Achieving Lumbar Epidural Block Competency in Inexperienced Trainees after a Structured Epidural Teaching Model: A Randomized, Single Blind, Prospective Comparison of CUSUM Learning Curves

Abstract

Aim. The aim of this randomized, prospective study was to investigate whether the use of the structured epidural teaching model (SETM) may affect the learning curve for lumbar epidural block in novice trainees when compared with a standard teaching module. Introduction. There is a paucity of literature regarding the efficacy of teaching epidural blocks and comparisons between the different educational approaches. Method. Forty-four PGY3 anesthesia trainees were randomized to receive (study group) or to not receive (control group) the SDM (structured didactic model) before the beginning of their 6 months clinical practice rotation in labor and delivery suites. A CUSUM learning curve was built for every trainee. The scores were assigned by the staff instructor, who was unaware of the group to which the trainee belonged. Results. The number of subjects who achieved an improvement in performance was 8 trainees from the control group and 14 from the study group. The probability of achieving an improvement was higher ( $p<05$ ) in the study group than in the control group, with an aOR of 3.25 (CI: 1.01; 12.1). The proportion of subjects in the study group who completed the epidural without help was 1.21 (1.05–1.41) times the proportion of subjects who completed the epidural without help in the control group. The probability of completing the epidural block without any assistance was 21% higher in the study group than in the control group ( $p<05$ ). Conclusion. We have demonstrated that the use of the structured epidural teaching model (SETM) may improve the learning curve (CUSUM) for lumbar epidural block in novice, entirely inexperienced, anesthesia trainees.