  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.

Human-Computer Interaction;Robotics