title: Generating a learning curve for penile block in neonates, infants and children: an empirical evaluation of technical skills in novice and experienced anaesthetists.
abstract: BACKGROUND
  Literature concerning learning curves for anaesthesiological procedures in paediatric anaesthesia is rare. The aim of this study was to assess the number of penile blocks needed to guarantee a high success rate in children.
  
  
  METHODS
  At a teaching hospital, the technical skills of 29 residents in anaesthesiology who performed penile blocks under the supervision of two staff anaesthesiologists were evaluated during a 12-month period using a standardized self-evaluation questionnaire. At the start of the study period, the residents had no prior experience in paediatric anaesthesia or in performing penile block. All residents entered the paediatric rotation after a minimum of 1-year training in adult general and regional anaesthesia. The blocks were rated using a binary score. For comparison, the success rates of the two supervising staff anaesthesiologists were collected during the same period using the same self-evaluation questionnaire. Statistical analyses were performed by generating individual and institutional learning curves by using the pooled data. The learning curves were calculated with the aid of a least square fit model. A 95% CI were estimated by a Monte Carlo procedure with a bootstrap technique.
  
  
  RESULTS
  In a total number of 392 blocks performed, the overall success rate was 92.1%. There was no statistical difference between the success rate of the two staff members (success rate: 96.3%) and the overall success rate of the 29 residents performing a total of 339 blocks. The total success rate for this group was 91.5%. The failure rate for the first 10 blocks performed by the residents was 8.82% (95% CI: 5.0-14.14%), it was 4.12% (95% CI: 1.13-10.22%) for the next 10 blocks and from blocks 21 to 40 it was 6.5% (95% CI: 2.65-12.9%). For blocks 41-60, the failure rate was 4.4% (95% CI 0.54-15.15%).
  
  
  CONCLUSIONS
  Penile block in children is easily learned by residents. A steep learning curve was found. The success rate was over 93.5% after more than 40 blocks.
authors.affiliation: International Research Center, University of Gent, UZ Gent, Gent, Belgium.
authors.forename: Guido
authors.initials: G
authors.lastname: Schuepfer
authors.forename: Martin
authors.initials: M
authors.lastname: Jöhr
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010413:Penis / Q000601:surgery*; D012655:Self-Evaluation Programs; D011795:Surveys and Questionnaires