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Savage M, Spence A, Turbitt L. The educational impact of technology-enhanced learning in regional anaesthesia: a scoping review. Br J Anaesth 2024:S0007-0912(24)00262-9. [PMID: 38824073 DOI: 10.1016/j.bja.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Effective training in regional anaesthesia (RA) is paramount to ensuring widespread competence. Technology-based learning has assisted other specialties in achieving more rapid procedural skill acquisition. If applicable to RA, technology-enhanced training has the potential to provide an effective learning experience and to overcome barriers to RA training. We review the current evidence base for use of innovative technologies in assisting learning of RA. METHODS Using scoping review methodology, three databases (MEDLINE, Embase, and Web of Science) were searched, identifying 158 relevant citations. Citations were screened against defined eligibility criteria with 27 studies selected for inclusion. Data relating to study details, technological learning interventions, and impact on learner experience were extracted and analysed. RESULTS Seven different technologies were used to train learners in RA: artificial intelligence, immersive virtual reality, desktop virtual reality, needle guidance technology, robotics, augmented reality, and haptic feedback devices. Of 27 studies, 26 reported a positive impact of technology-enhanced RA training, with different technologies offering benefits for differing components of RA training. Artificial intelligence improved sonoanatomical knowledge and ultrasound skills for RA, whereas needle guidance technologies enhanced confidence and improved needling performance, particularly in novices. Immersive virtual reality allowed more rapid acquisition of needling skills, but its functionality was limited when combined with haptic feedback technology. User friendly technologies enhanced participant experience and improved confidence in RA; however, limitations in technology-assisted RA training restrict its widespread use. CONCLUSIONS Technology-enhanced RA training can provide a positive and effective learning experience, with potential to reduce the steep learning curve associated with gaining RA proficiency. A combined approach to RA education, using both technological and traditional approaches, should be maintained as no single method has been shown to provide comprehensive RA training.
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Affiliation(s)
- Mairead Savage
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK.
| | - Andrew Spence
- Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
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2
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Dang D, Kamal M, Kumar M, Paliwal B, Nayyar A, Bhatia P, Singariya G. Comparison of human cadaver and blue phantom for teaching ultrasound-guided regional anesthesia to novice postgraduate students of anesthesiology: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2024; 40:276-282. [PMID: 38919433 PMCID: PMC11196044 DOI: 10.4103/joacp.joacp_234_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/18/2022] [Accepted: 10/19/2022] [Indexed: 06/27/2024] Open
Abstract
Background and Aims Simulation is increasingly used in medical teaching. Various studies have evaluated different simulation models for training of regional anesthesia (RA). We compared the use of human cadaver and blue phantom models for training of regional anesthesia to novice postgraduate students of anesthesiology. Material and Methods Fifty students were taught knobology of the ultrasonography (USG) machine. They were divided into two equal groups by computer-generated random number table, and the groups assigned were kept in sealed envelopes. In group BP, students were trained on a blue phantom model, and in group HC, students were trained on human cadaver. After training, a didactic video of sonoanatomy of the supraclavicular block was shown to all participants. The block performance was then judged on patients requiring supraclavicular block. The primary objective of the study was to compare the block performance time, and secondary objectives were the quality of image acquired, orientation of transducer to the target, identification of ultrasound artifacts, errors committed, complications, and success rate. Results The mean block performance time was shorter in group HC compared to group BP (451.96 ± 50.25 and 526.48 ± 43.486 s, respectively; P < 0.001). The image quality score, transducer orientation to the target, and identification of USG artifacts were better in group HC compared to group BP, with lesser number of needle passes. Conclusion Cadaver-based training produced better results compared to blue phantom simulator model for teaching of ultrasound-guided RA to novice postgraduate trainees of anesthesiology.
