Enhancing Anesthesia Training: Integrating Visual Ultrasound and Case-Based Learning

doi:10.21203/rs.3.rs-4942751/v1

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Enhancing Anesthesia Training: Integrating Visual Ultrasound and Case-Based Learning

https://doi.org/10.21203/rs.3.rs-4942751/v1

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Background: Ultrasound-guided nerve blocks, which provide precise diagnosis and treatment, are critical for anesthesiologists to master. In particular, for beginners under anesthesia, proficiency in ultrasound is challenging.

Objective: This study aimed to compare the teaching effects of visual ultrasound combined with case-based learning and the traditional lecture method in anesthesia training for undergraduate interns.

Methods: Thirty anesthesia undergraduate interns from the Ultrasound Department at Chongqing Emergency Medical Center, trained from January 2022 to March 2024, were selected as participants. They were randomly divided into two groups: the experimental group (n=15), which received visual ultrasound instruction combined with case-based learning, and the control group (n=15), which received traditional teaching methods. The effects of the teaching methods were evaluated through a combination of theoretical exams, ultrasonic map recognition, and a multidimensional questionnaire. An independent sample t test was used for statistical analysis in this study.

Results: The experimental group demonstrated superior performance in theory assessment and ultrasonic map recognition results after training [(75.77±4.51) vs. (89.23±3.76) and (74.70±2.71) vs. (90.33±1.95)], indicating particular strengths (P<0.05). Additionally, course evaluation surveys indicated that teaching satisfaction was markedly higher in the experimental group than in the control group (P<0.05).

Conclusion: Integrating visual ultrasound with case-based learning significantly enhances both the teaching efficiency and practical clinical skills of students in anesthesia training.

Visual ultrasound

case-based learning

anesthesia training student

anesthesia skills development

medical education methods

The traditional teaching method, didactic lecture-based learning (LBL), involves the teacher being the primary source of knowledge, delivering information through PowerPoint lectures ^[1]. Students passively accept the transmission of knowledge with minimal opportunity for active classroom participation. This approach has been found to be monotonous and may result in students losing interest in the subject matter, ultimately leading to unsatisfactory teaching outcomes ^[2–3]. Concurrently, medical education is evolving toward a competency-based model of instruction, which signifies a transition in pedagogical emphasis from a teacher-centric approach to a learner-centric approach ^[4]. The active learning mode, which is student-centered and allows for active participation, has been proven to be the most effective teaching mode ^[5–7]. Visualized ultrasound teaching is a student-centered active learning strategy that can stimulate students' motivation and improve their understanding of abstract theoretical knowledge; however, this innovative teaching method has not yet been reported in the literature.

The continuous development of ultrasound medicine has significantly enhanced its role in the timely diagnosis and treatment of acute and critically ill patients owing to its simple operation, real-time capability, convenience, and repeatability ^[8–9]. Often described as the visual “stethoscope” of clinicians, ultrasound is increasingly vital in diagnostic and treatment processes. Over the past decade, significant advancements have been made in regional anesthesia techniques, particularly in the utilization of ultrasound-guided peripheral nerve block techniques ^[10]. Ultrasound-guided nerve blocks, which provide precise diagnosis and treatment, alleviate postoperative pain, promote motor function recovery, and reduce cardiovascular and respiratory complications from general anesthesia, are crucial for anesthesiologists to master ^[11–12]. Traditionally, nerve block techniques have focused on neural theory, anatomy, pathogenesis, and clinical aspects through simple PowerPoint presentations. Despite teachers’ substantial efforts, this method had a limited impact on student outcomes. Consequently, enhancing the effectiveness of ultrasound training in anesthesia education, transitioning from theoretical knowledge to practical application under ultrasound guidance, and ensuring that students can apply their knowledge in future work remain pressing challenges.

