Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum ( ). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group ( ). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear. 1. Introduction Research in expert performance identifies deliberate practice as the hallmark of superior performance. Deliberate practice training as described by Ericsson and colleagues entails (1) motivated learners, (2) well-defined learning objectives, (3) precise measurements of performance, (4) focused and repetitive practice, and (5) informative real-time feedback concerning performance [1]. Deliberate practice has been shown to be effective in increasing performance skills in various domains including music, sports, and games such as chess and typing [2, 3]. Recently, educators in science and medicine have been using principles of deliberate practice to design training modules in an attempt to improve student performance [4]. Simulation technologies in particular have been used in the deliberate practice of procedural skills at the graduate medical education level as there is opportunity for repeated practice and immediate feedback in controlled, safe, representative scenarios. Simulation-based instruction of procedural skills in medicine is becoming widespread. Simulation-based medical education has been shown to increase knowledge, provide opportunities for practice, and allow for assessment
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