Background & Aims

Fluoroscopy-guided procedures play a large role in the practice of interventional pain management. Thus, exposure to these procedures during medical training is integral to gaining clinical competency. Mastery of each procedure requires the learner to understand the steps required to perform the procedure, best practices and safety considerations, and relevant anatomy /fluoroanatomy. They must also acquire the technical skills to perform the procedure successfully and safely. Simulation can be used to teach advanced procedural skills in a hands-on manner. Trainee performance of various technical skills has improved with simulation training across multiple specialties, including vascular surgery,1 obstetrics,2 and pediatrics.3 Trainees exposed to simulation as part of their education rate these experiences highly.4 This project assessed competence and comfort level following a formal simulation-based training curriculum5 developed for interventional pain management trainees.

Methods

Eligible subjects included pain medicine fellows at Brigham and Women’s Hospital. Trainees completed simulation sessions using two spine training systems encased in a gel mold covered with removable simulation skin. In each session, trainees were asked to perform a specific procedure, including lumbar epidural steroid injection (LESI), transforaminal epidural steroid injection (TFESI), lumbar medial branch block (LMBB), and cervical medial branch block (CMBB). Data collected included time to perform the procedure, number of fluoroscopic images taken, total radiation dosage, and performance on a novel grading rubric5 based on final needle placement and completion of items considered instrumental to performing a given procedure. Trainees then received an individual debriefing session and a didactic session on the proper procedural approach before performing the procedures again. Subjective outcomes were collected in pre- and post-course surveys.

Results

18 pain medicine fellows completed the simulation curriculum over a 2-year period (2022 and 2023). Scores for appropriate and safe final needle position improved significantly from pre-didactic session to post-didactic session across all tested procedure types (LESI p = 0.034, TFESI p = 0.046, LMBB p = 0.012, CMBB p = 0.00068). For each rubric item, percentage of fellows with successful completion improved from pre-didactic session to post-didactic session for all procedure types except LESI, for which there were very high completion rates in the pre-didactic session. Fellow ratings of comfort level with each procedure improved significantly from pre-didactic session to post-didactic session (LESI p = 0.030, TFESI p = 0.0011, LMBB p = 0.0081, CMBB p = 0.00093). Overall, 84% of fellows found simulation sessions to be very helpful, and 87.5% reported they would perform the procedure differently based on knowledge gained during the simulation sessions.

Conclusions

Simulation session training can provide valuable hands-on experience for physician trainees in the discipline of interventional pain management. In this simulation curriculum developed for pain medicine fellows, scores for appropriate and safe needle placement, as well as fellow ratings of their own comfort level with each type of procedure, showed statistically significant improvement from pre-didactic session to post-didactic session. Trends towards improved performance on completion of rubric items considered mandatory or useful to successful performance of the procedure were also observed. Fellows overall found the simulation sessions to be helpful and informative for their future practice.

References

1. Dawson DL, Meyer J, Lee ES, Pevec WC. Training with simulation improves residents’ endovascular procedure skills. J Vasc Surg. 2007 Jan;45(1):149-54.
2. Deering S, Brown J, Hodor J, Satin AJ. Simulation training and resident performance of singleton vaginal breech delivery. Obstet Gynecol. 2006 Jan;107(1):86-9.
3. De Ponti R, Marazzi R, Ghiringhelli S, Salerno-Uriarte JA, Calkins H, Cheng A. Superiority of simulator-based training compared with conventional training methodologies in the performance of transseptal catheterization. J Am Coll Cardiol. 2011 Jul 19;58(4):359-63.
4. Gordon JA, Wilkerson WM, Shaffer DW, Armstrong EG. “Practicing” medicine without risk: students’ and educators’ responses to high-fidelity patient simulation. Acad Med. 2001 May;76(5):469-72.
5. Sarno DL, Yong RJ, Fields KG, Lim SM, Gilligan CJ, Khan L, Nelson, ER. A Novel Interventional Pain Simulation-Based Education Curriculum: Implementation to Enhance Procedural Training. Interventional Pain Medicine. 2022;1(4):100167.

Presenting Author

Erika T. Yih

Poster Authors

Erika Yih

MD

Brigham and Women's Hospital

Lead Author

E-mail

Marissa J. Eckley

MD

Spaulding Rehabilitation Hospital, Harvard Medical School

Lead Author

E-mail

Zachary S. Crockett

MD

Spaulding Rehabilitation Hospital, Harvard Medical School

Lead Author

E-mail

Kevin Vu

MD

Spaulding Rehabilitation Hospital, Harvard Medical School

Lead Author

E-mail

Robert J. Yong

MD

Brigham and Women's Hospital, Harvard Medical School

Lead Author

E-mail

Ehren R. Nelson

MD

Stanford University School of Medicine

Lead Author

E-mail

Adlai L. Pappy II

MD

Brigham and Women's Hospital, Harvard Medical School

Lead Author

E-mail

Tracey L. Hunter

MD

Spaulding Rehabilitation Hospital, Harvard Medical School

Lead Author

E-mail

Ashley Gureck

MD

Spaulding Rehabilitation Hospital, Harvard Medical School

Lead Author

E-mail

Aimee C. Reilly

DO

Brigham and Women's Hospital, Harvard Medical School

Lead Author

E-mail

Stacey L. Burns

MD

Brigham and Women's Hospital, Harvard Medical School

Lead Author

E-mail

Danielle L. Sarno

MD

Brigham and Women's Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School

Lead Author

E-mail

Topics

  • Education