Furthermore, the case-based learning (CBL) teaching method is a group discussion teaching method based on clinical cases. The cases are designed to present problems related to the subject matter, and students are guided and inspired to engage in discussions about these problems. The method is designed to address specific problems related to the subject matter and is guided by the objective of inspiring students to engage in critical discourse ^[13]. The CBL teaching mode emphasizes students' active learning, and the passing of the case is an example of this approach. This approach combines theoretical knowledge with practical application to develop students' problem-solving and decision-making skills ^[14].

This study proposes the use of a combination of visual ultrasound and CBL in the teaching of anesthesia, a novel medical education method aimed at enhancing the development of skills in anesthesia. This study also evaluated the effectiveness of visual ultrasound and CBL in anesthesia training.

Participants

Thirty anesthesia undergraduate interns, who were trained in the Ultrasound Department of Chongqing Emergency Medical Center from January 2022 to March 2024, were selected as participants and numbered according to their admission sequence (1–30). This study was approved by the Medical Ethics Committee of the Fourth People's Hospital of Chongqing, Central Hospital of Chongqing University. The rotation period lasted two months and included eight men and twelve women, with an average age of 23.15 ± 1.56 years. They were randomly divided into two groups of ten each. The experimental group received visual ultrasound instruction combined with CBL, whereas the control group received traditional teaching methods.

Design

The experimental group (the visualized ultrasound + CBL group) utilized a visualized ultrasound technique, which involved the use of an ultrasound diagnostic instrument to display and precisely position the tissue structure within the observation area throughout the process. CBL uses clinical cases to guide the creation of related questions, positioning students as the central participants, with teachers facilitating group discussions. Using the Mindray M9 portable ultrasound diagnostic instrument, this group’s teaching included ultrasonic image interpretation and scanning of the brachial plexus, upper limb, and lower limb nerves (Fig. 1). Teachers demonstrated techniques for nerve ultrasound scanning and supervised students as they practiced the procedures themselves.

The control group (traditional teaching group) engaged in a conventional educational approach, with instructors primarily using PowerPoint to elucidate anatomical structures and ultrasonic images. The sessions included interactive discussions and queries, aligning the content and focus with that of the experimental group.

Effectiveness assessment

(1) Assessment criteria: The assessment combines theory examinations with ultrasonic map recognition. Both student groups followed the same teaching syllabus, covered identical knowledge points, and underwent similar ultrasonic map recognition and theoretical tests. The theory examination was a closed-book format, with questions randomly selected from the ultrasonic theory question bank. The total score was 100 points, comprising ultrasonic report writing (one report, 20 points) that included general information, report timeliness, ultrasonic description, and diagnosis. Additionally, there were multiple-choice questions (15 questions, 4 points each, totaling 60 points) and essay questions (two questions, 10 points each, totaling 20 points). The ultrasonography examination, also randomly selected from a question bank, included sections from basic ultrasonography (25 points), the brachial plexus (25 points), the upper limb nerve (25 points), and the lower limb nerve (25 points).

(2) Multidimensional curriculum evaluation: The evaluation involved questionnaires that included assessments of the teaching method by students and a teaching supervision group. The questionnaire items were rated on a five-point scale: very good (5 points), good (4 points), average (3 points), poor (2 points), and very poor (1 point). The factors assessed were the relevance and practical alignment of the teaching content, appropriateness of the teaching methods, clarity and engagement of the explanations, reasonable use of time, and overall preparation and interest generated by the course. The teaching supervision group’s evaluation totaled 100 points, assessing training preparation (15 points), training methods (45 points), the training process (30 points), and overall impressions (10 points).

Statistical analysis

Statistical analyses were performed via the SPSS statistical package (version 26.0, IBM Corp., Armonk, NY). The data are presented as the means ± standard deviations (SDs). Comparisons were analyzed by independent sample t tests. A significance of p ≤ 0.05 was applied to all the statistical tests performed.

