What defines expertise in regional anaesthesia? An observational analysis of practice †

Smith, Andrew F; Pope, Catherine; Goodwin, Dawn; Mort, Maggie

doi:10.1093/bja/ael175

Cited by 52 publications

(42 citation statements)

References 23 publications

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“…As previously mentioned, the blockades were performed by a single person, who was considered inexperienced through the definition of expertise in regional anaesthesia 9 . However, it is known that success in carrying out this technique requires basic knowledge of anatomy, so that the placement of the local anesthetic can be more accurate and, consequently, requiring smaller drug volumes to achieve the specific blockade of a nerve.…”

Section: Discussionmentioning

confidence: 99%

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A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

Mencalha¹,

Fernandes²,

Sousa

et al. 2014

Acta Cir. Bras.

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PURPOSE:To determine the minimum volume of methylene blue (MB) to completely color the brachial plexus (BP) nerves, simulating an effective anesthetic block in cats. METHODS:Fifteen adult male cat cadavers were injected through subscapular approach with volumes of 2, 3, 4, 5 and 6 ml in both forelimbs, for a total of 30 brachial plexus blocks (BPB). After infusions, the specimens were carefully dissected preserving each nervous branch. The measurement of the effective area was indicated by the impregnation of MB. Nerves were divided into four segments from the origin at the spinal level until the insertion into the thoracic limb muscles. The blocks were considered effective only when all the nerves were strongly or totally colored. RESULTS:Volumes of 2, 3 and 4 ml were considered insufficient suggesting a failed block, however, volumes of 5 and 6 ml were associated with a successful block. CONCLUSIONS:The injection of methylene blue, in a volume of 6 ml, completely colored the brachial plexus. At volumes of 5 and 6 ml the brachial plexus blocks were considered a successful regional block, however, volumes of 2, 3 and 4 ml were considered a failed regional block.

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Section: Discussionmentioning

confidence: 99%

“…The volume of solution injected is a relevant factor for successful anesthesia [7][8][9][10] . In the majority of the medical literature, the dose of local anesthetic chosen for brachial plexus block is mainly associated with the drug concentration and volume.…”

Section: Discussionmentioning

confidence: 99%

A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

Mencalha¹,

Fernandes²,

Sousa

et al. 2014

Acta Cir. Bras.

View full text Add to dashboard Cite

show abstract

“…Trainees often work with a large number of different clinical teachers, and they can find the variety in practice confusing. 97 An operating list of many short cases with rapid turnover makes it difficult to develop any discussion; 98 anesthesiologists must then be skilled at identifying and using the New directions in medical education 143 ''teachable moment''. How can the medical education literature inform how we improve clinical teaching in anesthesiology?…”

Section: Clinical Teachingmentioning

confidence: 99%

Review article: New directions in medical education related to anesthesiology and perioperative medicine

Bould

Naik

Hamstra

2011

Can J Anesth/J Can Anesth

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Purpose We aim to provide a broad overview of current key issues in anesthesiology education to encourage both ''clinician teachers'' and ''clinician educators'' in academic health centres to consider how medical educational theory can inform their own practice. Principal findings Evolving contextual issues, such as work-hour reform and the patient safety movement, necessitate innovative approaches to anesthesiology education. There is a substantial amount of relevant literature from other disciplines, such as sociology, psychology, and human factors research, using methodologies that are often unfamiliar to most clinicians. Recurring themes include the increasing use of simulation-based education, the importance of faculty development, challenges in teaching and assessing the non-medical expert roles, and the promise of team training and interprofessional education. Interdisciplinary collaborations are likely key to answering pressing questions in anesthesiology education, and a greater understanding of qualitative and mixed methods research

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“…Smith et al 30 describe the qualities of an expert in regional anesthesia as a practitioner with technical competence as well as the non-technical skills of handling the patient and knowing the limits of safe practice. In order to emphasize the skills other than technique, we recommend that regional anesthesia trainees acquire knowledge about the specific blocks, including the relevant anatomy, indications, and complications, prior to learning the basic practical skills.…”

Section: Knowledgementioning

confidence: 99%

The future of regional anesthesia education: lessons learned from the surgical specialty

Niazi

Peng

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Application of ultrasound in regional anesthesia has now become the standard of care and its use has shown to reduce complications. Nevertheless, gaining expertise in ultrasound-guided regional anesthesia requires the acquisition of new cognitive and technical skills. In addition, due to a reduction in resident working hours and enforcement of labour laws and directives across various states and countries, trainees perform and witness fewer procedures. Together, these issues create challenges in the teaching and learning of ultrasound-guided regional anesthesia in the time-based model of learning. Principal findings The challenges of teaching ultrasound-guided regional anesthesia are similar to those experienced by our surgical counterparts with the advent of minimally invasive surgery. In order to overcome these challenges, our surgical colleagues used theories of surgical skills training, simulation, and the concept of deliberate practice and feedback to shift the paradigm of learning from experience-based to competency-based learning. Conclusion In this narrative review, we describe the theory behind the evolution of surgical skills training. We also outline how we can apply these learning theories and simulation models to a competency-based curriculum for training in ultrasound-guided regional anesthesia.

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What defines expertise in regional anaesthesia? An observational analysis of practice †

Cited by 52 publications

References 23 publications

A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

Review article: New directions in medical education related to anesthesiology and perioperative medicine

The future of regional anesthesia education: lessons learned from the surgical specialty

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