Implementation and Evaluation of a Perceptual Learning Module Aimed at Improving the Identification of the Brachial Plexus in the Interscalene Groove With Ultrasound

Introduction:

Regional anesthesia has greatly benefited in recent years from the use of ultrasound to facilitate the location of nerves and of their surrounding structures. Allowing real-time visualization of anatomical structures, ultrasound has been shown to improve the success rate of blocks, to decrease procedure times and to improve patient safety by reducing accidental injections into vessels and nerves.

Ultrasound-guided regional anesthesia training, however, remains a long process. The conventional way to develop expertise is to practice on patients. The learner does the techniques under the supervision of an expert, who gives him feedback. While well established, this approach has several limitations: In addition to being time-consuming, it is limited by the number of available cases and access to supervising experts.

Perceptual learning modules (PLMs) represent an alternative modality to teach image interpretation in regional anesthesia and are already used in other fields. PLMs are online tools created to enhance the development of pattern recognition, a skill required to efficiently interpret ultrasound-guided images. With PLMs, learners observe a series of images or videoclips and must answer a question about each image in a short period of time. Each answer is followed immediately by feedback (the correct answer). By observing a large number of images online and by receiving systematic and expert feedback, the trainee quickly learns to extract efficiently the required information from the image.

PLMs developed with real ultrasound images could complement current training methods in regional anesthesia. A PLM could be especially useful for learning the interscalene block. Identification of the BP in the interscalene groove is often difficult in the absence of a reliable vascular marker. Furthermore, the presence of important surrounding structures to be avoided, like the vertebral artery and the pleura, make accurate image interpretation crucial to avoid complications.