To the Editor:—
We read with interest the recent editorial by Gaba 1discussing the application of video and simulation technology as novel approaches to medical education and training. We would like to explain how our institution is applying another new technology as an aide to teaching regional anesthesia to our residents, namely the use of the Sony Clie Personal Data Assistants (PDAs) with high-resolution color displays (e.g. , PEG-N760C, PEG-T615C) as teaching aides for regional anesthesia (fig. 1).
PDAs are gaining rapid popularity within the medical field because of their ability to store and rapidly retrieve vast amounts of data—both prepackaged and user-customized—in a small, readily-accessible package. PDA applications such as pharmacology references (e.g. , Ep-ocrates), electronic handbooks (e.g. , Harriet Lane, Five Minute ClinicalConsult), and patient logging programs are already widely utilized. The recent introduction of high-resolution color screens combined with ever-expanding PDA memory capacity now facilitate more display, or visual -based applications. Our PDA-based teaching tools are merely a specific application of the current display capabilities of the newest generation of PDAs.
The color Sony Clies are bundled with PC software (PictureGear Lite) that exports color photographs that can be displayed on the PDA (using PictureGear Pocket). The PDA image can be zoomed in and out, and repositioned both vertically and horizontally. The pictures, a compromise between fine detail and manageable file sizes, are surprisingly detailed and have good clarity. Average high quality pictures consume about 100 Kb of memory. While 128 Mb of Flash Memory (enough to store more than 1,000 pictures) costs about $100, smaller memory cards with more than adequate capability for our purposes are even less expensive.
Our PDA-based regional training aides are largely based on numerous photographs of our regional anesthetic techniques. These digital photographs have been organized by type of block, and loaded onto our PDAs. Typical photographs show proper patient positioning, the relevant anatomical landmarks, pertinent cadaveric dissections, and simplified diagrams. In addition to the visual information presented by digital photographs, considerable text-based information is also available for each block, including indications and contraindications, suggested drugs and dosage, guidance in finding an acceptable needle position with the aide of a nerve stimulator, and clinical “pearls.” The blocks that we currently have documented include the interscalene, infraclavicular, spinal, epidural, femoral, popliteal, and ankle blocks.
Clearly such PDA-based teaching aides can never replace the guidance of an experienced regional anesthesiologist. However, we believe that such tools may substantially speed the training process and serve as readily available reference material for regional anesthesia. The unsurpassed accessibility of PDA-based information serves as a valuable resource for those clinicians who do not perform regional anesthesia on a consistent basis. What remains to be seen is if the use of PDA-based information will in reality affect the learning curve in regional anesthesia for residents in training. This is a basis for future work from this department.
