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The Evolution of Training in Regional Anaesthesia

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The Evolution of Training in Regional Anaesthesia

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In this presentation that I gave at the 2021 Association of Anaesthetists Winter Scientific Meeting, I proposed the reimagination of training in regional anaesthesia into three stages: core training, advanced training, and innovation.

In this presentation that I gave at the 2021 Association of Anaesthetists Winter Scientific Meeting, I proposed the reimagination of training in regional anaesthesia into three stages: core training, advanced training, and innovation.

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The Evolution of Training in Regional Anaesthesia

  1. 1. @EMARIANOMD The evolution of training in regional anaesthesia Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative & Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System
  2. 2. @EMARIANOMD
  3. 3. @EMARIANOMD Time to Think Differently?
  4. 4. @EMARIANOMD Innovation Advanced Training Core Training
  5. 5. @EMARIANOMD Innovation Advanced Training Core Training
  6. 6. @EMARIANOMD “Regional anesthesia is a vital skill for any anesthesiologist and ultrasound-guided techniques have enhanced our ability to achieve effective and consistent blocks. It is important that we ensure our graduating residents have the requisite skills to perform basic regional techniques in a safe and effective manner in order to disseminate the benefits of regional anesthesia to the broader surgical population.” McCartney & Mariano. RAPM 2016
  7. 7. @EMARIANOMD Regional Anaesthesia “Learning Curve” Reg Anesth. 1996;21:182 Magic “60”
  8. 8. @EMARIANOMD
  9. 9. @EMARIANOMD 2000
  10. 10. @EMARIANOMD Time to Redefine What is Basic Turbitt, Mariano, El-Boghdadly. Anaesthesia 2020
  11. 11. @EMARIANOMD Time to Redefine What is Basic Plan A: Teach Transferable Skills Turbitt, Mariano, El-Boghdadly. Anaesthesia 2020
  12. 12. @EMARIANOMD Innovation Advanced Training Core Training
  13. 13. @EMARIANOMD The “10,000 Hours Rule”
  14. 14. @EMARIANOMD RAPM 2020;45:311-314
  15. 15. @EMARIANOMD Fellowship Directors Group • Started in 2002 and has remained informal • Twice-yearly meetings (ASA and ASRA Spring) • Initiatives: – Development of Fellowship Training Guidelines – Knowledge/Practise Sharing – Common Application – ACGME Accreditation
  16. 16. @EMARIANOMD Road to Accreditation • 2013 (May): Fellowship Directors agreed to pursue ACGME accreditation • 2013 (Dec): Letter submitted to Dr. Nasca (CEO) • 2014 (Sept): ACGME approval to develop subspecialty programme in RAAPM • 2015-16: Development and revision of programme requirements • 2016: ACGME opened applications for RAAPM • 2017-18: Milestones development
  17. 17. @EMARIANOMD
  18. 18. @EMARIANOMD Today (2020) • 87 RAAPM fellowships in US and Canada (+3 from 2019) • >200 positions available in the US and Canada https://www.asra.com/fellowship- directory?showType=1
  19. 19. @EMARIANOMD ACGME-Approved Programs (35) • Stanford • Cedars-Sinai • UCSF • UCLA-Harbor • Mayo Clinic (FL) • Northwestern • Univ Iowa • Johns Hopkins • Mass General • Brigham & Womens • Mayo Clinic (MN) • UT Southwestern • Dartmouth • Mt. Sinai West • Columbia • Cornell • Mt. Sinai • Duke • Univ Cincinnati • Univ Pittsburgh • Vanderbilt • Virginia Mason • Univ Nebraska • Univ Virginia • Montefiore • Natl Cap Consortium • Ochsner • Ohio State • OHSU • Penn State • UC Davis • UIC Chicago • Yale • Cleveland Clinic • West Virginia +4 from November 2019
  20. 20. @EMARIANOMD ACGME-Approved Programs (35) • Stanford • Cedars-Sinai • UCSF • UCLA-Harbor • Mayo Clinic (FL) • Northwestern • Univ Iowa • Johns Hopkins • Mass General • Brigham & Womens • Mayo Clinic (MN) • UT Southwestern • Dartmouth • Mt. Sinai West • Columbia • Cornell • Mt. Sinai • Duke • Univ Cincinnati • Univ Pittsburgh • Vanderbilt • Virginia Mason • Univ Nebraska • Univ Virginia • Montefiore • Natl Cap Consortium • Ochsner • Ohio State • OHSU • Penn State • UC Davis • UIC Chicago • Yale • Cleveland Clinic • West Virginia Continued Accreditation Status (15)
  21. 21. @EMARIANOMD Innovation Advanced Training Core Training
  22. 22. @EMARIANOMD Lectures, Scanning Iterative Practise, Simulation 8 Hour Program Mariano, et al. JUM 2015
  23. 23. @EMARIANOMD Ramlogan R, et al. RAPM 2017;42: 217 http://www.pie.med.utoronto.ca/VSpine/index.htm
  24. 24. @EMARIANOMD Hand Motion Analysis Chin, et al. RAPM 2011
  25. 25. @EMARIANOMD Eye Tracking Harrison & Mariano, et al. J Anesth 2015 The Expert 94 sec 1.85 fixations/sec The Novice 257 sec 0.86 fixations/sec
  26. 26. @EMARIANOMD Predictors of Learning UGRA Shafqat, et al. Anesth 2015
  27. 27. @EMARIANOMD Predictors of Learning UGRA Shafqat, et al. Anesth 2015 Maybe we are not all the same!
  28. 28. @EMARIANOMD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798897/
  29. 29. @EMARIANOMD Evaluate New Blocks/Protocols Mudumbai & Mariano, et al. Pain Manag 2018
  30. 30. @EMARIANOMD Evaluate New Blocks/Protocols Mudumbai & Mariano, et al. Pain Manag 2018 Point system = 100 total 25 50 15 10 Practise- dependent
  31. 31. @EMARIANOMD Summary • We discussed many of the ways in which regional anaesthesia training has evolved: –Core Training –Advanced Training –Innovation

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