title: Evaluation of a Standardized Program for Training Practicing Anesthesiologists in Ultrasound-Guided Regional Anesthesia Skills.
abstract: OBJECTIVE
  Practicing anesthesiologists have generally not received formal training in ultrasound-guided perineural catheter insertion. We designed this study to determine the efficacy of a standardized teaching program in this population.
  
  
  METHODS
  Anesthesiologists in practice for 10 years or more were recruited and enrolled to participate in a 1-day program: lectures and live-model ultrasound scanning (morning) and faculty-led iterative practice and mannequin-based simulation (afternoon). Participants were assessed and recorded while performing ultrasound-guided perineural catheter insertion at baseline, at midday (interval), and after the program (final). Videos were scored by 2 blinded reviewers using a composite tool and global rating scale. Participants were surveyed every 3 months for 1 year to report the number of procedures, efficacy of teaching methods, and implementation obstacles.
  
  
  RESULTS
  Thirty-two participants were enrolled and completed the program; 31 of 32 (97%) completed the 1-year follow-up. Final scores [median (10th-90th percentiles)] were 21.5 (14.5-28.0) of 30 points compared to 14.0 (9.0-20.0) at interval (P < .001 versus final) and 12.0 (8.5-17.5) at baseline (P < .001 versus final), with no difference between interval and baseline. The global rating scale showed an identical pattern. Twelve of 26 participants without previous experience performed at least 1 perineural catheter insertion after training (P < .001). However, there were no differences in the monthly average number of procedures or complications after the course when compared to baseline.
  
  
  CONCLUSIONS
  Practicing anesthesiologists without previous training in ultrasound-guided regional anesthesia can acquire perineural catheter insertion skills after a 1-day standardized course, but changing clinical practice remains a challenge.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.). emariano@stanford.edu.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
authors.forename: T Kyle
authors.initials: TK
authors.lastname: Harrison
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
authors.forename: T Edward
authors.initials: TE
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
authors.forename: Jack
authors.initials: J
authors.lastname: Kan
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
authors.forename: Cynthia
authors.initials: C
authors.lastname: Shum
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
authors.forename: David M
authors.initials: DM
authors.lastname: Gaba
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
authors.forename: Toni
authors.initials: T
authors.lastname: Ganaway
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
authors.forename: Alex
authors.initials: A
authors.lastname: Kou
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine (E.R.M., T.K.H., J.T.K., D.M.G., T.G., A.K., S.K.H.), VA Palo Alto Health Care System, Palo Alto, California USA; and Stanford University School of Medicine, Stanford, California USA; Department of Anesthesiology, Newport Harbor Anesthesia Consultants, Newport Beach, California USA (J.K.); and Department of Anesthesiology Duke University School of Medicine, Durham, North Carolina USA (A.D.U.).
authors.forename: Ankeet D
authors.initials: AD
authors.lastname: Udani
authors.forename: Steven K
authors.initials: SK
authors.lastname: Howard
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000706:statistics & numerical data*; D000776:Anesthesiology / Q000193:education* / Q000706:statistics & numerical data; D002140:California; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003479:Curriculum; D004521:Educational Measurement / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D015397:Program Evaluation; D011871:Radiology / Q000193:education / Q000706:statistics & numerical data; D013663:Teaching / Q000379:methods; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*
keywords: change implementation; continuous peripheral nerve block; education; perineural catheter; simulation; training; ultrasound education; ultrasound-guided regional anesthesia