How Do You Do it at Your Institution? A Look at Current Regional Anesthesia Education

By Adam Jacob, MD    Jan 24, 2019

How do you do it at your institution? This timeless question inevitably stirs up discussion highlighting the differences in regional anesthesia educational curricula across the country. In 2005, ASRA published the first guidelines for training in regional anesthesia. These were subsequently updated in 2010 (2nd edition) and again in 2014 (3rd edition). Though the guidelines were created specifically for fellowship training, the guiding principles hold true for training at any level. The recommended curriculum may be prescriptive; training programs undoubtedly vary in their approach.

In order to understand the current state of regional anesthesia and acute pain medicine (RAAPM) training in the United States, my fellow Education in Regional Anesthesia SIG member Dr. Melanie Donnelly and I conducted a survey of U.S. anesthesia residency programs. We created an 18-question survey addressing a variety of factors pertaining to RAAPM education. For example, what types of educational strategies are used to educate anesthesia residents? What level of training is RAAPM training introduced? In what ways (if any) is simulation used? What proportion of the program faculty are fellowship-trained in RAAPM? Program directors from a sample of ACGME-accredited anesthesia residency programs, balanced across the 6 geographic U.S. regions (Midatlantic, Midwest, Northeast, Southeast, Southwest, West), were surveyed.

A total of 31 program directors across the county responded. The majority of programs have 4 weeks of dedicated training in RAAPM in each of the CA1, CA2, and CA3 years. Sixty-two percent of programs offered an online curriculum to assist residents in learning regional anesthesia and acute pain medicine; the majority of which were through a commercially available product or institutional, “home-grown” content. Despite the growing recognition of value in simulation for regional anesthesia training, only 48% of programs required trainees to complete an ultrasound training curriculum prior to performing their first block; 52% of programs continue to use a “see one, do one, teach one” approach.

Three interesting and important findings emerged from this survey. First, there is widespread variability in approach (e.g., timing of first exposure, use of pre-clinical simulation, dedicated block rotation). Second, despite variability of RAAPM curricula, the use of online educational content is growing in popularity. Finally, less than half of programs required residents to complete pre-clinical ultrasound training before performing their first block. Clearly, a prescriptive approach to education is a challenge for many programs given constraints in resources, possibly faculty or facilities. These results may help provide ideas and incentives for future SIG efforts to broaden RAAPM resident education.  

Adam Jacob, MD, is an anesthesiologist at Mayo Clinic in Rochester, MN. He is also the Newsletter Liaison for ASRA's Education in Regional Anesthesia Special Interest Group.

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