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Extended reality, an umbrella term for virtual, augmented, and mixed reality, is increasingly used in health care education as it requires fewer human and logistical resources and offers reduced costs compared with high-fidelity simulations. Nevertheless, the impact of extended reality on education and training in anesthesiology is largely unknown. We aimed to explore the existing extended reality tools and applications in anesthesiology, identify current knowledge gaps, and highlight future research needs in anesthesiology education. We conducted a scoping review of studies published from January 2010 to December 2023 that focused on extended reality training in anesthesiology and included comparative analyses with other methods. We excluded publications investigating topics unrelated to anesthesiology or not involving interaction with extended reality. After screening 5,419 studies, we included 62 manuscripts in the final analysis. The definitions and uses of extended reality in anesthesiology education were very heterogeneous. Thirty-seven studies compared extended reality with other forms of training. Neuraxial procedures, peripheral blocks, central venous catheters, and bronchoscopy were primarily investigated. Extended reality improved technical skills, knowledge retention, confidence, and student satisfaction. Six studies reported at least one negative result related to learning, sense of realism, and usefulness. The results of this scoping review highlight the increasing interest of extended reality in anesthesiology education. Nevertheless, many studies lack objective outcome measures and relevant comparisons with existing standards. In addition, extended reality needs to be consistently defined in anesthesiology education to derive optimal benefit and impact. Future studies should also focus on defining extended reality's learning objectives and clinical assessments of trainees' performance, which are commonly missing compared with high-fidelity simulation teaching. Open Science Framework ( https://doi.org/10.17605/OSF.IO/PDT2F ); first submitted 28 June 2023.

We previously designed and validated a virtual reality-based simulator to help train novices in ultrasound-guided needling skills necessary for safe and competent ultrasound-guided regional anaesthesia. This study was designed to compare the performance and error rates of novices trained by a human faculty aided with the assistance of this virtual reality simulator (virtual reality-assisted training), versus novices trained wholly by humans (conventional training). In this single centre, randomised controlled study, we used a standardised teaching protocol, rigorous blinding, iterative training of assessors, and validated global rating scale and composite error score checklists to assess skills learning of novice participants. We recruited 45 novices and scored 270 assessments of performance and error rates. Inter-rater correlation coefficient of reliability of scoring between assessors for the global rating scale was 0.84 (95%CI 0.68–0.92) and for the composite error score checklist was 0.87 (95%CI 0.73–0.93). After adjustment for age, sex, Depression, Anxiety and Stress-21, and baseline score, there was no statistical difference for virtual reality-assisted training compared to conventional training in final global rating score (average treatment effect −3.30 (95%CI-13.07–6.48), p = 0.51) or in the final composite error score (average treatment effect 1.14 (95%CI -0.60–2.88), p = 0.20). Realism in the virtual reality simulator was similar to real-life when measured by the Presence Questionnaire, all components p > 0.79; and task workload assessed by the NASA-Task Load Index was not statistically different between groups, average treatment effect 5.02 (95%CI -3.51–13.54), p = 0.25. Results were achieved in the virtual reality-assisted group with half the human faculty involvement. Novices trained using a hybrid, virtual reality-assisted teaching program showed no superiority to novices trained using a conventional teaching program, but with less burden on teaching resources. •Virtual reality is a new type of simulation that can realistically simulate real-life needling skills and task loading in regional anaesthesia.•Using a custom-made virtual reality simulator, we found no superiority in teaching novices ultrasound-guided regional anaesthesia needling skills, versus a traditional human-only curriculum.•Further research is needed to explore if virtual reality simulation is non-inferior to current human-only teaching.

