Education and training in ultrasound-guided regional anaesthesia

239 Pages·2017·11.83 MB·English

by  Christine Middleton

Education and Training in Ultrasound –
Guided Regional Anaesthesia
(UGRA)

Dr. Atif Shafqat

Thesis submitted to the University of Nottingham
for the degree of Doctor of Philosophy

JUNE 2015
TABLE OF CONTENTS
TABLE OF CONTENTS ------------------------------------------------------------------- ii
ACKNOWLEDGEMENTS ---------------------------------------------------------------- iv
DEDICATION -------------------------------------------------------------------------------- v
SUMMARY OF THE THESIS ------------------------------------------------------------ vi
PUBLICATIONS --------------------------------------------------------------------------- viii
LIST OF FIGURES ------------------------------------------------------------------------- xii
LIST OF TABLES ------------------------------------------------------------------------- xiii
LIST OF APPENDICES ------------------------------------------------------------------ xiv
CHAPTER – 1 -------------------------------------------------------------------------------- 1
Background ------------------------------------------------------------------------------------ 1
Ultrasound-Guided Regional Anaesthesia ----------------------------------------------- 2
Present Training Model -------------------------------------------------------------------- 4
A New Training Model --------------------------------------------------------------------- 8
Competence And Assessment ------------------------------------------------------------- 12
Assessment Of Clinical Competency ----------------------------------------------------- 15
Competency And Anaesthesia ------------------------------------------------------------ 17
Technical Skills In Anaesthesia ---------------------------------------------------------- 18
Types of Assessment ----------------------------------------------------------------------- 19
Quality Of Assessment--------------------------------------------------------------------- 21
Methods For Evaluation Of Technical Skills ------------------------------------------- 24
Other Methods for Evaluation of Technical Skills ------------------------------------- 31
CHAPTER – 2 ------------------------------------------------------------------------------- 33
Visuospatial Ability As A Predictor Of Novice Performance In Ultrasound –
Guided Regional Anaesthesia (UGRA) -------------------------------------------------- 33
INTRODUCTION -------------------------------------------------------------------------- 34
METHODS --------------------------------------------------------------------------------- 37
RESULTS ----------------------------------------------------------------------------------- 52
DISCUSSION:------------------------------------------------------------------------------ 69
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CHAPTER – 3 ------------------------------------------------------------------------------- 83
Construct Validity And Reliability Of An Objective Structured Assessment Tool
For Performance Of Ultrasound – Guided Regional Anesthesia (UGRA) -------- 83
INTRODUCTION -------------------------------------------------------------------------- 84
METHODS --------------------------------------------------------------------------------- 90
RESULTS ----------------------------------------------------------------------------------- 98
DISCUSSION:---------------------------------------------------------------------------- 110
CHAPTER – 4 ----------------------------------------------------------------------------- 129
The Impact of Video games on Ultrasound – Guided Regional Anaesthesia
(UGRA) skills ------------------------------------------------------------------------------ 129
INTRODUCTION ------------------------------------------------------------------------ 130
METHODS ------------------------------------------------------------------------------- 134
RESULTS --------------------------------------------------------------------------------- 145
DISCUSSION----------------------------------------------------------------------------- 162
CHAPTER – 5 ----------------------------------------------------------------------------- 177
Conclusions --------------------------------------------------------------------------------- 177
CONCLUSION --------------------------------------------------------------------------- 178
FUTURE IMPLICATIONS ------------------------------------------------------------- 183
REFERENCES ---------------------------------------------------------------------------- 187

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ACKNOWLEDGEMENTS

Thanks to the God Almighty, the most merciful and the most beneficial
for being with me all the way. With his silent blessings each day was a
new chapter of hope.
I am grateful to Professor Jonathan G Hardman for providing me the
opportunity to study in the Department of Anaesthetics and Intensive
Care and his scientific support and advice throughout the course of the
PhD.
I am indebted to my supervisors and would like to thank Dr. Robert A
McCahon and Dr. Nigel M Bedforth for their constant support,
encouragement and guidance. My sincere thanks to Dr. Rachel Evley
and Jennie Spendlove.
I would specially like to thank my wife Shumaila, my parents, my
daughter Simra, my son Shahir, my sister Shazia, and last but not the
least, my lovely niece Aliza, for their heartful prayers, support and
inspiration.
Thank you all very much.

Atif

iv
DEDICATION

I dedicate this thesis to my wonderful wife “Shumaila”, my
children “Simra” and “Shahir” and above all my “Parents”
without their continuous understanding, support and
encouragement, inspiration and most important; “the belief in
me”, my achievement would not be possible.

v
SUMMARY OF THE THESIS

The PhD thesis contains five chapters, i.e.: the first chapter, presenting the
“Background”, information relevant to the topic in the form of literature review, the
second chapter, comprising of the first study project “Visuospatial Ability As A
Predictor Of Novice Performance In Ultrasound – Guided Regional Anaesthesia
(UGRA)”. The third chapter related to the second study project “Construct Validity
And Reliability Of An Objective Structured Assessment Tool For Performance Of
Ultrasound – Guided Regional Anesthesia (UGRA)”. This is followed by the fourth
chapter encompassing the third and final study project “The Impact of Video games on
Ultrasound – Guided Regional Anaesthesia (UGRA) skills” and finally the last chapter
revealing the “Conclusions”.

