Author: Flora Liu, MD
The Daily Dose
Mastering an anesthesia procedure requires more than understanding the individual steps. Trainees must combine cognitive knowledge, manual dexterity, visual attention, procedural flow, and repeated practice guided by meaningful feedback.
A session presented at the 2026 IARS and SOCCA Annual Meeting examined several emerging approaches to procedural education, including hand and eye motion tracking, virtual reality simulation, and proficiency-based assessment.
Measuring Hand Movement During Ultrasound Training
Santiago Uribe-Marquez, MD, discussed how motion-tracking technology can objectively measure a trainee’s movements during point-of-care ultrasound procedures.
The technology can record:
• Total hand-movement distance
• Rotational movements
• Acceleration
• Time required to complete the procedure
• Unnecessary or inefficient movements
These measurements transform complex motor behaviors into objective performance data. Motion Augmented eXperience feedback can then show trainees where their technique may be inefficient and help them make immediate corrections.
Traditional expert feedback may take several hours to provide. Motion-tracking systems can potentially reduce that delay to approximately 20 seconds, allowing learners to adjust their movements while the procedure is still fresh in their minds. This immediate feedback may improve the speed of skill acquisition.
Eye Tracking and Procedural Cognition
Eye-tracking technology provides insight into how clinicians visually process anatomy and imaging information during procedures.
Experts commonly maintain longer and more stable visual fixation on important anatomical structures or ultrasound targets. Novices tend to make more rapid eye movements and may frequently shift attention between relevant and irrelevant areas.
Wearable eye-tracking glasses and video-oculography systems can generate heat maps showing where a trainee is looking during a procedure. This allows educators to examine cognitive and visual behaviors that are otherwise difficult to observe.
Potential applications include:
• Point-of-care ultrasound training
• Airway management
• Crisis-resource management
• Regional anesthesia
• Augmented reality and virtual reality simulation
Current limitations include equipment costs, calibration difficulties, lighting sensitivity, and the need to interpret large amounts of tracking data.
Teaching Neuraxial Procedures Through Virtual Reality
Shiri Savir, MD, discussed the use of virtual reality to teach neuraxial anesthesia.
Traditional lectures and two-dimensional images may not adequately demonstrate the complex three-dimensional relationships among the vertebrae, ligaments, epidural space, and spinal canal. Virtual reality allows learners to explore this anatomy in an interactive three-dimensional environment.
VR-based neuraxial simulation can provide:
• Repeated practice without patient risk
• Standardized procedural scenarios
• Different patient anatomies and body types
• Variation in positioning and procedural difficulty
• Objective measurements of trainee performance
• Scalable training outside traditional simulation centers
Future systems may incorporate robotic haptic feedback to simulate tactile sensations such as tissue resistance and loss of resistance when entering the epidural space.
Studies have shown that immersive VR can improve anatomical knowledge and is generally well accepted by learners. It may become increasingly valuable as clinical opportunities to perform neuraxial procedures become more limited.
Moving From Case Numbers to Demonstrated Proficiency
Robina Matyal, MD, discussed the challenge of determining when a trainee is genuinely competent to perform a procedure.
Traditional assessment methods often rely on:
• The number of procedures performed
• Time required to complete the procedure
• General faculty observation
• Completion of a required rotation
These measures do not always demonstrate true proficiency. A trainee may complete many procedures without consistently performing them safely or efficiently.
Dr. Matyal described a preclinical proficiency index based on four major areas:
• Procedural workflow
• Knowledge
• Clinical skills
• Crisis management
The proficiency index has demonstrated content validity, inter-rater reliability, and the ability to distinguish among residents at different stages of training.
This model shifts education away from assuming that procedural exposure automatically produces competence. Instead, learners must demonstrate that they have achieved defined performance standards.
A Hybrid Model of Procedural Education
Simulation should not replace supervised clinical experience. The most effective educational model likely combines several methods:
• Virtual reality for learning anatomy and rehearsing procedural steps
• Mannequin simulation for developing tactile skills
• Motion tracking for improving movement efficiency
• Eye tracking for understanding visual attention
• Proficiency assessments for determining readiness
• Supervised operating-room experience for transferring skills to patient care
Trainees could be required to meet a virtual-reality or simulation benchmark before attempting a high-risk procedure on a patient or beginning a rotation involving greater procedural independence.
This would allow learners to develop basic competence before entering the clinical environment. It could also make each patient encounter more educational because the trainee would already understand the anatomy, workflow, and fundamental technical steps.
The Future of Procedural Training
Anesthesiology education is moving from a time-based system toward a data-driven mastery model. The number of procedures completed remains important, but objective evidence of competence may provide a more accurate measure of readiness.
Motion tracking, eye tracking, virtual reality, and proficiency indexes can make procedural education more efficient, standardized, transparent, and scalable. These technologies may also help identify specific weaknesses earlier, allowing educators to provide targeted instruction before the learner performs procedures independently.
The ultimate goal is not simply to help trainees complete procedures faster. It is to ensure that they perform them safely, efficiently, and consistently while improving both medical education and patient safety.
Thank you to The Daily Dose and the International Anesthesia Research Society for allowing us to summarize this educational session.