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.

翻译：麻醉医生的临床经验是导致意外硬膜穿刺和硬膜外阻滞失败——即分娩镇痛中最常见并发症——的主要原因之一。我们设计了一款双手触觉模拟器，用于培训麻醉医生并优化硬膜外镇痛技能的获取。我们报告了一项包含来自以色列多家医院22名不同能力水平麻醉医生的评估研究。本模拟器模拟了单手握住硬膜外（Tuohy）穿刺针时施加的力，以及另一只手握住阻力消失（LOR）注射器时施加的力。阻力基于由患者体重参数化的硬膜外区域层次模型计算得出。我们测量了两种触觉设备的运动，并对结果的成功率、失败硬膜外穿刺和硬膜穿孔、插入策略，以及参与者对模拟真实感认知的问卷回答进行了量化分析。通过表明模拟器能够区分真实新手与专家，我们验证了良好的构念效度。通过研究用户对模拟器真实感及目的达成度的印象，我们检验了表面效度和内容效度。我们发现了不同级别麻醉医生之间的策略差异，并建议在高级培训阶段采用基于学员的指导方式。