NHS Education for Scotland Invests in NeedleTrainer and ScanNav Anatomy PNB to Deliver Enhanced ‘Classroom to Clinic’ Learning

Dr Ed Mellanby is the Simulation Associate Postgraduate Dean for Scotland. He described that “It is a huge challenge to consistently meet the requirements of training in regional anaesthesia in a safe and reliable way to all trainees in Scotland. We are developing a national approach to simulation training in Scotland, with the aim of sharing resources and expertise across the country in order to improve quality and equitability of access. This technology aligns with that ambition and with both patient and curriculum requirements. I am really excited to see how this can reduce the variability in practice and training, and witness the positive impact on performance that we believe this will produce.”

Dr Alasdair Taylor (Consultant Anaesthetist, Ninewells Hospital, Dundee) is working closely with Dr Melanby to deliver this NES investment. Alasdair explained “as a team, we want to increase the delivery of safe and efficacious ultrasound guided regional anaesthesia (UGRA) to patients in Scotland as the potential benefits are well known. When performed well, patients benefit from reduced morbidity, improved pain scores, and a reduced opiate requirement and the consequent side effects. Organisations can benefit from greater theatre efficiency, and shorter length and cost of inpatient stay. Also, with the long-term aim of performing more awake regional anaesthesia, we can achieve a reduced carbon footprint for surgical procedures.”

However, the risks of poorly performed UGRA and ultrasound-guided needle insertion are well documented, including damage to nerves that can lead to chronic pain, loss of sensation and muscle weakness. Poor identification of structures on ultrasound can lead to needle trauma (such as to blood vessels, the lung, bowel and kidney).

This investment in novel artificial intelligence (AI)/augmented reality (AR) simulation equipment is being used to establish a national training resource to deliver teaching of this core skill as part of Stage 2 anaesthetic training in Scotland. Alasdair explained, “the key challenge of learning a complex procedure in a complex environment is managing cognitive load. This advanced AI/AR simulator allows all factors to be controlled and simplified, to improve communication and create optimal learning conditions specific to the individual, offering huge potential to impact postgraduate anaesthesia training, as well as other medical specialties and undergraduate training in Scotland.”

Intelligent Ultrasound’s Classroom to Clinic package, incorporating NeedleTrainer and ScanNav Anatomy Peripheral Nerve Block (PNB), is designed to meet the two key challenges of UGRA: ultrasound image acquisition/interpretation and ultrasound-guided needle insertion to deposit local anaesthetic at a target site. As a package, this provides three clear educational benefits; increased efficiency whereby education can be carried out in a cost-effective and scalable manner; enhancing educational outcomes; and transforming education design and delivery.

Using a combination of AI, to assist with identification of anatomical structures on ultrasound, and AR, for holographic representation of needles on real-time ultrasound feed, NeedleTrainer allows high-fidelity practise of ultrasound-guided needle insertion on humans, using genuine ultrasound images, but with no risk of harm to patients. Alasdair commented “it is the closest possible representation of the actual procedure without having the risk associated with inserting a needle into a real patient. There is no other resource currently available that uses this technology and offers this benefit.”