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Affiliation(s)
- Deepanshu Dang
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
| | - Manoj Kamal
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
| | | | - Bharat Paliwal
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
| | - Ashish Nayyar
- Department of Anatomy, AIIMS, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
| | - Geeta Singariya
- Department of Anaesthesiology, Dr S.N. Medical College, Jodhpur, Rajasthan, India
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Jo Y, Lee D, Baek D, Choi BK, Aryal N, Jung J, Shin YS, Hong B. Optimal view detection for ultrasound-guided supraclavicular block using deep learning approaches. Sci Rep 2023; 13:17209. [PMID: 37821574 PMCID: PMC10567700 DOI: 10.1038/s41598-023-44170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023] Open
Abstract
Successful ultrasound-guided supraclavicular block (SCB) requires the understanding of sonoanatomy and identification of the optimal view. Segmentation using a convolutional neural network (CNN) is limited in clearly determining the optimal view. The present study describes the development of a computer-aided diagnosis (CADx) system using a CNN that can determine the optimal view for complete SCB in real time. The aim of this study was the development of computer-aided diagnosis system that aid non-expert to determine the optimal view for complete supraclavicular block in real time. Ultrasound videos were retrospectively collected from 881 patients to develop the CADx system (600 to the training and validation set and 281 to the test set). The CADx system included classification and segmentation approaches, with Residual neural network (ResNet) and U-Net, respectively, applied as backbone networks. In the classification approach, an ablation study was performed to determine the optimal architecture and improve the performance of the model. In the segmentation approach, a cascade structure, in which U-Net is connected to ResNet, was implemented. The performance of the two approaches was evaluated based on a confusion matrix. Using the classification approach, ResNet34 and gated recurrent units with augmentation showed the highest performance, with average accuracy 0.901, precision 0.613, recall 0.757, f1-score 0.677 and AUROC 0.936. Using the segmentation approach, U-Net combined with ResNet34 and augmentation showed poorer performance than the classification approach. The CADx system described in this study showed high performance in determining the optimal view for SCB. This system could be expanded to include many anatomical regions and may have potential to aid clinicians in real-time settings.Trial registration The protocol was registered with the Clinical Trial Registry of Korea (KCT0005822, https://cris.nih.go.kr ).
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Affiliation(s)
- Yumin Jo
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chungnam National University and Hospital, 282 Munhwar-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Dongheon Lee
- Department of Biomedical Engineering, College of Medicine, Chungnam National University and Hospital, Daejeon, Republic of Korea
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Donghyeon Baek
- Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | | | | | - Jinsik Jung
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chungnam National University and Hospital, 282 Munhwar-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Yong Sup Shin
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chungnam National University and Hospital, 282 Munhwar-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Boohwi Hong
- Department of Anaesthesiology and Pain Medicine, College of Medicine, Chungnam National University and Hospital, 282 Munhwar-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
- Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Republic of Korea.
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4
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Robinson E, Little D. A practical guide to undergraduate radiology education. Clin Radiol 2022; 77:e826-e834. [DOI: 10.1016/j.crad.2022.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022]
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5
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Wu Z, Wang Y. Development of Guidance Techniques for Regional Anesthesia: Past, Present and Future. J Pain Res 2021; 14:1631-1641. [PMID: 34135627 PMCID: PMC8200162 DOI: 10.2147/jpr.s316743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/30/2021] [Indexed: 12/24/2022] Open
Abstract
Regional anesthesia has been widely used in clinical practice. Over the past 30 years, various guidance techniques have been developed for regional anesthesia ranging from paresthesia progressing to neurostimulation and currently ultrasound guidance. Especially, the use of point-of-care ultrasound greatly enhances the success rate of regional anesthesia. However, the poor imaging quality of ultrasound in patients with obesity, fat infiltration, etc., limits the use of ultrasound. The combined use of ultrasound with neurostimulator, electromyography, pressure monitoring, etc. is advocated in order to facilitate regional anesthesia in this cohort of patients. The accumulated evidence has shown that the ultrasound combined with other techniques (UCOT) can help to solve the difficulties of puncture location caused by obesity, anatomical variation, and other factors when using ultrasound guidance alone. In recent years, with the development of medical image fusion and medical image artificial intelligence identification technology, guidance techniques for regional anesthesia have advanced considerably. To understand the advantages and disadvantages of the various guidance techniques for regional anesthesia developed in recent years and to guide their rational clinical application, this paper reviews these techniques, describing the progression from the early use of paresthesia to the latest UCOT, as well as the latest research on UCOT, and the prospects for the development of new guidance techniques for regional anesthesia.
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Affiliation(s)
- Zehao Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
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6
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Johnston DF, Turbitt LR. Defining success in regional anaesthesia. Anaesthesia 2021; 76 Suppl 1:40-52. [PMID: 33426663 DOI: 10.1111/anae.15275] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/13/2022]
Abstract
Utilisation of regional anaesthesia is increasing globally; however, it remains challenging to determine the overall benefit of individual regional anaesthesia procedures. Like any peri-operative intervention, the benefit to the patient and healthcare system must outweigh any patient risk or resource implications. This review aims to identify markers of success in regional anaesthesia, categorise these into an objective framework and rationalise suggestions on how measuring outcomes in regional anaesthesia can be used to develop the widespread performance of this evolving subspecialty. This framework of measuring success of regional anaesthesia contains four pillars: patient-centred, population-centred, healthcare-centred and training-centred outcomes. Each pillar of success contains several outcomes which provide a structure for the measurement and development of regional anaesthesia success on a global scale.
