Jul 10, 2018, 10:55 AM by Adam K. Jacob, MD; Reva Ramlogan, MD, FRCPC; Colin J.L. McCartney, MB, ChB, FRCA, FRCPC

Helen Hayes is credited with saying, “The expert in anything was once a beginner.” Nowhere is that more true than the specialty of regional anesthesia (RA). The best, fastest, and safest way to educate someone on the science and art of RA to achieve proficiency—let alone, expert status—is an often-debated subject without a clear consensus. How many blocks are necessary? What is the role of simulation or other learning aids? What strategy should be used: didactic, webbased, self-directed, or group learning? These questions and others have been investigated and considered in the ongoing discussion of how best to educate anesthesia trainees.^[1–5] Compounding the complexity of these issues is the advancement and restructuring of residency training programs from a timebased model to a competency-based model through the achievement of specific milestones.

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“Technical proficiency is, of course, only one aspect of becoming competent in ultrasound-guided RA.”

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Technical proficiency is, of course, only one aspect of becoming competent in ultrasound-guided RA (UGRA). An equally important aspect of educating a trainee or current practitioner is the nontechnical nuances of RA: judgment, patient engagement, preparation, and follow-up. Furthermore, tracking outcomes and adverse events must be considered in the context of an individualized learning curve as well as ongoing practice improvement.

Addressing those challenges in the setting of a formal, structured anesthesia training program may be daunting. Guidelines to advise fellowship training in RA and acute pain medicine were first developed in 2005 and subsequently updated in 2010 and 2014.^[6] These guidelines provide a comprehensive framework for fellowship programs to follow regarding organization, content, and evaluation. However, many learners seeking training in RA have already graduated from formal anesthesia training programs and are currently practicing.^[7] Whether the same educational approach can be extrapolated to experienced, practicing clinicians interested in learning (or improving) UGRA skills has not been investigated and remains uncertain.

In 2013, Nix and colleagues^[8] presented a comprehensive review of evidence for teaching UGRA. From that, they identified three gaps in knowledge: (1) teaching styles that lend themselves to improved knowledge retention and performance improvement, (2) methods to assess learners' performance that would allow comparison across institutions, and (3) trainer and trainee characteristics or attitudes to training in RA. Their efforts represented a significant step forward in understanding limitations in current educational programs. The relative ambiguity of how best to create competent and safe regional anesthesiologists who provide high-quality care creates an opportunity to identify the best-available evidence in educational strategies, identify gaps in knowledge and practice, and lead collaborative research efforts to close those gaps.

History and Structure of the Special Interest Group (SIG)

Initially founded in 2016 by 26 ASRA members and led by Chair Dr Colin McCartney and Vice-Chair Dr Reva Ramlogan, the Education in RA SIG held its inaugural meeting at the 2017 ASRA meeting in San Francisco. The Education in RA SIG was established with the core mission of developing and advancing evidence-based educational best practices in RA training in the context of a competencybased educational model. Since its inception, the membership has grown to approximately 800 ASRA members. The SIG's goals and objectives are the following:

1. To promote an international collaboration for the development and advancement of assessment strategies of trainees in evidence-based education in RA
2. To develop methodology for the evaluation of assessment tools and simulation models, to determine the best instructional design and learning strategies for RA
3. To advance the education and implementation of RA techniques by anesthesiologists at all levels of training

Given the large size of the SIG and broad reach of education into other ASRA committees and interests, the SIG leadership created five liaison subcommittees: Continuing Medical Education (CME), Newsletter, Research, Podcast/Webcast, and Website. These liaison subcommittees were tasked with the following responsibilities:

• CME (led by Dr Stuart Grant, Duke University, Durham, North Carolina): Coordinate submitting panel suggestions, educational content, and meeting faculty to the scientific meeting planning committee and coordinate a monthly quiz question relevant to the SIG that would be sent to members and available on the website
• Newsletter (led by Dr Adam Jacob, Mayo Clinic, Rochester, Minnesota): Coordinate unique SIG newsletter articles for ASRA News and solicit a call to action for the quarterly communication to SIG members
• Research (led by Dr Alwin Chuan, University of New South Wales, Australia): Develop and maintain an online repository of ongoing research in education in RA and generate ideas for research in education in RA
• Webcast/Podcast (led by Dr Jaime Ortiz, Baylor College of Medicine, Houston, Texas): Coordinate the production of quarterly webcasts on a relevant SIG topic that is placed on the website and available to members
• Website (led by Dr Brian Allen, Vanderbilt University Medical Center, Nashville, Tennessee): Monitor the SIG webpage for updates, questions, and comments; disperse inquiries to the appropriate people; and develop and maintain a repository of key articles for the related SIG webpage

Progress to Date

In the short time since the inception of the SIG, the liaison leaders and subcommittees have been working to achieve their own objectives as well as the broader goals of the SIG. Accomplishments to date include the following:

• Development of a series of education podcasts that will be published on the website
• Initiation of multinational studies and mentorship of investigators in trials design
• Collaboration with ASRA News editorial staff to broaden education-based content and highlight efforts of all ASRA SIGs
• Updates to the ASRA Education in RA SIG website that will occur over the next several months, including educational resources for those interested in teaching RA (eg, links to assessment tools, guidance on how to teach technical and nontechnical skills around RA, helpful information for those pursuing education research)

Future Meeting

The next scheduled SIG meeting will be held during the 2018 World Congress on Regional Anesthesia and Pain Medicine, April 19–21, 2018, at the New York Marriott Marquis. For those unable to attend, a teleconference option will be available.

How Can I Join?

The Education in RA SIG invites all ASRA members who share an interest in education to join for free. Members can join the SIG by contacting membership services or via the ASRA website.

References

1. Neal JM, Gravel Sullivan A, Rosenquist RW, Kopacz DJ. Regional anesthesia and pain medicine: US anesthesiology resident training—the year 2015. Reg Anesth Pain Med 2017;42:437–441.
2. Allen BFS, McEvoy MD. Competency assessment in regional anesthesia: quantity today, quality tomorrow. Reg Anesth Pain Med 2017;42:429–431.
3. Niazi AU, Peng PW, Ho M, Tiwari A, Chan VW. The future of regional anesthesia education: lessons learned from the surgical specialty. Can J Anaesth 2016;63:966–972.
4. McCartney CJ, Mariano ER. Education in ultrasound-guided regional anesthesia: lots of learning left to do. Reg Anesth Pain Med 2016;41:663–664.
5. Neal JM. Education in regional anesthesia: caseloads, simulation, journals, and politics: 2011 Carl Koller Lecture. Reg Anesth Pain Med 2012;37:647–651.
6. Kopp SL, Hargett MJ, Liguori, GA, et al. Guidelines for fellowship training in regional anesthesiology and acute pain medicine: third edition, 2014. Reg Anesth Pain Med 2015;40:213–217.
7. Mariano ER, Harrison TK, Kim TE, et al. Evaluation of a standardized program for training practicing anesthesiologists in ultrasound-guided regional anesthesia skills. J Ultrasound Med 2015;34:1883–1893.
8. Nix CM, Margarido CB, Awad IT, et al. A scoping review of the evidence for teaching ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2013;38:471–480.