Assessment results

The theory assessment and ultrasonic map recognition results for the students in the experimental and control groups were compared (see Tables 1 and 2). The experimental group scored significantly higher than the control group (P < 0.05). Specifically, the experimental group excelled in report writing and ultrasonic map recognition.

Table 1

Comparison of theoretical assessment results between the two groups (mean ± SD, n = 15)
Group	Report writing	Multiple-choice questions	Questions and answers	Total score
Experimental group	18.17 ± 0.94	53.87 ± 2.56	17.20 ± 1.19	89.23 ± 3.76
Control group	14.53 ± 1.01	47.73 ± 3.85	13.50 ± 0.98	75.77 ± 4.51
T value	10.22	5.14	9.28	8.89
p value	0.000	0.000	0.000	0.000

Table 2

Comparison of the ultrasonic examination results between the two groups (mean ± SD, n = 15)
Group	Fundamentals of ultrasound images	Brachial plexus	Upper limb nerve	Lower limb nerve	Total score
Experimental group	22.93 ± 1.02	22.67 ± 1.01	22.30 ± 1.24	22.43 ± 1.25	90.33 ± 1.95
Control group	19.87 ± 1.62	18.37 ± 1.16	18.77 ± 1.58	17.70 ± 1.53	74.70 ± 2.71
T value	6.21	10.84	6.82	9.26	18.13
p value	0.000	0.000	0.000	0.000	0.000

Course evaluation

The questionnaire scores of the experimental group were higher than those of the control group, indicating that there was a significant difference in the number of course evaluations between the two groups (P < 0.05), as illustrated in Fig. 2 and Fig. 3.

Nerve block anesthesia involves the injection of local anesthetic drugs around the nerve trunk, plexus and ganglion, which blocks the conduction of impulses and thereby produces an anesthetic effect in the area that is innervated. This technique is widely used in surgical procedures and in the treatment of peripheral nerves. Among these methods, nerve block treatment involves the injection of local anesthetics, such as lidocaine, along with hormones and vitamins, into painful areas of the nerves. This improves the state of nerve nutrition and adjusts nerve conduction by blocking the nociceptive pathway, thereby achieving a treatment method that eliminates inflammation and relieves pain. The objective is to eliminate inflammation and relieve pain.

The traditional nerve block technique relies on identifying specific anatomical signs on the surface of nearby nerves, as well as on the nerve trunk, plexus, and ganglion of the periphery. This is achieved through a blind probing operation, whereby a puncture is made to block the conduction of impulses and thereby induce anesthesia in the innervated area. In recent years, the application of ultrasound-guided technology has enabled the use of ultrasound-guided nerve block, which allows for a clear display of the anatomical structure of the anesthetized area, guidance of the direction and depth of the anesthesia puncture needle, and realization of precise anesthesia ^[15]. This has significantly improved the success rate and safety of nerve block ^[16]. The technique of ultrasound-guided nerve block has gradually become a subject of increasing importance for anesthesiologists; however, for the majority of those in training, a lack of experience in clinical work and basic ultrasound application means that they are unable to apply their theoretical knowledge in practice. For these reasons, we propose a curriculum teaching method that combines ultrasound and CBL, with the aim of aligning our teaching content closer to clinical practice and facilitating students' ability to better master and utilize the technique.

Clinical application value of ultrasound-guided nerve block

Ultrasound-guided nerve block precisely locates the anatomical positions of nerve roots, trunks, plexuses, and nodes and blocks impulse conduction by injecting local anesthetics, thus producing analgesia in the dominant region. Ultrasound provides real-time, high-resolution images that clearly display the position, size, and shape of peripheral nerves, blood vessels, muscles, and tendons ^[17]. This capability allows physicians to determine nerve positions, guide the needle entry path in real time, and observe the puncture effects more accurately ^[18]. Precise drug application minimizes damage to nerves, blood vessels, and critical organs; enhances the success rate and safety of the block; reduces side effects; and decreases the risk of complications ^[19]. This method represents a significant advancement over traditional anesthesia techniques that use body surface markings for nerve localization. With ultrasound visualization, anesthesiologists can precisely and quantitatively deliver drugs, making ultrasound localization a “third eye” for anesthesiologists, improving the safety and control of clinical anesthesia, and aiding in the rapid recovery of patients ^[20], it is widely used in clinical anesthesia and postoperative analgesia.

