Abstract ID: A38

Abstract Title: Evaluation of Interscalene Block Performance: Establishing Construct Validity

Poster Type: Either


ABSTRACT BODY

Purpose: To assess the validity of a global rating scale and a 20-item checklist in evaluating trainee’s competency in performing interscalene brachial plexus block.

Method: We used a global rating scale and a 20-item checklist specifically designed to evaluate the performance of interscalene block to discriminate between junior and senior residents (Appendices 1,2).1,2 After IRB approval and informed consent from both residents and patients, ten junior and ten senior residents were videotaped while performing an interscalene brachial plexus block. Junior residents were PGY-2 residents who had completed a 2-week regional anesthesia rotation. Senior residents were PGY-5 residents or regional anesthesia fellows. Videotaping was done in a manner that masked the identity of each subject. The tapes were then reviewed by two independent, blinded examiners who rated the proficiency of each subject using the proposed global rating scale and 20-item checklist.

Results: Two subjects (one junior and one senior) were excluded from the study due to incomplete taping for technical reasons. Among the remaining 18 subjects, there is no significant statistical difference between the junior and senior residents in their global rating score (69.9%+/-10.0% vs 71.1%+/-8.2%, p=0.334). However, the senior residents were rated higher than the junior residents in the overall performance category (74.4%+/-7.3% vs 64.4%+/-11.3%, p=0.04). As for the checklist, five items were excluded after initial statistical analysis. Items #1, 3, 10 and 18 (Appendix 1) were excluded as they were non-discriminating (all subjects score correctly in both groups). Items #5 was excluded as it was an inverse discriminator (more juniors than seniors scored correctly). Analysis of the remaining 15-item checklist revealed higher scores for the senior residents in comparison to the junior residents (70.4%+/-13.5% vs 56.3%+/-13.5%, p=0.042).

Conclusion: This preliminary data suggest that the revised 15-item checklist is potentially a valid tool to evaluate residents’ performance of interscalene block. Future studies are required to evaluate its use as a standardized evaluation tool to guide residents’ training. Similar checklists may also be developed to evaluate the performance of other peripheral nerve blocks.

References:

1) Anastakis DJ, Wanzel KR, Brown MH, McIlroy JH, Hamstra SJ, Ali J, Hutchison CR, Murnaghan J, Reznick RK, Regehr G. Evaluating the effectiveness of a 2-year curriculum in a surgical skills center. Am J Surg. 2003 Apr;185(4):378-85.

2) Wigton RS. Measuring procedural skills – Editorial. Ann Int Med. 1996 Dec;125:1003-4.

ATTACHED FILES

A38_checklist.doc

A38_global rating scale.doc



Reg Anesth Pain Med 2004; 29(2):A38