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Affiliation(s)
- D F Johnston
- Department of Anaesthesia, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - L R Turbitt
- Department of Anaesthesia, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
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7
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Moll V, Schmidt PC, Amos C, Workneh RS, Tadesse M, Mulugeta E, Abate A. Building regional anesthesia capacity in limited-resource settings: a pilot study evaluating a 4-week curriculum. Pain Manag 2020; 11:29-37. [PMID: 33073715 DOI: 10.2217/pmt-2020-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To pilot a 4-week regional anesthesia curriculum for limited-resource settings. Intervention: A baseline needs assessment and knowledge test were deployed. The curriculum included lectures and hands-on teaching, followed by knowledge attainment tests. Results: Scores on the knowledge test improved from a mean of 37.1% (SD 14.7%) to 50.9% (SD 18.6%) (p = 0.017) at 4 weeks and 49% at 24 months. An average of 1.7 extremity blocks per month was performed in 3 months prior to the curriculum, compared with an average of 4.1 per month in 8 months following. Conclusion: This collaborative curriculum appeared to have a positive impact on the knowledge and utilization of regional anesthesia.
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Affiliation(s)
- Vanessa Moll
- Department of Anesthesiology, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA.,Institute of Anesthesiology, University of Zurich, Zurich, Switzerland
| | - Peter C Schmidt
- Department of Anesthesiology, Division of Pain Medicine, Stanford University, Stanford, CA, USA
| | - Corrie Amos
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY, USA
| | - Rediet S Workneh
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Mahelet Tadesse
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Ewnetu Mulugeta
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Ananya Abate
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
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8
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Education and training in ultrasound-guided regional anaesthesia and pain medicine. Curr Opin Anaesthesiol 2020; 33:674-684. [PMID: 32826622 DOI: 10.1097/aco.0000000000000908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Effective and safe regional anaesthesia and pain medicine procedures require clinicians to learn and master complex theoretical knowledge and motor skills. This review aims to summarize articles relevant to education and training in these skill sets in the previous 2 years. RECENT FINDINGS Twenty-two articles were identified, investigating nine out of the 13 top-ranked research topics in education and training in regional anaesthesia. Research topics addressed by these articles included prerotation simulation, deliberate practice combined with formative assessment tools, validation of assessment tools, three-dimensional-printed models, and knowledge translation from simulation to clinical practice. Emerging concepts investigated for their applications in regional anaesthesia included eye-tracking as a surrogate metric when evaluating proficiency, and elastography aiding visual salience to distinguish appropriate perineural and inappropriate intraneural injections. SUMMARY Research into education and training in regional anaesthesia covered multiple and diverse topics. Methodological limitations were noted in several articles, reflecting the difficulties in designing and conducting medical education studies. Nonetheless, the evidence-base continues to mature and innovations provide exciting future possibilities.
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9
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Woodworth G, Maniker RB, Spofford CM, Ivie R, Lunden NI, Machi AT, Elkassabany NM, Gritsenko K, Kukreja P, Vlassakov K, Tedore T, Schroeder K, Missair A, Herrick M, Shepler J, Wilson EH, Horn JL, Barrington M. Anesthesia residency training in regional anesthesiology and acute pain medicine: a competency-based model curriculum. Reg Anesth Pain Med 2020; 45:660-667. [DOI: 10.1136/rapm-2020-101480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/03/2022]
Abstract
The Accreditation Council for Graduate Medical Education has shifted to competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills and behaviors expected of competent trainees. It also requires an assessment program to provide formative feedback to trainees as they progress to competency in each outcome. Critical to the success of a curriculum is its practical implementation. This article describes the development of model curricula for anesthesiology residency training in regional anesthesia and acute pain medicine (core and advanced) using a competency-based framework. We further describe how the curricula were distributed through a shared web-based platform and mobile application.
