The case experience of anesthesiologists is one of the leading causes of accidental dural punctures and failed epidurals-the most common complications of epidural analgesia used for pain relief during delivery. We designed a bimanual haptic simulator to train anesthesiologists and optimize epidural analgesia skill acquisition. We present an assessment study conducted with 22 anesthesiologists of different competency levels from several Israeli hospitals. Our simulator emulates the forces applied to the epidural (Touhy) needle, held by one hand, and those applied to the Loss of Resistance (LOR) syringe, held by the other one. The resistance is calculated based on a model of the epidural region layers parameterized by the weight of the patient. We measured the movements of both haptic devices and quantified the results' rate (success, failed epidurals, and dural punctures), insertion strategies, and the participants' answers to questionnaires about their perception of the simulation realism. We demonstrated good construct validity by showing that the simulator can distinguish between real-life novices and experts. Face and content validity were examined by studying users' impressions regarding the simulator's realism and fulfillment of purpose. We found differences in strategies between different level anesthesiologists, and suggest trainee-based instruction in advanced training stages.

中文翻译：

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双手触觉硬膜外针插入模拟器的设计和评估

麻醉师的病例经验是硬膜外穿刺和硬膜外麻醉失败的主要原因之一，这是用于缓解分娩过程中疼痛的硬膜外镇痛最常见的并发症。我们设计了一款双手触觉模拟器来培训麻醉师并优化硬膜外镇痛技能的掌握。我们提出了一项评估研究，由来自以色列几家医院的 22 名不同能力水平的麻醉师进行。我们的模拟器模拟施加到一只手握住的硬膜外 (Touhy) 针上的力，以及施加到另一只手握住的失阻 (LOR) 注射器上的力。阻力是基于由患者体重参数化的硬膜外区域层模型来计算的。我们测量了两种触觉设备的运动，并量化了结果率（成功、失败的硬膜外麻醉和硬脑膜穿刺）、插入策略以及参与者对有关模拟现实感感知的问卷的回答。通过证明模拟器可以区分现实生活中的新手和专家，我们证明了良好的构造有效性。通过研究用户对模拟器的真实性和目的实现的印象来检查外观和内容的有效性。我们发现不同级别麻醉师之间的策略存在差异，并建议在高级培训阶段进行基于学员的指导。