Background Medical residents often struggle with complex clinical scenarios that require sophisticated decision-making skills. While case-based discussion (CBD) is widely used in medical education, its effectiveness can be limited by insufficient guidance and structured support. Scaffolding teaching, which provides graduated assistance aligned with learners’ development, may address these limitations. However, evidence from randomized controlled trials evaluating the integration of scaffolding with CBD in residency training remains limited. This study aims to compare an integrated scaffolded case-based learning approach with traditional lecture-based teaching that utilizes the same clinical case materials in enhancing residents’ clinical reasoning, self-directed learning, and knowledge acquisition in anesthesiology training. Methods This prospective randomized controlled trial encompassed 12 anesthesiology residents, systematically randomized into an experimental cohort (receiving scaffolding teaching integrated with case-based discussion) and a control cohort (receiving traditional lecture-based instruction utilizing the same clinical case). The intervention consisted of a structured 4-week curriculum focusing on HOCM anesthesia management, delivered through weekly instructional sessions. The investigation utilized validated assessment instruments to measure primary outcomes, including clinical reasoning proficiency and self-directed learning capacity, at three time points: baseline, post-intervention (Week 4), and follow-up (Week 8). Secondary outcome measures encompassed teaching satisfaction indices and knowledge retention metrics. Statistical analysis employed t-tests and Mann-Whitney U tests for comparative assessment. Results Post-intervention evaluation at Week 4 revealed statistically significant superiority in the experimental cohort across multiple parameters: clinical reasoning proficiency (83.58 ± 3.28 versus 74.17 ± 4.55, p  = 0.002), self-directed learning capacity (79.92 ± 2.56 versus 63.33 ± 3.52, p  < 0.001), and teaching satisfaction indices (100.00 ± 0.00 versus 73.00 ± 5.02, p  < 0.001). Follow-up assessment at Week 8 demonstrated sustained enhancement in the experimental group, maintaining significant advantages in clinical reasoning proficiency (89.08 ± 5.93 versus 68.17 ± 2.70, p  < 0.001), self-directed learning capacity (87.83 ± 2.56 versus 71.58 ± 3.50, p  < 0.001), and knowledge retention (98.33 ± 2.58 versus 95.00 ± 0.00, p  = 0.010). Conclusion This investigation demonstrates that an integrated scaffolding-supported case-based learning approach offers significant advantages over traditional lecture-based teaching that incorporates the same clinical case. The integrated approach significantly enhances clinical reasoning capabilities, self-directed learning competencies, and knowledge acquisition in complex clinical scenarios compared to the lecture-based approach. These findings establish a robust empirical foundation for the optimization of residency training methodologies, particularly within high-complexity clinical domains such as HOCM anesthesia management. The sustained improvements observed at follow-up further validate the long-term effectiveness of this integrated pedagogical approach. Clinical trial registration Not applicable. This study is an educational research project evaluating teaching methodologies through simulated training and does not involve health-related interventions or patient outcomes.

Background Mentorship is crucial to career advancement, medical education, and psychosocial support, especially for women and minorities. Although anesthesia mentoring programs have shown promise, there are no survey data regarding mentor-mentee relationship dynamics. This study aimed to explore the dynamics of the anesthesia mentor/mentee relationship. Methods A open cross-sectional web-based survey was distributed by the European Society of Anesthesiology and Intensive Care and European Society of Regional Anesthesia to European anesthesiologists. Participation was anonymous and consent was obtained. The study evaluated responses relating to preferences, facilitators, and barriers to mentorship relationships along with sociodemographic information. Results In total, 543 anesthesiologists responded to the survey, and 406 (111 mentees, 49 mentors, 193 both, 53 neither) responded to questions regarding mentorship. 184 anesthesiologists identified as woman and 22 as other genders (non-binary, transgender, gender-fluid, and self-described gender). Moreover, 250 anesthesiologists identified as white. Both mentors and mentees indicated that personal compatibility was the most important factor for successful mentorship. Barriers to mentorship included time consumption and perceived lack of interest from the mentor and mentee. Both mentors and mentees benefited from this relationship. The former reported feeling helpful, and the latter supported the development of clinical skills. The mentors indicated that their participation was important for protecting against burnout/exhaustion and impostor syndrome. Participants reported a preference for mentorship programs organized at the departmental level, offered at the start of the anesthesiology education curricula. Women were more likely to feel a ‘lack of interest’ in mentoring them as a barrier (OR = 2.49, P  = 0.033). Gender was a barrier for mentors of other genders (OR = 23.9, P  = 0.0027) and ethnicity (OR = 48.0, P  = 0.0023). White mentees found gender (OR = 0.14, P  = 0.021) and ethnicity (OR = 0.11, P  = 0.048) to be less important barriers to successful mentorship relationship. Conclusion When possible, programs should prioritize matching mentors and mentees based on personal compatibility and experience in the mentee’s area of interest. Addressing the perceived lack of interest in mentoring is essential for promoting diversity, equality, and inclusion within anesthesiology, as well as and uplifting women and minorities. Trial registration Clinicaltrials.gov identifier: NCT05968339, First posted (01/08/2023).

