Training In Ultrasound-guided Regional Anesthesia Research Articles

An Ultrasound-Guided Regional Anesthesia Elective for Emergency Medicine Residents.

This ultrasound-guided regional anesthesia elective is designed for emergency medicine residents. The proposed length of this curriculum is over one week. Ultrasound-guided regional anesthesia (UGRA) is a useful tool in the emergency department (ED) for managing painful conditions, and many programs have identified that these are useful skills for emergency providers; however, only about 53% of programs report teaching UGRA as part of their core curriculum, and there currently are no widely available or peer reviewed nerve block curricula designed for emergency medicine residents. To deliver an immersive 1-week elective to provide residents a strong foundation in principles of UGRA and an introduction to 14 nerve block procedures applicable to care provided in the ED. The educational strategies used in this curriculum include: instructional videos, written and online independent learning materials, one-on-one teaching at the bedside with an emergency ultrasound fellow, simulation of nerve block techniques using a femoral nerve block task trainer, and performance of supervised nerve block procedures on patients in the ED. All residents provided feedback through an online survey after completing the elective. Eight residents completed the elective in the first year of implementation. Following completion of the UGRA curriculum, 8/8 (100%) of residents reported increased level of confidence in performing UGRA. In addition, 8/8 (100%) of residents reported they were "likely" or "very likely" to incorporate UGRA into their future EM practice. All 8 (100%) residents responded they were "very likely" to recommend the elective to other trainees. The elective received high ratings for overall quality with an average rating of 9.4 out of 10 (±0.7). An elective in ultrasound-guided regional anesthesia can be successfully incorporated into an emergency medicine training program. The curriculum was successful in providing focused training in UGRA and resulted in increased resident confidence in performing nerve block procedures. Ultrasound-guided regional anesthesia, nerve block, resident, elective, pain.

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.

Ultrasound-Guided Regional Anesthesia Simulation Training: A Systematic Review.

Ultrasound-guided regional anesthesia (UGRA) has become the criterion standard of regional anesthesia practice. Ultrasound-guided regional anesthesia teaching programs often use simulation, and guidelines have been published to help guide URGA education. This systematic review aimed to examine the effectiveness of simulation-based education for the acquisition and maintenance of competence in UGRA. Studies identified in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were included if they assessed simulation-based UGRA teaching with outcomes measured at Kirkpatrick level 2 (knowledge and skills), 3 (transfer of learning to the workplace), or 4 (patient outcomes). Two authors independently reviewed all identified references for eligibility, abstracted data, and appraised quality. After screening 176 citations and 45 full-text articles, 12 studies were included. Simulation-enhanced training improved knowledge acquisition (Kirkpatrick level 2) when compared with nonsimulation training. Seven studies measuring skill acquisition (Kirkpatrick level 2) found that simulation-enhanced UGRA training was significantly more effective than alternative teaching methods or no intervention. One study measuring transfer of learning into the clinical setting (Kirkpatrick level 3) found no difference between simulation-enhanced UGRA training and non-simulation-based training. However, this study was discontinued early because of technical challenges. Two studies examined patient outcomes (Kirkpatrick level 4), and one of these found that simulation-based UGRA training improved patient outcomes compared with didactic teaching. Ultrasound-guided regional anesthesia knowledge and skills significantly improved with simulation training. The acquired UGRA skills may be transferred to the clinical setting; however, further studies are required to confirm these changes translate to improved patient outcomes.

Implementation of clinical practice changes by experienced anesthesiologists after simulation-based ultrasound-guided regional anesthesia training.

BackgroundAnesthesiologists who have finished formal training and want to learn ultrasound-guided regional anesthesia (UGRA) commonly attend 1 day workshops. However, it is unclear whether participation actually changes clinical practice. We assessed change implementation after completion of a 1 day simulation-based UGRA workshop.MethodsPracticing anesthesiologists who participated in a 1 day UGRA course from January 2012 through May 2014 were surveyed. The course consisted of clinical observation of UGRA procedures, didactic lectures, ultrasound scanning, hands-on perineural catheter placement, and mannequin simulation. The primary outcome was the average number of UGRA blocks per month reported at follow-up versus baseline. Secondary outcomes included preference for ultrasound as the nerve localization technique, ratings of UGRA teaching methods, and obstacles to performing UGRA.ResultsSurvey data from 46 course participants (60% response rate) were included for analysis. Participants were (median [10th–90th percentile]) 50 (37–63) years old, had been in practice for 17 (5–30) years, and were surveyed 27 (10–34) months after their UGRA training. Participants reported performing 24 (4–90) blocks per month at follow-up compared to 10 (2–24) blocks at baseline (P < 0.001). Compared to baseline, more participants at follow-up preferred ultrasound for nerve localization. The major obstacle to implementing UGRA in clinical practice was time pressure.ConclusionsParticipation in a 1 day simulation-based UGRA course may increase UGRA procedural volume by practicing anesthesiologists.

