title: A clinical assessment tool for ultrasound-guided axillary brachial plexus block.
abstract: BACKGROUND
  Competency in anesthesia traditionally has been determined subjectively in practice. Optimal training in procedural skills requires valid and reliable forms of assessment. The objective was to examine a procedure-specific clinical assessment tool for ultrasound-guided axillary brachial plexus block for inter-rater reliability and construct validity in a clinical setting.
  
  
  METHODS
  This was a prospective observational study. Using prior work at our institution, the clinical assessment tool was developed consisting of a 63-point task-specific checklist and a global rating scale. The anesthesiologists were assigned to three groups based on prior experience of performing an axillary block: group 1 ('novices') < 10 procedures, group 2 ('intermediates') 50-80 procedures and group 3 ('experts') > 100 procedures. Each participant performed two consecutive blocks that were videotaped. Two blinded independent experts trained in the marking of the tool evaluated the videotapes.
  
  
  RESULTS
  There were five participants per group. The inter-rater reliability between assessors was 0.842 and 0.795 for the checklist and global rating scale, respectively. There was a consistent difference between (each pair of) the three groups in terms of both the checklist and global rating scale (P < 0.05). For the checklist, expert vs. intermediate group P = 0.023, expert vs. novice group P < 0.001 and intermediate vs. novice group P = 0.019. For the global rating scale, expert vs. intermediate group P < 0.001, expert vs. novice group gave P < 0.001 and intermediate vs. novice group P = 0.023.
  
  
  CONCLUSIONS
  The objective of task-specific checklist and global rating scale are reliable and valid measures of axillary block performance between different levels of expertise.
authors.affiliation: Department of Anesthesia and Intensive Care Unit, Cork University Hospital and University College Cork, Ireland. sfarjads@gmail.com
authors.forename: S F
authors.initials: SF
authors.lastname: Sultan
authors.forename: G
authors.initials: G
authors.lastname: Iohom
authors.forename: J
authors.initials: J
authors.lastname: Saunders
authors.forename: G
authors.initials: G
authors.lastname: Shorten
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D057189:Checklist; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D015588:Observer Variation; D010147:Pain Measurement; D011446:Prospective Studies; D015203:Reproducibility of Results; D017211:Treatment Failure; D016896:Treatment Outcome; D014463:Ultrasonography; D014743:Videotape Recording