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Training and Education of a Physician for Regional Anesthesia

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Essentials of Regional Anesthesia

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Abstract

Expertise in the practice of regional anesthesia is not achieved with technical skill alone. Although the technically adept can adequately deliver local anesthetic adjacent to target nerves, it is the regional anesthesiologist who combines such applied anatomy with the practice of perioperative medicine. The nontechnical aspects of the practice of regional anesthesia cannot be ignored: clinical judgment, patient selection and communication, complication management and avoidance, a wide breadth of knowledge of physiology and pharmacology, and the formulation of an appropriate care plan with contingencies are examples. A discussion of regional anesthesia education should first acknowledge that the discipline, at its core, is the practice of medicine. Maintaining this perspective, this chapter aims to provide a pertinent overview addressing past, present, and future challenges including competency-based education within this exciting, rapidly evolving field.

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Abbreviations

ACGME:

Accreditation Council for Graduate Medical Education

ASRA:

American Society of Regional Anesthesia

CA:

Clinical anesthesia

ESRA:

European Society of Regional Anaesthesia and Pain Therapy

PNB:

Peripheral nerve block

QI:

Quality improvement

RCC:

Anesthesiology Residency Review Committee

USGA:

Ultrasound for regional anesthesia

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA

    Chris M. Farlinger MD, MSc, FRCPC & Jonathan C. Beathe MD

Authors
  1. Chris M. Farlinger MD, MSc, FRCPC
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  2. Jonathan C. Beathe MD
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Corresponding author

Correspondence to Chris M. Farlinger MD, MSc, FRCPC .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    This physician helped teach the founder of the modern specialty of anesthesiology and became the first president of xthe original American Society of Regional Anesthesia in 1923:

    1. (a)

      Emery Rovenstine

    2. (b)

      Gaston Labat

    3. (c)

      Victor Pauchet

    4. (d)

      Carl Koller

  2. 2.

    Between the year 1980 and 2000, the reported use of regional anesthetics by training programs increased by approximately what percent?

    1. (a)

      5%

    2. (b)

      10%

    3. (c)

      15%

    4. (d)

      20%

  3. 3.

    Considering the use of regional anesthesia (RA), wide discrepancies existed between training programs in the 1980s. Approximately what range of RA case percentages were observed between low RA volume and high RA volume programs during this time?

    1. (a)

      <5–55%

    2. (b)

      10–60%

    3. (c)

      15–45%

    4. (d)

      20–45%

  4. 4.

    By the year 2000, the overall use of regional anesthesia techniques by residents in training increased to approximately what percent of total case volume?

    1. (a)

      25%

    2. (b)

      30%

    3. (c)

      35%

    4. (d)

      40%

  5. 5.

    As of July 1, 2016, the ACGME Program Requirements for Graduate Medical Education in Anesthesiology state the following minimum number of epidural, spinal, and peripheral nerve blocks to be performed by each resident:

    1. (a)

      40

    2. (b)

      50

    3. (c)

      60

    4. (d)

      80

  6. 6.

    In the year 2011, approximately what percent of graduating anesthesia residents met the ACGME criteria for peripheral nerve blocks?

    1. (a)

      75%

    2. (b)

      80%

    3. (c)

      85%

    4. (d)

      90%

  7. 7.

    In early investigations of trainee “learning curves” in regional anesthesia, approximately what range of experience level was required to achieve a 90% success rate with spinal anesthesia?

    1. (a)

      45–70 cases

    2. (b)

      40–55 cases

    3. (c)

      30–45 cases

    4. (d)

      50–60 cases

  8. 8.

    After 60 ultrasound-guided nerve blocks performed by trainees, what is the approximate average number of errors committed per procedure?

    1. (a)

      1

    2. (b)

      3

    3. (c)

      5

    4. (d)

      7

  9. 9.

    Designated regional anesthesia faculty are observed to select a regional anesthetic technique for approximately what percentage of cases?

    1. (a)

      25%

    2. (b)

      50%

    3. (c)

      65%

    4. (d)

      30%

  10. 10.

    What has been observed to be the primary reason for not performing a regional anesthetic in clinical settings amenable to such a technique?

    1. (a)

      Surgeon preference

    2. (b)

      Patient refusal

    3. (c)

      Anesthesiology-related factors

    4. (d)

      Medical contraindications

  11. 11.

    Significant improvement in success rates of spinal anesthesia are observed after approximately what level of experience is achieved?

    1. (a)

      10 cases

    2. (b)

      15 cases

    3. (c)

      20 cases

    4. (d)

      25 cases

  12. 12.

    Significant improvement in success rates of epidural anesthesia are observed after approximately what level of experience is achieved?

    1. (a)

      10 cases

    2. (b)

      15 cases

    3. (c)

      20 cases

    4. (d)

      25 cases

  13. 13.

    After the experience of 90 cases is achieved, what is the approximate observed success rate of epidural anesthesia?

    1. (a)

      50%

    2. (b)

      70%

    3. (c)

      80%

    4. (d)

      94%

  14. 14.

    Comparisons between training in what surgery has led to further advancements in regional anesthesia training?

    1. (a)

      Shoulder arthroscopy

    2. (b)

      Laparoscopic surgery

    3. (c)

      Cystoscopy

    4. (d)

      Video-assisted thoracic surgery

  15. 15.

    The Accreditation Council for Graduate Medical Education (ACGME) did not formally recognize a minimum number of regional blocks as a requirement of training until:

    1. (a)

      1980

    2. (b)

      1996

    3. (c)

      1976

    4. (d)

      1970

Answers:

  1. 1.

    b

  2. 2.

    b

  3. 3.

    a

  4. 4.

    b

  5. 5.

    a

  6. 6.

    d

  7. 7.

    a

  8. 8.

    b

  9. 9.

    c

  10. 10.

    c

  11. 11.

    c

  12. 12.

    d

  13. 13.

    c

  14. 14.

    b

  15. 15.

    b

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Farlinger, C.M., Beathe, J.C. (2018). Training and Education of a Physician for Regional Anesthesia. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_3

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

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