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.

Visuospatial Ability as a Predictor of Novice Performance in Ultrasound-guided Regional Anesthesia

Visuospatial ability correlates positively with novice performance of simple laparoscopic tasks. The aims of this study were to identify whether visuospatial ability could predict technical performance of an ultrasound-guided needle task by novice operators and to describe how emotional state, intelligence, and fear of failure impact on this. Sixty medical student volunteers enrolled in this observational study. The authors used an instructional video to standardize training for ultrasound-guided needle advancement in a turkey breast model and assessed volunteers' performance independently by two assessors using composite error score (CES) and global rating scale (GRS). The authors assessed their "visuospatial ability" with mental rotation test (MRT), group embedded figures test, and Alice Heim group ability test. Emotional state was judged with UWIST Mood Adjective Checklist (UMACL), and fear of failure and general cognitive ability were judged with numerical reasoning test. High CES scores (high error rate) were associated with low MRT scores (ρ = -0.54; P < 0.001). Better GRS scores were associated with better MRT scores (ρ = 0.47; P < 0.001). Regarding emotions, GRS scores were low when anxiety levels were high (ρ = -0.35; P = 0.005) and CES scores (errors) were low when individuals reported feeling vigorous and active (ρ = -0.30; P = 0.01). An MRT predicts novice performance of an ultrasound-guided needling task on a turkey model and as a trait measure could be used as a tool to focus training resources on less-able individuals. Anxiety adversely affects performance. Therefore, both may prove useful in directing targeted training in ultrasound-guided regional anesthesia.

Evaluation of a Standardized Program for Training Practicing Anesthesiologists in Ultrasound-Guided Regional Anesthesia Skills.

Practicing anesthesiologists have generally not received formal training in ultrasound-guided perineural catheter insertion. We designed this study to determine the efficacy of a standardized teaching program in this population. Anesthesiologists in practice for 10 years or more were recruited and enrolled to participate in a 1-day program: lectures and live-model ultrasound scanning (morning) and faculty-led iterative practice and mannequin-based simulation (afternoon). Participants were assessed and recorded while performing ultrasound-guided perineural catheter insertion at baseline, at midday (interval), and after the program (final). Videos were scored by 2 blinded reviewers using a composite tool and global rating scale. Participants were surveyed every 3 months for 1 year to report the number of procedures, efficacy of teaching methods, and implementation obstacles. Thirty-two participants were enrolled and completed the program; 31 of 32 (97%) completed the 1-year follow-up. Final scores [median (10th-90th percentiles)] were 21.5 (14.5-28.0) of 30 points compared to 14.0 (9.0-20.0) at interval (P < .001 versus final) and 12.0 (8.5-17.5) at baseline (P < .001 versus final), with no difference between interval and baseline. The global rating scale showed an identical pattern. Twelve of 26 participants without previous experience performed at least 1 perineural catheter insertion after training (P < .001). However, there were no differences in the monthly average number of procedures or complications after the course when compared to baseline. Practicing anesthesiologists without previous training in ultrasound-guided regional anesthesia can acquire perineural catheter insertion skills after a 1-day standardized course, but changing clinical practice remains a challenge.

Ultrasound Guided Regional Anesthesia Training Simulator Using Microsoft Kinect

We present a system for the interactive simulation of ultrasound guided peripheral nerve blocks using a Microsoft Kinect®. The system performs motion tracking of both the ultrasound probe and the nerve block needle. Software generates synthetic ultrasound images from previously captured ultrasound images. Details of the software elements in the system are described. Some of the current challenges and future work in this research are discussed.