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10
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Turbitt LR, Mariano ER, El‐Boghdadly K. Patient‐centred care in regional anaesthesia – a reply. Anaesthesia 2019; 74:1343-1344. [DOI: 10.1111/anae.14820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - E. R. Mariano
- Stanford University School of Medicine Stanford CA USA
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11
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Beals T, Odashima K, Haines LE, Likourezos A, Drapkin J, Dickman E. Interscalene brachial plexus nerve block in the emergency department: an effective and practice-changing workshop. Ultrasound J 2019; 11:15. [PMID: 31359309 PMCID: PMC6638603 DOI: 10.1186/s13089-019-0131-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background The interscalene brachial plexus nerve block (ISNB) is a potentially useful method of regional analgesia for humerus fracture and shoulder dislocation reduction in the Emergency Department (ED). We examined the effectiveness of an ISNB workshop given to emergency medicine (EM) residents. We also explored complication rates and effectiveness of ISNBs performed in the ED. Methods One-hour evidence-based ISNB workshops were conducted with EM residents. Participants were given pre-, post-, and 3-month post-workshop knowledge and technical assessments. Results were analyzed using descriptive statistics. A pre- and post-workshop chart review examined ISNB utilization, complications, post-ISNB opiate administration, and post-ISNB procedural sedation. Results 41 residents enrolled in the workshop. Pre-workshop pass rate: knowledge assessment 22%. Immediate post-workshop pass rates: knowledge assessment 100%, image acquisition 93%, needle placement 100%. Three months post-workshop pass rates: knowledge assessment 73%, image acquisition 76%, needle placement 100%. Areas of poorest knowledge retention were anatomical landmarks, block distribution, and early signs of LAST. In the chart review, 2 ISNBs were performed in the pre-workshop period, and 12 in the post-workshop period. No serious complications were recorded. 78.5% of attempted ISNBs were successful, without need for procedural sedation. Of the 11 successfully performed ISNBs, 91% received no opiates after the procedure. Conclusions Our study suggests that EM residents can learn the ISNB, perform it safely in the emergency department, and that the ISNB may be an alternative to procedural sedation and opiate use for shoulder dislocation. Residents are adept at ISNB technical skills but demonstrate some deficits in knowledge retention.
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Affiliation(s)
- Tyler Beals
- Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Rosenberg 2, Boston, MA, 02215, USA.
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12
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Conlon TW, Lin EE, Bruins BB, Manrique Espinel AM, Muhly WT, Elliott E, Glau C, Himebauch AS, Johnson G, Fiadjoe JE, Lockman JL, Nishisaki A, Schwartz AJ. Getting to know a familiar face: Current and emerging focused ultrasound applications for the perioperative setting. Paediatr Anaesth 2019; 29:672-681. [PMID: 30839154 DOI: 10.1111/pan.13625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 02/26/2019] [Accepted: 03/03/2019] [Indexed: 12/18/2022]
Abstract
Ultrasound technology is available in many pediatric perioperative settings. There is an increasing number of ultrasound applications for anesthesiologists which may enhance clinical performance, procedural safety, and patient outcomes. This review highlights the literature and experience supporting focused ultrasound applications in the pediatric perioperative setting across varied disciplines including anesthesiology. The review also suggests strategies for building educational and infrastructural systems to translate this technology into clinical practice.
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Affiliation(s)
- Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaina E Lin
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin B Bruins
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ana Maria Manrique Espinel
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wallis T Muhly
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Elliott
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christie Glau
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gregory Johnson
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John E Fiadjoe
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alan Jay Schwartz
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
OBJECTIVES Education 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. DESIGN Electronic structured Delphi questionnaire over three rounds. SETTING International. PARTICIPANTS 38 experts in regional anaesthesia education and training, identified through the American Society of Regional Anesthesia Education Special Interest Group research collaboration. RESULTS 82 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. CONCLUSIONS Researchers and educators can use these identified topics to assist in planning and structuring their research and training in regional anaesthesia education.
