A survey of exposure to regional anesthesia techniques in American anesthesia residency training programs

Abstract

Background and objectives: The American Board of Anesthesiologists and the Residency Review Committee for Anesthesiology do not keep records regarding the individual resident's cumulative exposure to specific peripheral nerve block techniques. Further, little is known about individual trainee confidence in performing regional anesthetic blocks. To improve training and anesthesia practice, such information is necessary. In this nationwide survey, we assessed residents' perceived cumulative regional anesthesia experience and their confidence level.

Methods: A survey was distributed to 42 U.S. residency programs in 22 states. Information collected included the resident's clinical anesthesia (CA) training level, estimated number of regional anesthetics performed, and the resident's confidence level in performing these techniques. Confidence was graded on a 3-point scale, as being very confident (1.0), somewhat confident (2.0), or not confident (3.0). We analyzed the estimated cumulative number and type of blocks performed in relation to training level and confidence level; differences were considered significant when P< .001.

Results: The response rate was 67.2% (736/1,096); 32% (n = 232) of responders were CA-3 residents. At all training levels, the number of blocks performed varied widely according to type of block, with spinal and epidural blocks being performed most often at all training levels and sciatic, retrobulbar, and femoral blocks being performed least (median = 0 each for CA-1, CA-2, and CA-3 residents). Confidence was high with frequently performed blocks (spinal and lumbar epidural) and low for those performed less than 10 times per resident. The CA-3 residents reported a cumulative experience with a median (interquartile range) of 100 (50-100) spinal anesthetics and 150 (100-200) lumbar epidural blocks with all residents being very confident. The CA-3 residents completed a median of 20 (10-30) axillary blocks but a median of less than 10 for each of these techniques: intravenous regional anesthesia, ankle, interscalene, femoral, sciatic, and retrobulbar. For interscalene block, 51% of CA-3 residents were not confident; for femoral, 62%; for sciatic, 75%; and for retrobulbar block, 91%, were not confident.

Conclusions: Most CA-3 residents are confident in performing lumbar epidural and spinal anesthesia. However, many are not confident in performing the blocks with which they have the least exposure. Changes need to be made in the training processes so that residents can graduate with enough confidence to continue selecting less familiar blocks in postgraduate practice.