Efficacy of computer-based video and simulation in ultrasound-guided regional anesthesia training

Study ObjectiveTo determine the effectiveness of a short educational video and simulation on improvement of ultrasound (US) image acquisition and interpretation skills. DesignProspective, randomized study. SettingUniversity medical center. Subjects28 anesthesia residents and community anesthesiologists with varied ultrasound experience were randomized to teaching video with interactive simulation or sham video groups. SubjectsParticipants were assessed preintervention and postintervention on their ability to identify the sciatic nerve and other anatomic structures on static US images, as well as their ability to locate the sciatic nerve with US on live models. Main ResultsPretest written test scores correlated with reported US block experience (Kendall tau rank r = 0.47) and with live US scanning scores (r = 0.64). The teaching video and simulation significantly improved scores on the written examination (P < 0.001); however, they did not significantly improve live US scanning skills. ConclusionsA short educational video with interactive simulation significantly improved knowledge of US anatomy, but failed to improve hands-on performance of US scanning to localize the nerve.

A Novel Phantom for Teaching and Learning Ultrasound-guided Needle Manipulation

Training in ultrasound-guided regional anesthesia can be acquired by attending peripheral nerve block courses. The most common novice error is “advancement of needle when tip was not visualized.” The use of simulation has shown improvement in the skill and success of ultrasound-guided procedures. Phantoms provide a simple tool that aid in the improvement of such skills. We describe a gelatin-based phantom that can be easily constructed and used to identify novice errors and facilitate in learning relevant skills. The phantom can be transilluminated to identify the target and is helpful in providing real-time, immediate feedback to novices as they practice probe–needle–target orientation.

A Scoping Review of the Evidence for Teaching Ultrasound-Guided Regional Anesthesia

A scoping review was performed to assess published evidence regarding how best to teach ultrasound-guided regional anesthesia (UGRA). The literature search yielded 205 articles, of which 35 met the inclusion criteria. Current literature on the topic can be divided into 3 main themes: the development of motor skills, learning and teaching sonoanatomy, and understanding of the requirements for establishing a UGRA education program and evaluation. We discuss the current status and future direction of research on UGRA training.

Novel real‐time feedback and integrated simulation model for teaching and evaluating ultrasound‐guided regional anesthesia skills in pediatric anesthesia trainees

To assess, teach, and improve core competencies and skills sets associated with ultrasound-guided regional anesthesia (UGRA) of pediatric anesthesia trainees. To effectively assess and improve UGRA-associated cognitive and technical skills and proficiency of pediatric anesthesia trainees using simulators and real-time feedback. Ultrasound usage has been increasingly adopted by anesthesiologists to perform regional anesthesia. Pediatric UGRA performance significantly lags behind adult UGRA practice. Lack of effective UGRA training is the major reason for this unfortunate lag. Integration of ultrasound imaging, target location, and needling skills are crucial in safely performing UGRA. However, there are no standards to ensure proficiency in practice, nor in training. We implemented an UGRA instructional program for all trainees, in two parts. First, we used a unique training model for initial assessment and training of technical skills. Second, we used an instructional program that encompasses UGRA and equipment-associated cognitive skills. After baseline assessment at 0 months, we retested these trainees at 6 and 12 months to identify progression of proficiency over time. Cognitive and technical UGRA skills of trainees improved significantly over the course of time. UGRA performance average accuracy improved to 79% at 12 months from the baseline accuracy of 57%. Cognitive UGRA-related skills of trainees improved from baseline results of 52.5-79.2% at 12 months. Implementing a multifaceted assessment and real-time feedback-based training has significantly improved UGRA-related cognitive and technical skills and proficiency of pediatric anesthesia trainees.

Peripheral Nerve Blockade

Peripheral Nerve Blockade

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.

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.

Unbiased inference of parameter distributions for nonlinear models: The underdetermined case

Training in ultrasound-guided regional anesthesia can be acquired by attending peripheral nerve block courses. The most common novice error is “advancement of needle when tip was not visualized.” The use of simulation has shown improvement in the skill and success of ultrasound-guided procedures. Phantoms provide a simple tool that aid in the improvement of such skills. We describe a gelatin-based phantom that can be easily constructed and used to identify novice errors and facilitate in learning relevant skills. The phantom can be transilluminated to identify the target and is helpful in providing real-time, immediate feedback to novices as they practice probe–needle–target orientation.