ASRA Pain Medicine Update

How I Do It: Learning Lessons From Organizing an Ultrasound-Guided Regional Anesthesia Course at the Cleveland Clinic

Aug 6, 2019

Hari Krishna Prasad Kalagara, MD, FCARCSI, EDRA

Involvement in the organization of an ultrasound-guided regional anesthesia (UGRA) course for the past six years has given me personal experiences and lessons learned that I can share with ASRA members. Here are some potential challenges and strategies to increase the success of a regional anesthesia workshop.


After completing my anesthesia training in the United Kingdom, I moved to the United States for a regional anesthesia and acute pain medicine (RAAPM) fellowship at the Cleveland Clinic in 2012. With my previous experiences as a learner and teacher at various UGRA workshops throughout Europe, I felt a strong need to provide lifelong learning opportunities on a regional scale at my new institution. In light of concurrent problems with opioid shortages and abuse, these courses can serve as a backbone for anesthesiologists to become familiarized and incorporate regional anesthesia into their daily clinical practice, ultimately improving patient care.

I learned quickly that strong mentorship can have a profound impact on success. I initially conceived the idea of a regional UGRA course during my RAAPM fellowship, and Drs David Brown and Richard Rosenquist, former ASRA presidents at the Cleveland Clinic, were available to guide and encourage me. Strong mentorship is crucial to guide scientific content of the workshops and facilitate the availability of organizational resources.


A key element for the establishment of any workshop or course is robust strategic planning. Preparation should begin by surveying various existing national regional anesthesia courses and assessing learning gaps. We discovered that the region lacked a cadaveric UGRA course with fresh frozen human cadavers, so we introduced one as a regional anesthesia course at the Cleveland Clinic. Providing an anatomical perspective to commonly used regional anesthesia techniques would lead to an increase in learner understanding and skill.

Budget and Continuing Medical Education

An important starting point for any course is to consider educational content and financial budget planning. Course success largely depends on a well-planned educational program with learning goals and objectives that align with participants’ expectations. The biggest challenge for any workshop organizer is obtaining continuing medical education (CME) approval because it can be a lengthy and time-consuming process. However, providing CME is critical to make sure that adequate numbers of attendees will register. Submission of the course CME application, listing all faculty financial disclosures and grants, and ensuring that course educational material remains commercial interest-free are mandatory requirements for CME accreditation. Every step in the course organization process is closely monitored by the CME department, which may be associated with significant costs. Other costs might include course advertisement and promotion, conference space, speaker fees, and food. Applying for small educational and industry grants may provide financial resources.

Course Logistics

Scheduling the course to avoid overlap with major conferences is absolutely critical. A venue that facilitates easy travel or might be seen as an attractive vacation destination may increase the pool of potential attendees. Course content and faculty may also impact the desire to attend any particular course. Speakers with varied backgrounds and experience will diversify the course and increased the educational value for participants. Effective marketing and advertising strategies include listing the course on major websites and social media, as well as sending e-mails and mailed pieces directly to potential registrants. Course announcements should be made well in advance so that attendees can plan their leave from work and obtain necessary funding.

Course Design

When designing a course, the goal should be to deliver a world-class learning experience to all participants. The faculty-to-learner ratio should be kept low to ensure that attendees are provided with adequate speaker contact and attention. In our course, we generally provide two faculty with two ultrasounds per group to ensure ample time for a quality learning experience.

In light of the concurrent problems with opioid shortages and abuse, these courses can serve as a backbone for anesthesiologists to familiarize and incorporate regional anesthesia into their daily clinical practice and ultimately improve patient care.

In our experience, cadaveric UGRA workshops represent a phenomenal way to familiarize participants with sonoanatomy, ultrasound probe handling, needling practice, and catheter placement. Certain techniques such as spine imaging and interfascial plane blocks are well appreciated on fresh frozen human cadavers. Live model scanning provides a demonstration of sonoanatomy relevant to the provision of various regional anesthesia techniques (eg, adjacent vascular structures, muscle planes, how patient movement may enhance visualization). Didactic lectures should enhance and emphasize the hands-on demonstrations. Provide educational material in advance to allow for learners to arrive to the course well prepared and more able to learn advanced or more complex skills and materials.

Course Day

Despite the tremendously long days for faculty and participants, proper execution and demonstration of regional anesthesia techniques by expert faculty ensures that courses run smoothly and are enjoyable for participants. “Ask the Experts” sessions provide attendees with additional opportunities to gain perspective on various approaches to pain management. Cadaveric teaching sessions facilitate a greater appreciation of the applied anatomy and corresponding sonoanatomy relevant to RA. Patient safety and outcomes aspects relevant to RA are also important topics.

Listen, Learn, and Practice

The educational structure of listen, learn, and practice functions well for regional anesthesia courses. This can be delivered using robust lectures, cadaver and live model hands-on skill stations, and with expert faculty interactive sessions.

Other aspects that enhance the learning experience are timely communications with the faculty and participants, a friendly atmosphere and collegiality during the course for networking, motivated faculty to facilitate effective learning and problem solving, and a good management team for administrative tasks.

Feedback and Course Remodeling

Feedback and evaluations are a vital source of material to plan future events and ensure that content matches participants’ needs. Ideally, feedback should be obtained prior to participants departing or soon after the course to ensure that they are able to recall aspects that were done well or could use improvement.

Point-of-Care Ultrasound

Point-of-care ultrasound (PoCUS) topics closely related to regional anesthesia, such as assessment for pneumothorax and diaphragmatic assessment with a specific focus on recognizing the complications or side effects from specific nerve blocks, may also interest regional anesthesia providers. We added PoCUS skills to our course following feedback from attendees. As with any course, ensure that course topics are not overly broad or ambitious and that appropriate faculty are providing education on any given subject.


Developing a UGRA course requires advanced strategic planning, budgeting, good administrative teamwork, and experienced and motivated faculty. It is an evolving process involving constant remodeling of course content to customize the learning experience at different time points. The learning atmosphere is equally important to facilitate effective learning and course attendance. Operating these courses has been rewarding in that it has provided great opportunities to support and promote colleagues from my own institution as well as interact and collaborate with course faculty from other institutions.

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