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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Prospectively registered

Titles & IDs
Public title
Can we use a test of spatial relationships to identify future doctors who might benefit from increased training to better perform ultrasound-guided regional anaesthesia?
Scientific title
Does Targeted Educational Intervention based on Psychometric Screening Improve Ultrasound-Guided Regional Anaesthesia Performance in medical students?
Secondary ID [1] 292136 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
medical students with low spatial relationships as screened using the Mental Rotations Test-A 303560 0
Condition category
Condition code
Public Health 302970 302970 0 0
Health service research

Study type
Description of intervention(s) / exposure
In this prospective, multicentre, 1:1 allocation, double blinded, stratified randomised interventional (non-drug) trial, we will perform screening of innate spatial relationships on medical students ("participants") recruited into the study. This is performed using the revised Mental Rotations Test-A (MRTA). This paper and pen based form is validated and standardised for visuopatial skills testing. The test is timed, has explicit instructions to be read out verbatim to participants, and the entire test takes 15 minutes.

Using population norms, participants are stratified into low (below mean) and high (above mean) ability groups. Participants are then randomised into control (discovery learning) or intervention (deliberate practice) training, creating 4 groups: low-control, low-intervention, high-control, and high-intervention.

Each participant will then be brought individually to an identical in vitro benchtop pork model and be asked to perform an ultrasound-guided regional anaesthesia (UGRA) needle task. The attempt will be recorded as time taken (seconds), and evaluated using a global rating scale previously used for UGRA assessment. This is the baseline test.
Physician anaesthetists who are experts in UGRA will conduct these assessments. This will be assessed in real-time, while the participant performs the task. These “examiners” are blinded to participant MRTA scores and group allocation. The examiners are not involved in any other training of participants.

After performance of baseline testing, the intervention group receives deliberate practice in UGRA skills. Deliberate practice is a technique of 1 on 1 teaching by expert faculty using graded goals and providing feedback after every attempt. This training period lasts 20 minutes. Faculty are also physician anaesthetists, not involved in assessment. The control group receives discovery learning, an educational technique where participants explore how to perform the UGRA task by themselves. They will also have 20 minutes of discovery training.

After training, all participants are brought back to the benchtop model and asked to repeat the UGRA task. They will be timed and their procedural skill assessed using the global rating scale by the examiner anaesthetists. This is the final test.

Intervention code [1] 298279 0
Treatment: Other
Comparator / control treatment
The control group receives discovery learning. This group is allowed the same time (20min), access to identical models and equipment as the intervention group. However, no expert faculty is involved with discovery learning.
Control group

Primary outcome [1] 302357 0
Time taken to complete the UGRA task, recorded on a stopwatch by a research assistant from picking up the needle and injecting saline into the 6- and 12-o'clock positions of the in vitro nerve benchtop model
Timepoint [1] 302357 0
immediately after MRTA screening (baseline test), and after exposure to educational control or intervention (final)
Secondary outcome [1] 335713 0
proficiency score on a global rating scale
Timepoint [1] 335713 0
at baseline, and at final tests

Key inclusion criteria
medical students
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Participants with any previous training, tutorials, workshops or actual performance of UGRA.
Participants with prior psychometric or neurocognitive testing in the past 12 months.

Study design
Purpose of the study
Educational / counselling / training
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Participant allocation is concealed by using sealed opaque envelopes
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
stratified randomisation. Stratification by visuospatial ability. Then randomisation by computerised allocation into groups
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Other design features
Not Applicable
Type of endpoint(s)
Statistical methods / analysis
Determining the effect of targeted deliberate practice will be assessed using repeated measures mixed ANOVA of the primary endpoint of time taken to complete the UGRA task from baseline to final testing. Thus, the comparisons will be between the low-intervention and high-intervention groups, and between the low-intervention and high-control groups.

The effect of targeted deliberate practice on the secondary endpoint of global rating scores between the low-intervention and high-intervention groups, and between the low-intervention and high-control groups, will use repeated measures ANOVA.

To measure the effect of deliberate practice as an educational intervention versus no training, comparisons will be made between the low-intervention and low-control groups, and between the high-intervention and high-control groups. These analyses will use repeated measures mixed ANOVA for time taken, and for global rating scale scores.
All analyses will use Bonferroni corrected, two-tailed p values < 0.05 for statistical significance.

