Comparison Between Self-directed Online Educational Material and Conventional Teaching in Acquiring Ultrasound-guided Regional Anesthesia Skills for Supraclavicular Brachial Plexus Block by Novice Performers

Introduction Anatomical-based ultrasound imaging has been one of the most rapidly advancing innovations in the field of regional anesthesia in recent years. Compared with landmark based or peripheral nerve stimulation techniques, benefits of ultrasound guided regional anesthesia (UGRA) include increased nerve block success rate, faster onset time, decreased volume of local anesthetic, and reduced risk of complications. Most experts now consider ultrasound-guidance to be the standard of care for peripheral nerve blocks. To successfully perform a UGRA procedure, a triad of three distinct but interrelated skills is required: image acquisition and anatomical interpretation are needed to identify the needle insertion point; hand-eye coordination is then needed to advance the needle to the target. First, the clinician must successfully acquire an image and then correctly interpret the sonoanatomy. Next, the needle must be visualized and guided to the desired target. This dynamic process often requires constant needle manipulation with simultaneous adjustments of the ultrasound transducer.

The proper performance of UGRA is a useful competency for any anesthesiologist, and most anesthesia residency programs are required to have a minimum curriculum for education of the most frequent and well stablished peripheral nerve blocks. However, there are some obstacles in regional anesthesia education for trainees. The traditional "apprenticeship model" of learning while concurrently providing clinical care can result in inconsistent learning experiences, variability in case numbers, and compromised patient safety. It is not feasible to practice all UGRA steps (especially needling) in live voluntary models. Simulation-based techniques (animal, cadavers) can be expensive and logistically difficult to use on a regular basis. Conventional regional anesthesia training in most regional anesthesia courses and workshops consists of theoretical teaching (in-person instruction of indications, anatomical concepts, techniques and complications) followed by hands-on image acquisition demonstration and practice on live voluntary models. This structured teaching method can be impractical in a medical residency program, where time constraints during clinical care can limit teaching opportunities. Moreover, for novices, it provides a brief, isolated exposure to the procedure, which limits long-term retention and associated with decay of skill execution.

There is a growing availability of online UGRA related material, including good quality open access educational information, assembled by related societies (The New York School of Regional Anesthesia - NYSORA; Ultrasound for Regional Anesthesia - USRA). Therefore, an opportunity may exist for using this kind of content for UGRA learning in anesthesiology medical residency programs.

Significance The increasing availability of UGRA related online information may have an important educational value for trainees and consultants. The structured use of this material, can contribute to learners' skill acquisition and reduce requirements for human resources and time needed for UGRA training. It also provides easy access to review skills to improve retain competency.

Objectives To assess the impact of using educational material from NYSORA and USRA websites on image acquisition and anatomical interpretation learning process of novice trainees performing supraclavicular brachial plexus block.