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Affiliation(s)
- Alwin Chuan
- Faculty of Medicine, University of New South Wales, Liverpool, New South Wales, Australia
- Department of Anaesthesia, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Reva Ramlogan
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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14
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Mullaney P. Qualitative ultrasound training: defining the learning curve. Clin Radiol 2019; 74:327.e7-327.e19. [DOI: 10.1016/j.crad.2018.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/24/2018] [Indexed: 12/01/2022]
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15
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Chuan A, Ramlogan R. Prioritizing research topics in regional anesthesia education. Reg Anesth Pain Med 2019; 44:rapm-2019-100512. [PMID: 30923254 DOI: 10.1136/rapm-2019-100512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/08/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Alwin Chuan
- Faculty of Medicine, University of New South Wales, Putney, New South Wales, Australia
- Department of Anaesthesia, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Reva Ramlogan
- Anesthesiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
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16
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Kessler J. Education and Training in Ultrasound-Guided Neuraxial Anaesthesia. Anaesth Intensive Care 2019; 42:447-8. [DOI: 10.1177/0310057x1404200403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Kim TE, Tsui BCH. Simulation-based ultrasound-guided regional anesthesia curriculum for anesthesiology residents. Korean J Anesthesiol 2018; 72:13-23. [PMID: 30481945 PMCID: PMC6369343 DOI: 10.4097/kja.d.18.00317] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 01/22/2023] Open
Abstract
Proficiency in ultrasound-guided regional anesthesia (UGRA) requires the practitioner to acquire cognitive and technical skills. For anesthesiology residents, an assortment of challenges has been identified in learning UGRA skills. Currently, a validated UGRA curriculum for residents does not exist, and the level of UGRA proficiency achieved during residency training can vary considerably. Simulated practice has been shown to enhance proficiency in UGRA, and a competency-based education with simulation training has been endorsed for anesthesiology residents. The objective of this review is to outline simulation-based training that can be implemented in a UGRA curriculum and to explore educational tools like gamification to facilitate competency in regional anesthesiology.
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Affiliation(s)
- T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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18
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Ultrasonography and Italian anesthesiology: a national cross-sectional study. J Ultrasound 2018; 22:77-83. [PMID: 30387039 DOI: 10.1007/s40477-018-0334-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE In recent years, ultrasound has seen a rapid development with numerous applications in anesthesia, intensive-care medicine, and pain medicine, increasing efficacy and safety of procedures. We investigated the prevalence of ultrasound use among Italian anesthetists. METHODS A cross-sectional prevalence study was carried out on a sample of 735 anesthetists. The research was conducted during the ultrasound training in anesthesia and intensive care, in the Italian Associazione Anestesisti Rianimatori Ospedalieri - Emergenza Area Critica "SimuLearn®" training centre (Bologna, Italy). RESULTS The overall prevalence of a dedicated ultrasound devices in the operating room was 70% [95% CI 66-73%], while 74% [95% CI 69-78%] in northern Italy, 61% [95% CI 52-68%] in southern Italy, and 70% [95% CI 63-77%] in central Italy, indicating a significant difference between the north and south of Italy. The prevalence of regular use of ultrasound was high for regional anesthesia and for central venous cannulation [82-95% CI 79-85%] and low for pain therapy procedures [7-95% CI 6-10%]. Multivariate logistic analysis showed that the presence of a dedicated ultrasound device and high expertise were factors associated with routine use of ultrasound for regional anesthesia in upper and lower limb blocks and in vascular access. CONCLUSION The appropriate training in the use of ultrasound in anesthesia, intensive-care medicine, and pain therapy should be implemented in south of Italy to make uniform the widespread of ultrasonography in anesthesia, in all Italian regions.
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Shafqat A, Rafi M, Thanawala V, Bedforth N, Hardman J, McCahon R. Validity and reliability of an objective structured assessment tool for performance of ultrasound-guided regional anaesthesia. Br J Anaesth 2018; 121:867-875. [DOI: 10.1016/j.bja.2018.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/13/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022] Open
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Deliberate practice using validated metrics improves skill acquisition in performance of ultrasound-guided peripheral nerve block in a simulated setting. J Clin Anesth 2018; 48:22-27. [DOI: 10.1016/j.jclinane.2018.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/13/2018] [Accepted: 04/27/2018] [Indexed: 01/22/2023]
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Chuan A, Wan A, Royse C, Forrest K. Competency-based assessment tools for regional anaesthesia: a narrative review. Br J Anaesth 2018; 120:264-273. [DOI: 10.1016/j.bja.2017.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/02/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022] Open
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McCormick TJ, Miller EC, Chen R, Naik VN. Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists. Can J Anaesth 2018; 65:427-436. [DOI: 10.1007/s12630-018-1049-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 01/16/2023] Open
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Young J, Coles-Black J, Chao I, Barrington MJ. Steps on how a phantom can be 3D printed and embedded within a medium suitable for training of ultrasound-guided procedures. ACTA ACUST UNITED AC 2017. [DOI: 10.2217/3dp-2017-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Practice is required for acquiring procedural proficiency and this can be obtained from clinical practice, or more sensibly, having novices first practice the skill on an inanimate phantom or trainer. Commercially produced phantoms are expensive and 3D printing is becoming more cost effective. In our example, we have used a 3D-printed thoracic spine. This allows practitioners to improve their ultrasound-guided regional anesthesia needle imaging skills through deliberate practice. In this report, we describe in detail the requirements for producing a 3D-printed phantom comprising a 3D segment of thoracic spine set within a semi-solid medium.
