How to Teach the Epidural Block in Obstetric Anesthesia

Preface
Contents
Contributors
Teaching the Epidural Technique
	1	 Introduction
	2	 We Teach as We Were Taught
	3	 The Needs of the Students and Their Difficulties
	4	 General Principles
		4.1	 Premises
		4.2	 Learning Skills
		4.3	 Learning Methods
		4.4	 Theoretical Knowledge
		4.5	 Teaching and Learning Procedural Skills in the Clinical Setting
		4.6	 Training in Nontechnical Skills
		4.7	 Assessment of Learning
	5	 The Educator and the Learning Environment
	References
Epidural Simulators
	1	 The “Greengrocer” Model
	2	 Anthropomorphic-Based Simulators
		2.1	 The Modified P61 Simulator: The Epidural ModuleEESOA
		2.2	 Anthropomorphic Model-Based Simulators Ultrasound Compatible
	3	 Haptic Simulators
	4	 Comparative Considerations
	5	 Educational Effectiveness of Epidural Simulators
	6	 Appendix. the Epidural ModuleEESOA
		6.1	 Required Materials
		6.2	 Module Construction
		6.3	 Realism
		6.4	 Validation
	References
Assessing Learning
	1	 General Principles
	2	 Techniques for Evaluating Learning
	3	 Direct Observation Without Specific Criteria
	4	 Direct Observation with Specific Criteria
	5	 Checklists
		5.1	 How to Structure and Validate a Checklist
		5.2	 Epidural Checklist
	6	 Global Rating Scales
		6.1	 GRS and Epidural Technique
	7	 Psychometric Tests
	8	 Self-Assessment and Procedure Registry
	9	 Other Methods
		9.1	 Movement Analysis
		9.2	 Indirect Observation: Video Evaluation
	10	 The Kirkpatrick Pyramid
	References
Learning Curves
	1	 History and Definition
	2	 Construction of the Learning Curve
	3	 Example of a Complex Learning Curve
	4	 Examples of Applications of Learning Curves
	5	 Control Chart and CUSUM Learning Curve: Construction and Application in Monitoring the Learning of the Epidural Technique
	6	 Advantages and Limitations of CUSUM Analysis
	References
Teaching with Ultrasounds
	1	 Introduction
	2	 Technical Description
	3	 The Conventional Teaching Model
	4	 Nonconventional and Innovative Educational Models
		4.1	 Cadaver Workshop
		4.2	 Workshops on Animals
		4.3	 Mannequin Simulators
		4.4	 Online Simulation Courses
		4.5	 Virtual Reality
	5	 Ultrasound Assistance of the Spine in Cases of Expected or Unexpected Technical Difficulties
	References
The Structured and Standardized EESOA Model
	1	 Module 1: Anatomy—From Bidimensional Vision to 3D Vision for Haptic Perception
		1.1	 Personal Analysis of the Known
		1.2	 3D Anatomy Laboratory
		1.3	 Examples of Materials Needed for each Student (Figs. 1 and 2)
	2	 Module 2: General Principles
		2.1	 Familiarization with the Materials
		2.2	 Familiarization with the General Principles of the Loss of Resistance Technique
	3	 Module 3: Fundamentals with the Simulator
		3.1	 Four Hands Technique on the Simulator
	4	 Module 4: See and Hear What Is Perceived with the CompuFlo-Trainer
	5	 Module 5: Problem Setting, or how to Reduce the Complexity of the Technique—Creation of a Checklist and Use of the EMME Video Method
	6	 Module 6: The “Hands-on” Technique: The Proficient Epidural
		6.1	 Sterility of Execution
		6.2	 Local Anesthesia
		6.3	 Epidural Catheter
		6.4	 Aspiration
		6.5	 Fixing the Catheter to the Skin
	7	 Module 7: The Technique as in the Real World
	8	 Module 8: The Technique on the Patient in Hospital/Operating Room/Labor–Delivery Room
	9	 Monitoring and Certification of Students’ Skills
	10	 Conclusions
	Appendix 1: The EMME Model
	Appendix 2: Epidural Metrics
	References
Future Perspectives
	1	 Augmented Reality (AR)
	2	 Virtual Reality (VR)
	3	 Artificial Intelligence
	4	 Metaverse
	5	 Educational Perspectives
		5.1	 Anesthesiology Training Based on Immersive Virtual Environments
		5.2	 Potential Use of the Metaverse
	6	 Conclusions
	References