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 a validation study conducted with 22 anesthesiologists of different competency levels from several hospitals in Israel. 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. Good face and content validity were exhibited 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：麻醉医生的临床经验是导致意外硬脊膜穿破和硬膜外阻滞失败的主要原因——这两种情况是分娩镇痛中硬膜外麻醉最常见的并发症。我们设计了一种双手触觉模拟器，用于训练麻醉医生并优化硬膜外镇痛技能习得。本验证研究纳入来自以色列多家医院的22名不同专业水平麻醉医生。该模拟器可模拟手持硬膜外（Touhy）针时施加的力以及另一手持阻力消失（LOR）注射器时施加的力，阻力基于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装置的运动轨迹，量化操作结果（成功率、硬膜外阻滞失败及硬脊膜穿破率）、穿刺策略，并通过问卷收集参与者对模拟真实性的感知评价。结果表明，模拟器能够区分真实场景中的新手与专家，展示出良好的结构效度；经验丰富的使用者认为该模拟器真实且目标明确，体现出良好的表面效度与内容效度。我们还发现不同级别麻醉医生间的策略差异，建议在高级训练阶段采用基于受训者的个性化指导。