Regional Anesthesia Education Research Articles

The Development, Implementation, and Evolution of an Emergency Medicine Ultrasound-guided Regional Anesthesia Curriculum.

Despite the inclusion of both diagnostic and procedural ultrasound and regional nerve blocks in the original Model of the Clinical Practice of Emergency Medicine (EM), there is no recommended standardized approach to the incorporation of ultrasound-guided regional anesthesia (UGRA) education in EM training. We developed and implemented a structured curriculum for both EM residents and faculty to learn UGRA in a four-hour workshop. Each Regional Anesthesia Anatomy and Ultrasound Workshop was four hours in length and followed the same format. Focusing on common UGRA blocks, each workshop began with an anatomist-led cadaveric review of the relevant neuromusculoskeletal anatomy followed by a hands-on ultrasound scanning practice for the blocks led by an ultrasound fellowship-trained EM faculty member, fellow, or a postgraduate year (PGY)-4 resident who had previously participated in the workshop. Learners identified the relevant anatomy on point-of-care ultrasound and reviewed how to conduct the blocks. Learners were invited to complete an evaluation of the workshop with Likert-scale and open-ended questions. In the 2020 academic year, six regional anesthesia anatomy and ultrasound workshops occurred for EM faculty (two sessions, N = 24) and EM residents (four sessions, N = 40, including a total of five PGY4s, 10 PGY3s, 12 PGY2s, and 13 PGY1s). Workshops were universally well-received by both faculty and residents. Survey results found that 100.0% of all responding participants indicated that they were "very satisfied" with the session. All were likely to recommend this session to a colleague and 95.08% of participants believed the session should become a required component of the EM curriculum. The use of UGRA is increasing, and and it critical in EM. An interdisciplinary approach in collaboration with anatomists on an interactive, nerve block workshop incorporating both gross anatomy review and hands-on scanning was shown to be well-received and desired by both EM faculty and residents.

Clinical education in regional anesthesia: current status and future directions

Clinical education in regional anesthesia: current status and future directions

Five Institutions Tell Us How They Use Simulation in Regional Anesthesia Education

Five Institutions Tell Us How They Use Simulation in Regional Anesthesia Education

Piloting a New Curriculum: Guided At-Home Pediatric Regional Anesthesia Education Using a Portable Ultrasound.

Ultrasound-guided regional anesthesia is the standard of care for most regional blocks in pediatric anesthesiology.Training programs must educate physicians to perform regional blocks safely and efficiently. Hands-on learning with simulation and live models is the gold standard. The coronavirus disease 2019 (COVID-19) pandemic has greatly hampered our ability to safely hold in-person workshops. We describe an at-home, guided virtual workshop using portable ultrasound to safely continue experiential trainee education.The primary objective of this pilot virtual workshop was to develop an effective experiential learning program without the need for live child models. The main goal was to give trainees hands-on experience obtaining anatomical ultrasound images necessary for regional anesthesia blocks in a guided-virtual setting and to evaluate the effectiveness of skills acquisition. This workshop included two pediatric anesthesiology fellows and a pediatric anesthesiologist.Trainees were instructed on ultrasound-guided regional block acquisition. For two weeks, trainees acquired images/movies of regional block anatomy at home using their own children. Virtual video assistance was available. Trainees then used acquired images/movies to discuss needle and local anesthetic placement with a pediatric regional anesthesiologist. Trainees completed pre- and post-workshop surveys assessing attitudes, perceived educational efficacy, and procedural skill acquisition. The faculty member also assessed trainees’ skills.The virtual workshop was successful. Trainees expressed successful active learning and increased comfort in performing regional blocks on live patients. They correctly identified relevant anatomy of acquired images/movies, as well as needle and local anesthetic placement at the time of debriefing. Faculty were pleased with trainees’ initial performance of regional blocks.Adapting an in-person workshop to an at-home guided experience is a safe, feasible, and well-received method for anesthesiology trainees to obtain experiential learning of ultrasound-guided regional anesthesia. This facilitated at-home learning experience allows for hands-on skill practice while preventing exposure of child models to the hospital setting during a pandemic.

Teaching ultrasound guided femoral nerve block in the emergency department.