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Affiliation(s)
- J Young
- Wellington Hospital, Wellington, New Zealand
| | - J Coles-Black
- Department of Surgery, Austin Health, The University of Melbourne, VIC, Australia
| | - I Chao
- Eastern Health Department of Anesthesia, Austin Health, Austin 3D labs, Melbourne, VIC, Australia
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Kim TE, Ganaway T, Harrison TK, Howard SK, Shum C, Kuo A, Mariano ER. Implementation of clinical practice changes by experienced anesthesiologists after simulation-based ultrasound-guided regional anesthesia training. Korean J Anesthesiol 2017; 70:318-326. [PMID: 28580083 PMCID: PMC5453894 DOI: 10.4097/kjae.2017.70.3.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 11/21/2022] Open
Abstract
Background Anesthesiologists 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. Methods Practicing 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. Results Survey 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. Conclusions Participation in a 1 day simulation-based UGRA course may increase UGRA procedural volume by practicing anesthesiologists.
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Affiliation(s)
- T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Toni Ganaway
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Cynthia Shum
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alex Kuo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Lahham S, Smith T, Baker J, Purdy A, Frumin E, Winners B, Wilson SP, Gari A, Fox JC. Procedural simulation: medical student preference and value of three task trainers for ultrasound guided regional anesthesia. World J Emerg Med 2017; 8:287-291. [PMID: 29123607 DOI: 10.5847/wjem.j.1920-8642.2017.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks. METHODS This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device. RESULTS Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10 (40%) of the participants preferred the Blue Phantom model, while 10 (40%) preferred the homemade gelatin model and 5 (20%) preferred the homemade tofu model. After cost awareness, the majority, 18 (72%) preferred the gelatin model. CONCLUSION The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.
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Affiliation(s)
- Shadi Lahham
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Taylaur Smith
- UC Irvine School of Medicine, Irvine, California, USA
| | - Jessa Baker
- UC Irvine School of Medicine, Irvine, California, USA
| | - Amanda Purdy
- UC Irvine School of Medicine, Irvine, California, USA
| | - Erica Frumin
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Bret Winners
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Sean P Wilson
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Abdulatif Gari
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - John C Fox
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
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Ahmed OMA, O'Donnell BD, Gallagher AG, Breslin DS, Nix CM, Shorten GD. Construct validity of a novel assessment tool for ultrasound-guided axillary brachial plexus block. Anaesthesia 2016; 71:1324-1331. [DOI: 10.1111/anae.13572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 01/22/2023]
Affiliation(s)
- O. M. A. Ahmed
- University College Cork and Cork University Hospital; Cork Ireland
| | - B. D. O'Donnell
- Cork University Hospital and the ASSERT Centre; University College Cork; Cork Ireland
| | | | | | - C. M. Nix
- University Hospital Limerick; Limerick Ireland
- University of Toronto; Toronto Ontario Canada
| | - G. D. Shorten
- Cork University Hospital and the ASSERT Centre; University College Cork; Cork Ireland
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Lam NCK, Baker EB, Fishburn SJ, Hammer AR, Petersen TR, Mariano ER. A Randomized Double-Blinded Trial on the Effects of Ultrasound Transducer Orientation on Teaching and Learning Ultrasound-Guided Regional Anesthesia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1509-1516. [PMID: 27246662 DOI: 10.7863/ultra.15.09031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Learning ultrasound-guided regional anesthesia skills, especially needle/ beam alignment, can be especially difficulty for trainees, who can often become frustrated. We hypothesized that teaching novices to orient the transducer and needle perpendicular to their shoulders will improve performance on a standardized task, compared to holding the transducer and needle parallel to the shoulders. METHODS This study compared the effects of transducer orientation on trainees' ability to complete a standardized ultrasound-guided nerve block simulation. The time to task completion and percentage of the attempt time without adequate needle visualization were measured. Participants were right-handed healthy adults with no previous ultrasound experience and were randomly assigned to training in either transducer and needle alignment in a coronal plane, parallel to the shoulders (parallel group) or transducer and needle alignment in a sagittal plane, perpendicular to the shoulders (perpendicular group). Participants used ultrasound to direct a needle to 3 targets in a standardized gelatin phantom and repeated this task 3 times. Their efforts were timed and evaluated by an assessor, who was blinded to group assignment. RESULTS Data were analyzed on 28 participants. The perpendicular group was able to complete the task more quickly (P < .001) and with a smaller proportion of time lost to inadequate needle visualization (P < .001). CONCLUSIONS Ultrasound-guided regional anesthesia trainees complete a standardized task more quickly and efficiently when instructed to hold the transducer and needle in an orientation perpendicular to their shoulders.