Challenges of ultrasound-guided nerve block teaching

Ultrasound-guided local anesthesia is regarded as a critical skill for anesthesiologists and is known to increase the success rate of blocks, decrease onset time, reduce complications, and reduce anesthesia toxicity ^[21–22]. However, this technique is highly specialized and complex, requiring trainees to understand the anatomical locations and functions of nerves, blood vessels, muscles, and tendons, as well as to perform dynamic observations with ultrasound during real applications. Many students specializing in anesthesia have not been trained in ultrasound imaging and lack the necessary theoretical and clinical application skills ^[23]. Consequently, traditional teaching methods are inadequate for preparing these students to master ultrasound-guided nerve block techniques, as they transition to clinical roles.

The application value of visual ultrasound and CBL teaching in anesthesia training

Ultrasound examination is indispensable in clinical settings owing to its flexibility, noninvasiveness, affordability, repeatability, and high diagnostic accuracy ^[24–25]. It also facilitates effective communication between doctors and patients, fostering a strong doctor–patient relationship. The integration of actual cases into ultrasound visualization teaching reveals students’ real-time anatomical images of patients’ joints, tendons, and nerves, linking theoretical knowledge from textbooks with practical ultrasound findings. This approach enhances students’ understanding of complex anatomical details and enhances their clinical ultrasound thinking, which is crucial for their future clinical practice ^[26]. Furthermore, ultrasound visualization teaching encourages interactive learning, with significant student engagement in discussions and questions, thereby increasing learning interest and improving educational outcomes. CBL is a student-centered and patient-oriented method that uses clinical cases to develop students’ critical thinking and problem-solving skills by integrating theory with practical application.

Ultrasound visualization, when combined with CBL teaching, effectively engages students, enhancing their initiative and enthusiasm for learning. This approach aids in developing their clinical thinking and exploratory skills. Increased student participation makes it easier to assimilate key concepts, transforming potentially tedious lessons on ultrasound and neural theory into dynamic, visually oriented clinical thinking exercises. This method improves students’ memory efficiency and critical thinking skills, thereby increasing overall learning effectiveness. However, the overall study sample size is limited; multicenter and large sample studies should be performed in the future.

CBL: Case-based learning; LBL: Lecture-based learning.

Acknowledgments

We would like to thank colleagues in the educational and scientific departments for their administrative and academic support. We would also like to thank all the students who participated in this study.

Authors’ contributions

Yan Du conceived and designed the research; Jiangshan Cen and Chenpeng Zheng performed the experiments; Xiaoling Hu analyzed the data; and all the authors participated in the writing of the article and approved the final version of the manuscript.

Funding

The present study did not receive funding.

Availability of data and materials

The data used in the present study are available upon request to the corresponding author.

Ethics approval and consent to participate

This study was approved by the Medical Ethics Committee of the Fourth People's Hospital of Chongqing, Central Hospital of Chongqing University. All participants provided informed consent to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors report that there are no competing interests to declare.

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No competing interests reported.

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You are reading this latest preprint version

Enhancing Anesthesia Training: Integrating Visual Ultrasound and Case-Based Learning

Status:

Version 1

Abstract

Figures

Background

Methods

Participants

Design

Effectiveness assessment

Statistical analysis

Results

Assessment results

Course evaluation

Discussion

Clinical application value of ultrasound-guided nerve block

Challenges of ultrasound-guided nerve block teaching

The application value of visual ultrasound and CBL teaching in anesthesia training

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1