Patients with hip fracture are often not given adequate analgesia in the Emergency Department. Ultrasound guidedfemoral nerve block is an effective option but it is not commonly used due to limited experience, inadequate training andinfrequent clinical exposure. We aimed to develop a workshop to bridge the current gap in the training of ultrasound guidedfemoral nerve block. A 3-hour workshop was developed in accordance to guidelines for education andtraining in ultrasound-guided regional anesthesia. The components included an online learning module for pre-reading, as wellas team-based learning and simulation practice during the session. Evaluation of the participants was performed and feedbackof the course was collected. The workshop was conducted successfully for a total of 30 participants. All participantsachieved the minimum standard required. Across all domains, the mean scores for the workshop were more than 4.7 out of 5on the Likert scale. Participants were satisfied with the workshop and would recommend it to a colleague. Thisworkshop met its educational objectives and various principles of medical education were used effectively in the delivery ofthe content. Further research is necessary to demonstrate the impact of this educational effort on clinical practice and patientoutcomes.

Research priorities in regional anaesthesia education and training: an international Delphi consensus survey.

ObjectivesEducation in regional anaesthesia covers several complex and diverse areas, from theoretical aspects to procedural skills, professional behaviours, simulation, curriculum design and assessment. The objectives of this study were to summarise these topics and to prioritise these topics in order of research importance.DesignElectronic structured Delphi questionnaire over three rounds.SettingInternational.Participants38 experts in regional anaesthesia education and training, identified through the American Society of Regional Anesthesia Education Special Interest Group research collaboration.Results82 topics were identified and ranked in order of prioritisation. Topics were categorised into themes of simulation, curriculum, knowledge translation, assessment of skills, research methodology, equipment and motor skills. Thirteen topics were ranked as essential research priority, with four topics each on simulation and curriculum, three topics on knowledge translation, and one topic each on methodology and assessment.ConclusionsResearchers and educators can use these identified topics to assist in planning and structuring their research and training in regional anaesthesia education.

Prioritizing research topics in regional anesthesia education.

To the editor Delivering regional anesthesia education is a formidable challenge. It requires evidence-based approaches to diverse topics such as teaching of theoretical knowledge, competency in technical skills,[1][1] professional behaviors, use of simulation,[2][2] curriculum design,[3][3] and

Improving Regional Anesthesia Education in Pre-op and PACU: Development of a Standardized Regional Anesthesia Patient Education Protocol and Staff Education Plan

Improving Regional Anesthesia Education in Pre-op and PACU: Development of a Standardized Regional Anesthesia Patient Education Protocol and Staff Education Plan

Education in Ultrasound-Guided Regional Anesthesia

Education in Ultrasound-Guided Regional Anesthesia

The future of regional anesthesia education: lessons learned from the surgical specialty.

Application of ultrasound in regional anesthesia has now become the standard of care and its use has shown to reduce complications. Nevertheless, gaining expertise in ultrasound-guided regional anesthesia requires the acquisition of new cognitive and technical skills. In addition, due to a reduction in resident working hours and enforcement of labour laws and directives across various states and countries, trainees perform and witness fewer procedures. Together, these issues create challenges in the teaching and learning of ultrasound-guided regional anesthesia in the time-based model of learning. The challenges of teaching ultrasound-guided regional anesthesia are similar to those experienced by our surgical counterparts with the advent of minimally invasive surgery. In order to overcome these challenges, our surgical colleagues used theories of surgical skills training, simulation, and the concept of deliberate practice and feedback to shift the paradigm of learning from experience-based to competency-based learning. In this narrative review, we describe the theory behind the evolution of surgical skills training. We also outline how we can apply these learning theories and simulation models to a competency-based curriculum for training in ultrasound-guided regional anesthesia.

Education in Regional Anesthesia: The Next Level

The apprenticeship model of teaching procedural skills in regional anesthesia may no longer be effective because of the increasing number of peripheral nerve blocks currently performed. A time-based training program is restrictive, and this is compounded by limitations in duty hours and time pressures concerning operating room efficiency. Forty percent of residents do not fulfill the recommended minimum number of blocks required upon graduation. In this review we discuss the issues with the current apprenticeship model of teaching; how simulation addresses some of these issues, and why the future of regional anesthesia education will be modeled on an experiential competency-based paradigm as opposed to the traditional time-based model.

Acute pain medicine in anesthesiology

The American Academy of Pain Medicine and the American Society for Regional Anesthesia have recently focused on the evolving practice of acute pain medicine. There is increasing recognition that the scope and practice of acute pain therapies must extend beyond the subacute pain phase to include pre-pain and pre-intervention risk stratification, resident and fellow education in regional anesthesia and multimodal analgesia, as well as a deeper understanding of the pathophysiologic mechanisms that are integral to the variability observed among individual responses to nociception. Acute pain medicine is also being established as a vital component of successful systems-level acute pain management programs, inpatient cost containment, and patient satisfaction scores. In this review, we discuss the evolution and practice of acute pain medicine and we aim to facilitate further discussion on the evolution and advancement of this field as a subspecialty of anesthesiology.