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Affiliation(s)
- Nicholas C K Lam
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA
| | - Elizabeth B Baker
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA
| | - Steven J Fishburn
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA
| | - Angie R Hammer
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA
| | - Timothy R Petersen
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA. Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA
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Chuan A, Lim YC, Aneja H, Duce NA, Appleyard R, Forrest K, Royse CF. A randomised controlled trial comparing meat-based with human cadaveric models for teaching ultrasound-guided regional anaesthesia. Anaesthesia 2016; 71:921-9. [DOI: 10.1111/anae.13446] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Chuan
- Liverpool Hospital; Sydney New South Wales Australia
| | | | - H. Aneja
- Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - N. A. Duce
- Liverpool Hospital; Sydney New South Wales Australia
| | - R. Appleyard
- Macquarie University; Sydney New South Wales Australia
| | - K. Forrest
- Macquarie University; Sydney New South Wales Australia
| | - C. F. Royse
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
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Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists’ Acquisition of Ultrasound-Guided Regional Anesthesia Skills. Reg Anesth Pain Med 2016; 41:151-7. [DOI: 10.1097/aap.0000000000000361] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McIsaac D, Cole E, McCartney C. Impact of including regional anaesthesia in enhanced recovery protocols: a scoping review. Br J Anaesth 2015; 115 Suppl 2:ii46-56. [DOI: 10.1093/bja/aev376] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Chuan A, Graham PL, Wong DM, Barrington MJ, Auyong DB, Cameron AJD, Lim YC, Pope L, Germanoska B, Forrest K, Royse CF. Design and validation of the Regional Anaesthesia Procedural Skills Assessment Tool. Anaesthesia 2015; 70:1401-11. [DOI: 10.1111/anae.13266] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 11/30/2022]
Affiliation(s)
- A. Chuan
- Liverpool Hospital Sydney New South Wales Australia
| | - P. L. Graham
- Macquarie University Sydney New South Wales Australia
| | - D. M. Wong
- St Vincent's Hospital Melbourne Victoria Australia
| | - M. J. Barrington
- St Vincent's Hospital Melbourne Victoria Australia
- University of Melbourne Melbourne Victoria Australia
| | - D. B. Auyong
- Virginia Mason Medical Centre Seattle Washington USA
| | | | | | - L. Pope
- Liverpool Hospital Sydney New South Wales Australia
| | | | - K. Forrest
- Macquarie University Sydney New South Wales Australia
| | - C. F. Royse
- University of Melbourne Melbourne Victoria Australia
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Przkora R, McGrady W, Vasilopoulos T, Gravenstein N, Solanki D. Evaluation of the Head-Mounted Display for Ultrasound-Guided Peripheral Nerve Blocks in Simulated Regional Anesthesia. PAIN MEDICINE 2015; 16:2192-4. [DOI: 10.1111/pme.12765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 11/27/2022]
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Mariano ER, Harrison TK, Kim TE, Kan J, Shum C, Gaba DM, Ganaway T, Kou A, Udani AD, Howard SK. Evaluation of a Standardized Program for Training Practicing Anesthesiologists in Ultrasound-Guided Regional Anesthesia Skills. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1883-1893. [PMID: 26384608 DOI: 10.7863/ultra.14.12035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.)
| | - T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.)
| | - Jack Kan
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.)
| | - Cynthia Shum
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.)
| | - David M Gaba
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.)
| | - Toni Ganaway
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.)
| | - Alex Kou
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.)
| | - Ankeet D Udani
- Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.)
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Udani AD, Kim TE, Howard SK, Mariano ER. Simulation in teaching regional anesthesia: current perspectives. Local Reg Anesth 2015; 8:33-43. [PMID: 26316812 PMCID: PMC4540124 DOI: 10.2147/lra.s68223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The emerging subspecialty of regional anesthesiology and acute pain medicine represents an opportunity to evaluate critically the current methods of teaching regional anesthesia techniques and the practice of acute pain medicine. To date, there have been a wide variety of simulation applications in this field, and efficacy has largely been assumed. However, a thorough review of the literature reveals that effective teaching strategies, including simulation, in regional anesthesiology and acute pain medicine are not established completely yet. Future research should be directed toward comparative-effectiveness of simulation versus other accepted teaching methods, exploring the combination of procedural training with realistic clinical scenarios, and the application of simulation-based teaching curricula to a wider range of learner, from the student to the practicing physician.
