Purpose
Ultrasound guided regional anesthesia (UGRA) has numerous benefits for patients when used appropriately, such as reduced postoperative pain and postoperative opioid use, reduced hospital length of stay, reduced postoperative respiratory complications, and improved patient satisfaction. Despite the fact that UGRA is an essential skill that all anesthesia providers must possess, the traditional method for teaching these skills leaves many trainees lacking the ability to perform UGRA confidently and competently upon graduation. In order to create more graduate certified registered nurse anesthetists (CRNAs) who are proficient in the skills of UGRA, a simulation based training program was developed and implemented to address this training and educational practice gap.
Methodology
A simulation based training program for UGRA was developed and implemented in four phases. Phase 1 involved delivering a needs assessment to current student registered nurse anesthetists (SRNAs) to gather baseline data and guide curriculum development. Phase 2 involved delivering online modules with lectures and readings aimed at improving participants’ anatomical knowledge. Phase 3 involved in-person workshops aimed at developing participants’ image acquisition and needling technique skills. Phase 4 involved data analysis. Three workshops were created to divide UGRA procedures into three anatomical categories. These three workshops were: “Approaches to the Brachial Plexus”, “Lower Extremity Blocks”, and “Abdominal and Thoracic Wall Blocks”. The four outcome measures evaluated during this project were: anatomical knowledge; image acquisition skills; needling technique; and participant confidence assessed with the Confidence Scale (C-Scale).
Results
Posttest scores related to anatomical knowledge went up dramatically for each of the three UGRA workshops. The “Approaches to the Brachial Plexus” workshop had a mean pretest score of 0.60 with a standard deviation of 0.13 (n=10) and a posttest mean of 0.75 with a standard deviation of 0.09 (n=5). The “Lower Extremity Blocks” workshop had a mean pretest score of 0.60 with a standard deviation of 0.11 (n=7) and a posttest mean of 0.87 with a standard deviation of 0.08 (n=6). The “Abdominal and Thoracic Wall Blocks” workshop had a mean pretest score of 0.41 with a standard deviation of 0.17 (n=2) and a posttest mean of 0.80 without a calculated standard deviation due to only one participant taking this examination (n=1).
All image acquisition (IA) skills were found to improve with positive percent change values from pre to post workshop assessment checklist (AC) scores in each of the three workshops. Needling technique (NT) was found to have a positive percent change for each of the three workshops. Additionally, all C-Scale scores increased for each workshop throughout this entire project.
Implications
Findings from this project suggested that implementation of a simulation-based curriculum for teaching UGRA created improvements in anatomical knowledge, trainee confidence, image acquisition skills, and needling technique. These simulation-based workshops are a necessary supplement to traditional methods for teaching UGRA in nurse anesthesia programs that involved didactic lectures followed by clinical rotations. Despite a limited sample size from a single training program, the benefits of simulation-training for UGRA were dramatic. Further research would be needed with larger samples of SRNAs and CRNAs to truly determine the magnitude and generalizability of the benefits for adding simulation-based training curriculums for UGRA.