The case experience of anesthesiologists is one of the leading causes of accidental dural puncture and failed epidural - the most common complications of epidural analgesia. We designed a bimanual haptic simulator to train anesthesiologists and optimize epidural analgesia skill acquisition, and present a validation study conducted with 15 anesthesiologists of different competency levels from several hospitals in Israel. Our simulator emulates the forces applied on the epidural (Touhy) needle, held by one hand, and those applied on the Loss of Resistance (LOR) syringe, held by the second hand. The resistance is calculated based on a model of the Epidural region layers that is parameterized by the weight of the patient. We measured the movements of both haptic devices, and quantified the rate of results (success, failed epidurals and dural punctures), insertion strategies, and answers of participants to questionnaires about their perception of the realism of the simulation. We demonstrated good construct validity by showing that the simulator can distinguish between real-life novices and experts. Good face and content validity were shown in experienced users' perception of the simulator as realistic and well-targeted. We found differences in strategies between different level anesthesiologists, and suggest trainee-based instruction in advanced training stages.

翻译：麻醉师的操作经验是导致意外硬膜穿刺和硬膜外阻滞失败——硬膜外镇痛最常见并发症——的主要原因之一。我们设计了一款双手操作触觉模拟器，用于训练麻醉师并优化硬膜外镇痛技能习得，同时汇报了一项由来自以色列多家医院的15名不同能力水平麻醉师参与的验证研究。我们的模拟器模拟了一只手握持的硬膜外穿刺针所受的力，以及另一只手握持的阻力消失注射器所受的力。阻力基于一个由患者体重参数化的硬膜外区域分层模型计算得出。我们测量了两种触觉设备的运动，并量化了结果率（成功、失败和硬膜穿刺）、穿刺策略，以及参与者对模拟逼真度感知的问卷调查答案。通过展示模拟器能够区分真实情境中的新手与专家，我们证明了良好的结构效度。经验丰富的用户认为模拟逼真且针对性良好，从而验证了良好的表面效度和内容效度。我们发现了不同水平麻醉师在策略上的差异，并建议在高级训练阶段采用基于受训者的指导。