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Affiliation(s)
- Ankeet D Udani
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA ; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA ; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA ; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Lam NCK, Fishburn SJ, Hammer AR, Petersen TR, Gerstein NS, Mariano ER. A Randomized Controlled Trial Evaluating the See, Tilt, Align, and Rotate (STAR) Maneuver on Skill Acquisition for Simulated Ultrasound-Guided Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1019-1026. [PMID: 26014321 DOI: 10.7863/ultra.34.6.1019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Achieving the best view of the needle and target anatomy when performing ultrasound-guided interventional procedures requires technical skill, which novices may find difficult to learn. We hypothesized that teaching novice performers to use 4 sequential steps (see, tilt, align, and rotate [STAR] method) to identify the needle under ultrasound guidance is more efficient than training with the commonly described probe movements of align, rotate, and tilt (ART). METHODS This study compared 2 instructional methods for transducer manipulation including alignment of a probe and needle by novices during a simulated ultrasound-guided nerve block. Right-handed volunteers between the ages of 18 and 55 years who had no previous ultrasound experience were recruited and randomized to 1 of 2 groups; one group was trained to troubleshoot misalignment with the ART method, and the other was trained with the new STAR maneuver. Participants performed the task, consisting of directing a needle in plane to 3 targets in a standardized gelatin phantom 3 times. The performance assessor and data analyst were blinded to group assignment. RESULTS Thirty-five participants were recruited. The STAR group was able to complete the task more quickly (P < .001) and visualized the needle in a greater proportion of the procedure time (P = .004) compared to the ART group. All STAR participants were able to complete the task, whereas 41% of ART participants abandoned the task (P = .003). CONCLUSIONS Novices are able to complete a simulated ultrasound-guided nerve block more quickly and efficiently when trained with the 4-step STAR maneuver compared to the ART method.
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Affiliation(s)
- Nicholas C K Lam
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Steven J Fishburn
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Angie R Hammer
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Timothy R Petersen
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.)
| | - Edward R Mariano
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA (N.C.K.L., S.J.F., A.R.H., T.R.P., N.S.G.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA (E.R.M.); and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA (E.R.M.).
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Computerized training system for ultrasound-guided lumbar puncture on abnormal spine models: a randomized controlled trial. Can J Anaesth 2015; 62:777-84. [DOI: 10.1007/s12630-015-0367-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/18/2015] [Indexed: 01/22/2023] Open
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Abstract
Available evidence favoring the use of ultrasound for regional anesthesia is reviewed, updated, and critically assessed. Important outcome advantages include decreased time to block onset; decreased risk of local anesthetic systemic toxicity; and, depending on the outcome definition, increased block success rates. Ultrasound guidance, peripheral nerve blocks, and central neuraxial blocks are discussed.
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Affiliation(s)
- Francis V Salinas
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA.
| | - Neil A Hanson
- Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop B2-AN, Seattle, WA 98101, USA
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Abstract
Ultrasound has permeated the practice of anesthesiology and is becoming an essential tool for the obstetric anesthesiologist in the labor and delivery suite. The most common applications include guidance for neuraxial (epidural and spinal) anesthesia and acute pain nerve blocks, as well as guidance for central and peripheral vascular access. Obstetric anesthesiologists are becoming increasingly familiar with diagnostic applications, including transthoracic echocardiography (TTE) and lung and gastric ultrasound. There is intense interest in developing standard curricula for achieving competency in ultrasound skills during residency training and expanding the role of ultrasound in education and research.
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Affiliation(s)
- Allison Lee
- Department of Anesthesiology, Columbia University, 630 West 168th St PH5, New York, NY 10032.
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Laurent DAB, Niazi AU, Cunningham MS, Jaeger M, Abbas S, McVicar J, Chan VW. A Valid and Reliable Assessment Tool for Remote Simulation-Based Ultrasound-Guided Regional Anesthesia. Reg Anesth Pain Med 2014; 39:496-501. [DOI: 10.1097/aap.0000000000000165] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evaluation of a Task-Specific Checklist and Global Rating Scale for Ultrasound-Guided Regional Anesthesia. Reg Anesth Pain Med 2014; 39:399-408. [DOI: 10.1097/aap.0000000000000126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Development of an Ultrasound Phantom for Spinal Injections With 3-Dimensional Printing. Reg Anesth Pain Med 2014; 39:429-33. [DOI: 10.1097/aap.0000000000000136] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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