Background Medical education, particularly in specialized fields like anesthesiology, faces challenges of extensive knowledge systems and low teaching efficiency. Traditional teaching methods often fail to meet individualized learning needs and effectively assess students’ mastery of key learning points. Anesthesiology education is further complicated by its broad learning points and densely constructed knowledge systems, yet it occupies a small portion of undergraduate medical curricula. Recent advancements in generative artificial intelligence (AI) offer promising solutions to enhance medical education. This study explores the application of a DeepSeek-based AI teaching assistant in teaching anesthesiology theories. Methods A single-center, randomized controlled trial was conducted with 48 participants, including 24 fourth-year medical students and 24 non-anesthesiology resident physicians. Participants were stratified by trainee type, then randomized 1:1 via a random-number table. Whereas the control group received traditional teaching (lectures, Q&A, clinical rotations); the experimental group received traditional teaching (same as the control group) plus 24/7 online support, personalized learning plans, and real-time performance analysis from the AI assistant. Results The experimental group achieved significantly higher theoretical test scores immediately after the course compared to the control group ( P  = 0.007). However, no significant difference was observed in knowledge retention one month later ( P  = 0.277). Student satisfaction surveys showed significantly higher scores in learning engagement and responsiveness to questions for the experimental group ( P  < 0.05), but no significant differences in learning interest or satisfaction. Conclusions The DeepSeek-based AI teaching assistant enhanced short-term knowledge acquisition and learning engagement in anesthesiology education. However, long-term knowledge retention and overall satisfaction were not significantly improved. Future studies with larger sample sizes and longer observation periods are needed to further validate the effectiveness of AI teaching assistants in medical education and explore their potential in promoting clinical skill training.

Background Utilising ultrasound technology has resulted in higher success and lower complication rates during regional anaesthesia (RA) procedures. Proper training is necessary to accurately identify structures, optimise images, and improve hand–eye coordination. Simulation training using immersive virtual environments and simulation models has enabled this competency training to be conducted safely before performing on patients. We conducted a study to compare the simulator performance and users’ feedback on a Blue Phantom Regional Anaesthesia Ultrasound Training Block and NeedleTrainer™. Methods Forty-seven participants were recruited via convenient sampling during a RA workshop for novice practitioners. They were divided into the N or B group and then crossover to experience using both Blue Phantom and NeedleTrainer model. Time-to-reach-target, first-pass success rate, and complication rate were assessed, while the learning and confidence scores were rated using six-item and three-item questionnaires, respectively, via a 5-point Likert scale. Results Blue Phantom model has a longer time-to-target as compared to the NeedleTrainer model (16 ± 8 vs 8 ± 3 s, p  < 0.001), higher first- pass success rate (100% vs 80.9%), and lower complication rate (0% vs 19.1%). Higher overall learning satisfaction scores (28 ± 4 vs 25 ± 4, p  = 0.003) and confidence scores after training (13 ± 2 vs 12 ± 2, p  < 0.001) were recorded for the Blue Phantom model. Conclusions We postulated that the artificial intelligence structure recognition software enables NeedleTrainer users to attain shorter time-to-target. That being said, Blue Phantom provides better operator learning satisfaction, improved confidence, higher success and lower complication rates among novice RA practitioners, possibly due to greater tactile feedback during the simulated training.

Background Test enhancing learning (TEL) had shown a significant effect in promoting the learning of many learning contents. However, its effect on the postgraduate medical level was unclear. This study aimed to investigate the effect of TEL in 1st year anesthesiology residents learning neuroanesthesia. Method The residents were randomized to either group A, which was assigned to do the intervention exam (exam A) for two times during learning in neuroanesthesia, or group B, which studied in the same environment without doing the exam. All participants were assigned to do the assessment exam (exam B) at one month after the end of the rotation. All of the exams were ten multiple choice questions (MCQ). Since the anesthesia residents rotated to neuroanesthesia for two weeks twice during the first year, we conducted the experiments twice, using exams that covered both basic science (BS) and clinical science (CS) topics. Results There was no significant difference in mean ± SD of the scores for assessment exams asking about the basic science topic (BS_B) [group A (5.25 ± 2.05) VS group B (4.90 ± 1.80); p  = 0.570] and the clinical science topic (CS_B) [group A (6.30 ± 1.26) VS group B (5.95 ± 1.61); p  = 0.448]. Conclusion This study showed null findings on the effect of TEL on learning in residents of the first year of anesthesiology. More studies on TEL were required to confirm the effect of TEL and find the appropriate test format that could enhance learning for post-graduate medical trainees.