The first chapter of the thesis the “Background” includes an introduction to the
topic. It reviews the achievement of proficiency in procedural skills, common
principles regarding the educational theory behind assessment. It also examines the
literature about the diverse methods that can be used for the assessment of procedural
skills in anaesthesia and make important implications from the literature in other
fields of medicine.

In the second chapter, entitled “Visuospatial Ability As A Predictor Of Novice
Performance In Ultrasound – Guided Regional Anaesthesia (UGRA)”, the
experimental and original study will be presented, which intends to identify if
visuospatial ability could predict technical performance of an ultrasound – guided
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needle task by novice operators, and also to describe how emotional state, intelligence
and fear of failure could have impact on this.

In the third chapter, termed “Construct Validity And Reliability Of An Objective
Structured Assessment Tool For Performance Of Ultrasound – Guided Regional
Anesthesia (UGRA)” another experimental and original study project will be
validated, focusing on the construct validity and reliability of a new assessment tool
for the performance of ultrasound – guided regional anaesthesia, by examining
whether it can adequately differentiate between performance levels in anaesthetists
across the spectrum of expertise.

In the fourth chapter, designated “The Impact of Video games on Ultrasound –
Guided Regional Anaesthesia (UGRA) Skills” additional experimental, original part
will be presented, focusing on whether playing video games will predict psychomotor
performance of an ultrasound – guided needling task or could impact on tests of
visuospatial ability and also examine the correlation between these innate abilities.

At the end of each chapter are drawn a series of conclusions, concerning the
investigations performed and the results obtained. The “Conclusions” are summarized
in chapter five, where the possible future investigations are also indicated.

vii
PUBLICATIONS

Some parts of this thesis have contributed to a publication and an additional two other
publications are also under consideration.

PEER-REVIEWED PUBLICATION
Shafqat, A., Ferguson, E., Thanawala, V., Bedforth, N.M., Hardman, J.G., McCahon,
R.A., Accepted for publication in Anesthesiology in June 2015. Visuospatial ability as
a predictor of novice performance in ultrasound – guided regional anesthesia
(UGRA). (Chapter 2)

MANUSCRIPTS IN PREPARATION FOR SUBMISSION FOR PEER-
REVIEW
Shafqat, A., Rafi, K.M., Thanawala, V., McCahon, R.A., Bedforth, N.M., Hardman,
J.G. Unpublished manuscript. Construct validity and reliability of an objective
structured assessment tool for performance of ultrasound – guided regional anesthesia
(UGRA). (Chapter 3)

Shafqat, A., McCahon, R.A., Bedforth, N.M., Hardman, J.G. Unpublished
manuscript. The impact of video games on ultrasound – guided regional anaesthesia
(UGRA) skills. (Chapter 4)

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AUTHOR CONTRIBUTIONS TO MANUSCRIPT ACCEPTED FOR
PUBLICATION

Chapter 2
Shafqat, A., Ferguson, E., Thanawala, V., Bedforth, N.M., Hardman, J.G., McCahon,
R.A., Accepted for publication in Anesthesiology in June 2015. Visuospatial ability as
a predictor of novice performance in ultrasound – guided regional anesthesia
(UGRA).

This study was truly a collaborative effort. As the primary author, I was responsible
for formulating the research questions, refining the study design, conducting the study
and all statistical analyses, drafting the manuscript, responding to reviewers‟ reports
and coordinating submission and publication of the original research paper.
All co-authors were involved in planning the study; choice of measures including the
statistical methods used and commented on the manuscript for submission, response
to reviewers‟ reports and final version of the original research paper. Anonymous
reviewers provided constructive comments on the submitted manuscript, which were
incorporated into the manuscript.

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AUTHOR CONTRIBUTIONS TO UNPUBLISHED MANUSCRIPTS

Chapter 3
Shafqat, A., McCahon, R.A., Bedforth, N.M., Hardman, J.G. Unpublished manuscript.
Construct validity and reliability of an objective structured assessment tool for
performance of ultrasound – guided regional anesthesia (UGRA).

This study was a team effort. As the primary author, I was responsible for formulating
the research questions, refining the study design, conducting the study and all
statistical analyses, drafting the manuscript. All co-authors were involved in planning
the study; choice of statistical methods used and commented on the manuscript for
submission. It is now in the latter stages of preparation for submission to a peer-
reviewed journal.

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