Achieving change in practice by using unembalmed cadavers to teach ultrasound-guided regional anaesthesia

Abstract

We are at risk of teaching our trainees to be ‘image-seekers’. Sonoanatomy is easily demonstrated but teaching the practical skills of ultrasound-guided nerve block constitutes a greater challenge. Participants may return to their institutions after attending educational courses as proficient ‘image-seekers’, yet still unsure about performing nerve blocks. Safe ultrasound-guided regional anaesthesia (USGRA) requires integration of several skills. These are correct image acquisition, accurate needle guidance and appropriate spread of local anaesthesia. Most educational courses cannot combine all these skills. We describe realtime nerve blocks on cadavers to teach USGRA. Unembalmed cadavers offer more realistic imaging and tactile needle feedback than other models. We evaluated participants' perceptions of cadavers for training, their impact on confidence and whether subsequent change in practice occurred. Fifty participants completed pre- and post-training questionnaires and were followed up at three months. Confidence was scored on a five-point scale. Complete data-sets were received from 42 participants (84%). Most (98%) found the cadavers to be of educational benefit and 86% found the imaging and tissue properties comparable to clinical practice. Mean (±SD) confidence score increased from 1.7 (±0.92) precourse to 4.3 (±0.65) postcourse ( P < 0.0001). At three-month follow-up, 84% considered they had received sufficient training to introduce ultrasound into their clinical practice and 87% (27% precourse) now used ultrasound routinely. Only four participants had not made a change to their practice.