Education in Regional Anesthesia

This special article is an essay version of the European Society of Regional Anaesthesia and Pain Therapy 2011 Carl Koller Award lecture. Historically, evaluations of a trainee's regional anesthesia learning focused on caseload numbers. The deficiency of this unidimensional approach is that case numbers alone say little about the resident's mastery of the nontechnical aspects of regional anesthesiology. Simulation can refine technical skills, but also expands the teaching paradigm to include management of rare complications. Teachers are further challenged by requirements to incorporate systems-based practice topics, including the optimization of operating room efficiency and patient safety. Journals play an important role in regional anesthesia education for both trainees and mature anesthesiologists. Editorial boards build valuable educational foundations by providing critical analysis of new technologies and sponsoring practice advisories. Subspecialty societies such as European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine foster regional anesthesia education through their efforts to define curricula, produce guidelines, and promote international collaboration.

Assessing the Impact of a Regional Anesthesia Workshop on Anesthesiology Residents’ Perceived Comfort in Performing Peripheral Nerve Blocks

Different methods of regional anesthesia education have been described in the literature, but none have proven to be superior. The objective of this study was to evaluate the educational value as perceived by the anesthesia resident of a regional anesthesia workshop. Twenty-eight anesthesia residents participated in a workshop, which reviewed nerve blocks of the upper and lower extremities. Prior to the workshop, each resident completed a survey assessing their confidence in their ability to perform 13 nerve blocks. At the conclusion of the workshop and at 3 months post-workshop, the residents completed similar surveys. Paired sample t-test was used to compare pre- and post-workshop confidence levels. Twenty-eight residents completed the pre-, post-, and 3-month follow-up questionnaires. There was a statistically significant increase in residents' confidence level post-workshop for 11 block s evaluated. This was sustained in 5 blocks at the 3 month follow-up survey. Senior residents had higher baseline confidence scores when compared to junior residents. When all blocks were considered, junior residents demonstrated a statistically signifi cant increase in confidence level in independently performing nerve blocks immediately post workshop and at 3 month follow-up. Senior residents had a statistically significant increase in confidence level immediately post workshop, but not at the 3 month follow-up. 100% of participants found the workshop to be beneficial. Participants with less prior experience showed sustained increase in comfort levels at 3 months post-workshop (p=0.007). Based on self-reported trainee comfort level, the workshop was an effective teaching tool. Future workshops might be most effective when targeted at learners with less baseline regional anesthesia experience. Peripheral nerve block workshops can provide an important adjunct in the regional anesthesia ed ucation of resident anesthesiologists.

Developing Effective Web-Based Regional Anesthesia Education

Little is known about the use of Web-based education in regional anesthesia training. Benefits of Web-based education include the ability to standardize learning material quality and content, build appropriate learning progressions, use interactive multimedia technologies, and individualize delivery of course materials. The goals of this investigation were (1) to determine whether module design influences regional anesthesia knowledge acquisition, (2) to characterize learner preference patterns among anesthesia residents, and (3) to determine whether learner preferences play a role in knowledge acquisition. Direct comparison of knowledge assessments, learning styles, and learner preferences will be made between an interactive case-based and a traditional textbook-style module design. Forty-three Mayo Clinic anesthesiology residents completed 2 online modules, a knowledge pretest, posttest, an Index of Learning Styles assessment, and a participant satisfaction survey. Interscalene and lumbar plexus regional techniques were selected as the learning content for 4 Web modules constructed using the Blackboard Vista coursework application. One traditional textbook-style module and 1 interactive case-based module were designed for each of the interscalene and lumbar plexus techniques. Participants scored higher on the postmodule knowledge assessment for both of the interscalene and lumbar plexus modules. Postmodule knowledge performance scores were independent of both module design (interactive case-based versus traditional textbook style) and learning style preferences. However, nearly all participants reported a preference for Web-based learning and believe that it should be used in anesthesia resident education. Participants did not feel that Web-base learning should replace the current lecture-based curriculum. All residents scored higher on the postmodule knowledge assessment, but this improvement was independent of the module design and individual learning styles. Although residents believe that online learning should be used in anesthesia training, the results of this study do not demonstrate improved learning or justify the time and expense of developing complex case-based training modules. While there may be practical benefits of Web-based education, educators in regional anesthesia should be cautious about developing curricula based on learner preference data.