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 8305 0
Liverpool Hospital - Liverpool
Recruitment postcode(s) [1] 16368 0
2170 - Liverpool
Recruitment outside Australia
Country [1] 8954 0
State/province [1] 8954 0
Country [2] 8955 0
State/province [2] 8955 0

Funding & Sponsors
Funding source category [1] 296673 0
Name [1] 296673 0
Liverpool Hospital Department of Anaesthesia
Address [1] 296673 0
Level 1, New Clinical Building,
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
Country [1] 296673 0
Primary sponsor type
Liverpool Hospital
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
Secondary sponsor category [1] 295633 0
Name [1] 295633 0
Address [1] 295633 0
Country [1] 295633 0

Ethics approval
Ethics application status
Ethics committee name [1] 297900 0
South Western Sydney HREC
Ethics committee address [1] 297900 0
‘Research and Ethics Office’
Locked Bag 7103
Ethics committee country [1] 297900 0
Date submitted for ethics approval [1] 297900 0
Approval date [1] 297900 0
Ethics approval number [1] 297900 0

Brief summary
Ultrasound-guided regional anaesthesia (UGRA) is a complex procedural skill to learn. A diverse and extensive mix of knowledge, motor skills, cognitive planning, and mental reconstruction of anatomical structures is necessary. Successful performance of UGRA thus requires hand-eye coordination and interpreting 3-dimensional anatomy using 2-dimensional ultrasound images.

Currently, an UGRA teaching curriculum is taught to all novices at an institution. However, novices learn at different rates and are receptive to different styles of teaching. Learning curves in UGRA consistently demonstrate a large inter-individual variation in proficiency and error rates, despite all novices receiving instruction from the same expert faculty.

One possible reason for this wide variability is the innate psychometric ability of novices. Psychometric ability is a subset of human intelligence, further divided into visuospatial and psychomotor abilities. Visuospatial ability is the capacity to generate, retrieve, and process visual information. Psychomotor ability influences the accuracy, reaction speed, and coordination required to control objects through hand-eye coordination. In complex tasks, innate differences in psychometric ability could contribute as much as 40% of differences in inter-individual learning speed and performance.

Previous studies suggest that a) visuospatial abilities are a better predictor of UGRA performance than psychomotor abilities, and b) certain visuospatial factors are more predictive of UGRA performance than others, specifically spatial visualisation (e.g., the ability to visualize and rotate 3-dimensional objects based on 2-dimensional images).

There is evidence in other complex medical procedures that visuospatial ability influences performance, with shorter times taken to complete procedures and reduction in errors. 10-12 These procedures include laparoscopic surgery, plastic reconstructive surgery, 15 basic surgical knot tying, colonoscopy and gastroscopy. Of these numerous psychometric tests, the MRTA remained consistently useful in discriminating low and high ability novices, and has the advantage of extensive population data.

An unexplored avenue in UGRA education research is thus being able to identify novices for which the UGRA task will be difficult to learn. Early identification may allow training to be individualised, allowing educators to target and allocate scarce training resources to novices who will benefit greatly from extra attention.

In this study, we will be recruiting medical students without prior exposure to UGRA. We will use the MRTA to assess participants’ visuospatial ability. Participants will then be randomised into a control group (no training) and a deliberate practice group.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 75406 0
Dr Alwin Chuan
Address 75406 0
Department of Anaesthesia
Room 124, Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
NSW 2170
Country 75406 0
Phone 75406 0
Fax 75406 0
Email 75406 0
Contact person for public queries
Name 75407 0
Dr Alwin Chuan
Address 75407 0
Department of Anaesthesia
Room 124, Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
NSW 2170
Country 75407 0
Phone 75407 0
Fax 75407 0
Email 75407 0
Contact person for scientific queries
Name 75408 0
Dr Alwin Chuan
Address 75408 0
Department of Anaesthesia
Room 124, Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
NSW 2170
Country 75408 0
Phone 75408 0
Fax 75408 0
Email 75408 0

No information has been provided regarding IPD availability
Summary results
No Results