Impact of an ultrasound-guided regional anesthesia workshop on participants' confidence levels and clinical practice

Abstract

The use of ultrasound-guided regional anesthesia (UGRA) has increased, leading to a growing demand for UGRA training [1]. Education may be particularly challenging for those already in established practice because educational opportunities are less obvious. In 2009, the American and European Societies of Regional Anesthesia published guidelines for training pathways in UGRA [2]. For practicing anesthesiologists, they recommended workshops consisting of "didactic teaching and hands-on experience [2]. " However, there is limited evidence [3] suggesting that these workshops are effective and can impact participants' clinical practice. We aimed to assess if attendance at a UGRA workshop improved confidence in block performance and impacted clinical practice. Since 2004, the regional anesthesia group at Toronto Western Hospital, University Health Network has conducted semi-annual UGRA workshops. These 2-day workshops consist of didactic lectures, live scanning of models under expert supervision, and needling practice on low fidelity simulators. The course curriculum includes teaching on upper and lower limb blocks, truncal blocks, and neuraxial ultrasound. To assess the impact of the workshop, participants were sent an online survey after completion of two courses in 2018. The primary outcome assessed with our survey was the change in participants' confidence levels post-workshop. Secondary outcomes included participants' perceptions on whether or not the workshop made a relevant impact on their clinical practice and to identify the important factors, which can increase the use of UGRA in clinical practice. Of the 99 people who participated in the two workshops, 58 (59%) responded to the follow-up survey, and 34% of the participants stated that they felt confident in performing UGRA blocks prior to attending the workshop, which increased to 66% after the workshop (P < 0.001; McNemar's test) (Fig. 1A). The major reason participants said they were not confident was the lack of needling practice (67%). Other common reasons included inadequate scanning practice (20%) and insufficient knowledge of block procedure (13%). For less experienced participants (defined as having previously performed less than 50 blocks), there was a significant increase in the percentage of participants who felt confident after the workshop. The number of confident participants in the less experienced group rose from 6% before the workshop to 61% after (P < 0.001; McNemar's test) (Fig. 1B). In contrast, more experienced participants (defined as having previously performed more than 50 blocks) showed no change in their confidence levels before and after the workshop (Fig. 1B). Most (95%) participants stated that the workshop made a relevant impact on their clin

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