the effects of real-time computerized needle tip location feedback on students’ state anxiety and immediate task performance during a simulated UGRA training lab. Methods: An experimental design with repeated measures was used to assess the effects of real-time computerized needle tip location feedback on the anxiety and performance of student nurse anesthetists during a simulated UGRA training. After completing the Vandenberg and Kuse Mental Rotation Test (MRT-A) to assess visuospatial ability, subjects were randomly assigned to one of two groups: an experimental group (n =15) receiving standard UGRA training with real-time computerized needle tip feedback intervention using the Simulab© Regional Anesthesia Trainer with SmarTissue or a control group (n =14) receiving standard UGRA training using the Simulab© Regional Anesthesia Trainer with SmarTissue. A post-performance assessment for both groups was conducted by UGRA experts using the assessment checklist (AC) and global rating score (GRS) measurement tools. Repeated measures using the State-Trait Anxiety Inventory (STAI) Form Y measured state and trait anxiety at time 1 (T1) and state anxiety at times 1, 2, and 3 (T1, T2, and T3). Results: Statistical analysis included independent samples t-test, mixed regression model, multivariate multiple regression, Pearson’s correlation, and structural equation modeling, all using a significance level of alpha .05. Based on the current cohort data analysis, using computerized needle tip feedback during a UGRA training lab did not show a significant effect on changes in student state anxiety scores when compared with the control group over time (p = .555). The state anxiety scores of students in both groups increased similarly at T2 and T3 when compared to T1. No significant differences were found in the immediate performance outcome measures between the experimental and control group when including and controlling for covariates (p = .178). Even though the path analysis showed a significant relationship between ground and STAI Y1 at T2 (p = .008) and AC score (p = .023), STAI Y1 at T2 showed no significant relationship between and the outcome measure scores in the AC (p = .356) and GRS (p = .332). Therefore, STAI Y1 was not identified as a mediator between the group membership and the outcome measures. Discussion: Despite the innovative technology, real-time computerized needle tip feedback did not result in improvement in state anxiety or performance in the current study and may not be cost-effective for training. Students’ unfamiliarity with the Simulab© Regional Anesthesia Trainer with SmarTissue may have resulted in technostress, manifested by significantly higher state anxiety in the experimental group compared to the control group at T2 and T3. The higher anxiety scores may have negatively affected student performance; therefore, teaching strategies should include student preparation for any new technology. The AC and GRS tools were found to be reliable UGRA performance measures and their continued use is supported. Conclusions: Overall, the intervention did not show a significant effect on changes in student state anxiety or performance outcome scores.