The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee Recommendations for Education and Training in Ultrasound-Guided Regional Anesthesia

Ultrasound-guided regional anesthesia (UGRA) is a growing area of both clinical and research interest. The following document contains the work produced by a joint committee from ASRA and the European Society of Regional Anesthesia and Pain Therapy. This joint committee was established to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of UGRA.This document specifically defines the following:1. 10 common tasks used when performing an ultrasound-guided nerve block,2. The core competencies and skill sets associated with UGRA,3. A training practice pathway for postgraduate anesthesiologists, and4. A residency-based training pathway.In both the residency and postgraduate pathways, training, competency, and proficiency requirements include both didactic and experiential components. The Joint Committee recommends that the decision to grant UGRA privileges be based at the individual institution level. Each institution that conducts UGRA is encouraged to support a productive quality improvement process.

AAOS Guidelines for the Prevention of Symptomatic Pulmonary Embolism After Total Hip and Total Knee Arthroplasty: Advantages and Disadvantages

The American Academy of Orthopedic Surgeons has published a clinical guideline for the prevention of symptomatic pulmonary embolism in patients undergoing total hip and total knee arthroplasty. This guideline includes recommendations from a consensus process and a review and analysis of 42 publications since 1996. The end points for analysis were symptomatic and fatal pulmonary embolism rates, total death rates, and major bleeding complications. The guideline recommends preoperative risk stratification of all patients for “standard” and “high” risks of both pulmonary embolism and major bleeding complications. The use of regional anesthesia, mechanical prophylaxis, rapid mobilization, and patient education were consensus recommendations. The choice of a specific medication postoperatively by the surgeon should be based on an individual risk–benefit analysis of pulmonary embolism and major bleeding complications. The advantages of this guideline include a greater concern for bleeding and other local wound complications that could affect overall patient outcome, and the ability of the surgeon to treat each patient as an individual. The disadvantages of this guideline include placing hip and knee arthroplasty patients into a single group, the lower levels of evidence for the recommendations, and the relative lack of acceptance by other specialty groups and governmental agencies.

The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee Recommendations for Education and Training in Ultrasound-Guided Regional Anesthesia

Ultrasound-guided regional anesthesia (UGRA) is a growing area of both clinical and research interest. The following document contains the work produced by a joint committee from ASRA and the European Society of Regional Anesthesia and Pain Therapy. This joint committee was established to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of UGRA.This document specifically defines the following:In both the residency and postgraduate pathways, training, competency, and proficiency requirements include both didactic and experiential components. The Joint Committee recommends that the decision to grant UGRA privileges be based at the individual institution level. Each institution that conducts UGRA is encouraged to support a productive quality improvement process.

The Training and Careers of Regional Anesthesia Fellows—1983–2002

The education and subsequent careers of regional anesthesia fellows have not been examined but may provide insight into improving future fellowship training and/or the future of the subspecialty. Regional anesthesia fellows educated during a 20-year period (1983-2002) were asked to complete a comprehensive survey that detailed their training, current professional setting, and use of regional anesthesia, and how they foresee the future of regional anesthesia. A separate survey of academic anesthesiology chairs assessed the role of and need for regional anesthesiologists in teaching departments. Twelve regional anesthesia fellowship programs in the United States and Canada provided contact information on 176 former fellows. The survey response rate from those practicing in North America was 49% (77/156). Two of the 12 responding institutions have trained 68% of regional anesthesia fellows. Of respondents, 61% are or have been in academic practice. Regional anesthesia remains an integral part of most respondents' current practice, as evidenced by significant use of regional techniques, active involvement in subspecialty societies, and participation in continuing medical education programs. Academic chairs indicate that fellowship-trained regional anesthesiologists play important roles in resident education and are in demand by academic departments. This report details how regional anesthesia fellows from 1983 to 2002 were trained and how they currently practice and examines their insights regarding the strengths and weaknesses of past and future regional anesthesia education.

Bewertung eines Anatomieworkshops f�r die Regionalan�sthesieausbildung

The aim of the present investigation was to survey former participants (n=869) of a cadaver workshop using a mail questionnaire to assess the demographic data and the impact of these courses on daily practice. The deadline for acceptance of return mail was 60 days. Descriptive statistics were employed for analysis of results. The response rate was 36.7% and the course was judged to be recommendable by 98.2%. The average course attendant was board certified and had spent a mean time of 9+/-6 years in anesthesiology. The highest quality and degree of subsequent practicability in daily routine was attributed to peripheral nerve block training on cadavers. Of the course participants two-thirds performed regional anesthesia procedures more often following attendance. The majority of course attendants had to defray at least a part of the course fee themselves, and one-third was required to invest leisure time to attend. Attendance of a cadaver workshop increased knowledge of clinical anatomy and enhanced performance of regional anesthesia procedures. Courses of this format constitute a currently underestimated adjunct to contemporary regional anesthesia education.