Talk: Training, Practice and Assessment of Arthrocentesis Procedure Skills without Risk to a Patient (2009 ACR/ARHP Annual Scientific Meeting)

Monday, October 19, 2009: 4:30 PM

104 A (Pennsylvania Convention Center)

Richard Brasington, Washington Univ Schl of Med, St Louis, MO, Jane Miller, University of Minnesota, Vic Spitzer, V. M. Holers, U Colo Denver, Aurora, CO, Ann Sherzinger, Adam Lawson and Maren L. Mahowald, Univ of MN, Minneapolis, MN

Presentation Number: 1220

Purpose: The ‘See One, Do One, Teach One’ method for learning arthrocentesis is no longer acceptable because of risk to patients. However, trainees are not able to practice these procedures with sufficient repetition and supervision on patients to become proficient (Roberts et al 2002), and there is no objective, standardized method to document that the trainee is competent to perform these procedures independently. We developed a Virtual Reality-Based Joint Injection Simular (VR-JIS) (Touch of Life Technologies, Inc.) with haptically enabled virtual palpation and needle insertion for repeated simulated arthrocenteses.

Methods: As part of a systematic process of simulator validation and development of an Arthrocentesis Competency Level Assessor, we designed a “mini-Arthro CEX to use with the VR-JIS. A field test was carried out with 15 trainees in a regional ROSCE for 5 US rheumatology training programs. Using a haptically enabled virtual syringe and palpation device, the trainee attempted to locate the landmarks for anterior entry into the glenohumeral joint, to advance the needle into the virtual joint, and withdraw virtual fluid. Pre-specified performance metrics were assessed by the computer and by observational assessment. Each metric was scored on a 9 point Likert scale by a senior rheumatologist with extensive experience with arthrocentesis and using the simulator.
Results: Two clinical evaluators piloted a 13-item dichotomous checklist to establish a performance baseline as part of a validation study of the VR-JIS. An educational consultant collected field notes describing the conditions of each of the 15 residents’ encounters with the simulator. Each of the residents was oriented briefly to the simulator. Nine of 15 fellows needed direction during each procedure. Most expressed discomfort and/or confusion over the virtual anatomical landmarks as represented on the simulator. Expert evaluators concluded that trainees would need more time practicing on the simulator prior to competency assessment and more time for immediate feedback and opportunity to repeat the procedure if they fail. Future field tests will include a revised assessment tool for clinical evaluators, modification of the tactile reality and more robust evaluation of the simulator by trainees.
Conclusion: The VR-JIS is a unique technology for arthrocentesis training and and practice as well as a method for objective competency testing without concern for patient disomfort. The simulator provides an objective consistent testing paradigm for multiple trainees and the Arthro-CEX contains a set of standard procedure metrics for preceptor assessment. Problems encountered included: 1)electronic complexity of the VR-JIS, 2)time required for the trainee to become oriented to using the VR-JIS, and 3) expense and fragility of the haptic devices. Thi work was supported by an NIH/SBIR Grant

Keywords: arthrocentesis

Disclosure: R. Brasington, Human Genome Sciences, 2, 9, Biogen Idec, 2, Centocor, Inc., 2, Centocor, Inc., 5, Abbott Immunology Pharmaceuticals, 2, Abbott Immunology Pharmaceuticals, 5, Bristol-Myers Squibb, 5, Wyeth Pharmaceuticals, 2, UCB, 5, TolTech, 5 ; J. Miller, TolTech, 5 ; V. Spitzer, TolTech, 3 ; V. M. Holers, TolTech, 3 ; A. Sherzinger, TolTech, 3 ; A. Lawson, TolTech, 3 ; M. L. Mahowald, Allergan Pharmaceuticals, 5, TolTech, 5 .

1220 - Training, Practice and Assessment of Arthrocentesis Procedure Skills without Risk to a Patient