Background Monitoring the brain under general anaesthesia using the electroencephalogram (EEG) can help to optimise anaesthetic levels and improve patient outcomes. Therefore, it has been recommended by several societies and organisations. Yet, many clinicians only consider the processed indices, even though they are prone to interference and their information value is limited in many situations. To use EEG monitoring systems to their full potential, clinicians need to be able to integrate all information provided. Here, we introduce a structured teaching course and evaluate its effect on the participants’ knowledge and attitudes. Methods The course contents were derived from learning goals, that we considered as required to leverage the full potential of the EEG monitoring systems. The course structure was built using several didactic tools to facilitate learning, including a high level of algorithmisation as well as tools for knowledge repetition, activation, and transfer. To investigate the effects of the course, we compared the participants’ self-ratings of their knowledge with regard to the learning goals as well as their attitudes towards using EEG monitoring before and after the course. For this purpose, we anonymously questioned the participants of one course conducted in Greifswald/Germany in December 2023. Results The ratings of 36 participants before and after the course show that participation led to a significant improvement in knowledge throughout all learning goals (paired Wilcoxon signed-rank tests, p < 0.001 for each learning goal). Self-ratings of knowledge and competence increased across all learning goals from a mean of 1.9 before the course to 4.0 after the course, rated on Likert scales between 0 (‘No knowledge/competency’) and 5 (‘Expert knowledge/competency’). Furthermore, the attitude towards applying EEG monitoring during general anaesthesia improved significantly (paired Wilcoxon signed-rank test, p = 0.019) from 3.0 ± 1.7 to 3.8 ± 1.2 (mean ± sd), rated on a Likert scale between 0 (‘never’) and 5 (‘always’). Conclusions We show that the course improves the participants’ self-ratings of knowledge with and attitude towards EEG monitoring. By providing teaching methods and resources with standardized contents we aim to facilitate training of the highest quality and motivating clinicians to improve anaesthesia practice, and ultimately patient outcome.

Background While simulation is widely employed in anesthesia crisis management training, its effectiveness is often hindered by lack of preparation. Flipped classroom (FC) is a novel teaching method that encourages active student engagement and preparation. We aim to investigate whether FC could enhance the residents’ engagement in preparation activities and improve the learning outcomes in anesthesia crisis management simulation. Methods This quasi-experimental study included anesthesiology residents from the anesthesiology department, Shanghai General Hospital between January 2023 and July 2023. The participants were randomly divided into the FC group and the conventional lecture (CL) group. The primary outcome was the Anesthetists’ Non-Technical Skills (ANTS) scores of all participants. Secondary outcomes included crisis response performance, theoretical test scores, and time spent on training-related activities. Results A total of 40 anesthesiology residents in their first two postgraduation years at Shanghai General Hospital were recruited for analysis. The FC group ( n  = 20) achieved significantly higher overall ANTS scores (FC vs. CL: 11.95 ± 2.14 vs. 9.55 ± 2.40, p  = 0.002) than the CL group. The FC group had higher correct response rates in two out of six observational checkpoints in the simulation (FC vs. CL: ‘Recognize acute pulmonary embolism and deal with it accordingly’, 95% vs. 60%, p  = 0.020; ‘Provide circulatory support and heparin treatment’, 100% vs. 75%, p  = 0.047). The FC group also obtained higher post-training theoretical test scores (FC vs. CL: 90.9 ± 4.8 vs. 84.8 ± 7.8, p  = 0.005) than the CL group. While the FC group spent more time studying before the simulation session (FC vs. CL (mean [min, max]): 2.6 [1.3, 3.6] vs. 1.3 [0.3, 2.3], p  < 0.0001), there was no significant difference in total studying time between the two groups (FC vs. CL (mean [min, max]): 3.6 [2, 5.6] vs. 3.4 [1.8, 4.9], p  = 0.418). Conclusion FC may improve the learning performance in the management of perioperative pulmonary embolism within anesthesia crisis management simulation training compared to CL-based learning. Trial registration The study was registered with No. ChiCTR2300070086.

Teaching endotracheal intubation is uniquely challenging due to its technical, high-stakes, and highly time-sensitive nature. The GoPro is a small, lightweight, high-resolution action camera with a wide-angle field of view that can encompass both the airway as well as the procedurist's hands and positioning technique when worn with a head mount. We aimed to evaluate its effectiveness in improving intubation teaching for novice learners in a simulated setting, via a two-arm, parallel group, randomized controlled superiority trial with 1:1 allocation ratio. We recruited Year 4 medical students at the start of their compulsory 2-week Anesthesia posting. Participants underwent a standardized intubation curriculum and a formative assessment, then randomized to receive GoPro or non-GoPro led feedback. After a span of three months, participants were re-assessed in a summative assessment by blinded accessors. Participants were also surveyed on their learning experience for a qualitative thematic perspective. The primary outcomes were successful intubation and successful first-pass intubation. Seventy-one participants were recruited with no dropouts, and all were included in the analysis. 36 participants received GoPro led feedback, and 35 participants received non-GoPro led feedback. All participants successfully intubated the manikin. No statistically significant differences were found between the GoPro group and the non-GoPro group at summative assessment (85.3% vs 90.0%, p = 0.572). Almost all participants surveyed found the GoPro effective for their learning (98.5%). Common themes in the qualitative analysis were: the ability for an improved assessment, greater identification of small details that would otherwise be missed, and usefulness of the unique point-of-view footage in improving understanding. The GoPro is a promising tool for simulation-based intubation teaching. There are considerations in its implementation to maximize the learning experience and yield from GoPro led feedback and training.