NYSORA has introduced an International certification process of minimal skills acquisition for ultrasound-guided regional anesthesia and point-of-care interventional procedures. The certificate is obtained after successful passing of a written examination documenting sufficient understanding of ultrasound-technology, artifacts and safe use of ultrasound equipment. The certification candidates are then subjected to a practical test requiring demonstration of proper operating of the ultrasound machine, recognition of ultrasound anatomy and ability to reliably monitor needle advancement toward a given target in-plane and out-of-plane using ULTRASOUND SIMULATORS.
Currently there are no standards for training in ultrasound-guided regional anesthesia or point of care interventional procedures. Even before the ultrasound revolution, a mere 40 “nerve blocks” was (and remains) all that is necessary to graduate anesthesiology residency in the USA and obtain hospital privileges to practice regional anesthesia. 1 For instance, one can perform 40 Beer blocks (IV regional anesthesia) and never have trained on actual nerve blocks, and can still meet requirements to get hospital privileges to practice anything from paravertebral blocks to axillary blocks to lumbar plexus blocks etc.
In 2001 we wrote a commentary on training requirements for peripheral nerve block expressing the concern that many US residency programs may be failing to prepare their anesthesiology graduates to practice regional anesthesia. 2,3,4 This was in response to a report of several devastating complications associated with interscalene brachial plexus block that led to permanent cervical cord injury. While the report blamed the practice of blocks under sedation, our commentary argued that the complications were the results of the lack of training.(1) Fast forward 20 years to 2018 and the lack of training standards has still not been remedied. Moreover, the introduction of ultrasound guidance, proliferation of new nerve block techniques and lack of established standards of practice and safety monitoring in regional anesthesia are in disparity with highly standardized and protocoled principles of patient care in other areas of medicine, anesthesiology included. What is at odds, is that for independent placement of an IV catheter or intubation, practitioners are required to demonstrate adequate skills, perform a supervised pre-set number of procedures and then are granted privileges to perform the procedures in which they were credentialed. In contrast, to practice ultrasound-guided nerve blocks, all one needs is an ultrasound machine and a needle without any proof of prior acquisition of adequate skill to assure patient safety.
In residency training programs, it is a norm that new incoming residents or fellows, request to “try” some blocks in patients. The trainees often have no prior training on the use of ultrasound equipment or any certification demonstrating adequate skills to safely guide the needle under ultrasound guidance. One may ask a question whether this learning in patients without demonstrating minimal skills in SIMULATED practice would pass the standards of medical ethics?
NYSORA’S Adductor Canal ULTRAOUND SIMULATOR with ultrasound anatomy image obtained on the simulator
NYSORA has always strived to standardize the training at its residency program, fellowship program, workshops, books and other instructional material. At our workshops – we request that instructors teach NYSORA techniques for consistency and enhanced retention of the knowledge imparted in the workshops. However, one always wonders what do the workshop delegates do with the acquired knowledge after the workshops and whether they were able to acquire the adequate skillset to apply such knowledge in patients at their practice.
Dr Ine Leunen teaching at NYSORA Boutique Workshop using NYSORA’s standardized techniques
To assure that the trainees and delegates at NYSORA meet a minimal skill-set acquisition, NYSORA has introduced an International certification process of minimal skills acquisition for ultrasound-guided regional anesthesia and point-of-care interventional procedures. The certificate is obtained after successful passing a written examination documenting sufficient understanding of ultrasound-technology, artifacts and safe use of ultrasound equipment. The certification candidates are then subjected to a practical test requiring demonstration of proper operating of the ultrasound machine, recognition of ultrasound anatomy and ability to reliably monitor needle advancement toward a given target in-plane and out-of-plane using ULTRASOUND SIMULATORS ( http://medxpress.pro/). The certificate is issued to candidates who successfully pass the test and demonstrate the practical knowledge. There are several levels of certification, the Level I being demonstration of the general skills. Thus far, NYSORA has issued certificates to the delegates who participated in NYSORA’s Boot Camp program ( https://nysoraevents.com/event-categories/regional-anesthesia-boot-camps/) – all delegates will be offered a complimentary ULTRASOUND Level I test at the end of the training. Likewise,, all our incoming residents who are required to acquire certification before performing the ultrasound-guided procedures in patients. Our experience with the certification program is that the mere process forces the delegates to acquire the knowledge for successful passing.
Drs. Thibault Vaneste and Ana Lopez administering NYSORA-Ultrasound Certification Examination Level II to NYSORA-Europe fellow in regional anesthesia Dr. Stefanie Vanhoenaker
NYSORA’s ULTRASOUND SIMULATORS ready for certification examination
The NYSORA’s certifications process has been developed by a group of NYSORA’s international collaborators and continues to evolve as it starts getting traction in residency programs throughout the world. The NYSORA’s Middle East Boutique Workshop Program in November in Dubai will open 10 (ten) seats for certification on a first-come-first-served basis (https://nysoraevents.com/event-categories/pain-management-boutique-workshop/)
1 Hadzic et al. Anesthesiology, 2001;95 (http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1944756)
2 Kopacz DJ, Bridenbaugh LD: Are anesthesia residency programs failing regional anesthesia? The past, present, and future. Reg Anesth 1993; 18: 84–7Kopacz, DJ Bridenbaugh, LD
3 Hadzic A, Vloka JD, Kuroda MM, Koorn R, Birnbach DJ: The practice of peripheral nerve blocks in the United States: A national survey. Reg Anesth Pain Med 1998; 23: 241–6Hadzic, A Vloka, JD Kuroda, MM Koorn, R Birnbach, DJ
4 Blumenthal D, Gokhale M, Campbell EG, Weissman JS: Preparedness for clinical practice. Reports of graduating residents at academic health centers. JAMA 2001; 286: 1027–34Blumenthal, D Gokhale, M Campbell, EG Weissman, JS
5 Benumof JL: Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000; 93: 1541–4Benumof, JL