Title: Competency and Proficiency with Peripheral Nerve Blocks (PNB) in a
Structured Training Program.
Authors: Paloma Toledo, M.D., Mark Kendall, M.D., Tripti C. Kataria, M.D., M.P.H., Radha Sukhani, M.D., Robert J. McCarthy, Pharm.D.
Affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.

Introduction: The ability to achieve effective analgesia with minimal side effects has increased the acceptance and demand for PNB anesthesia. A recent study however, suggest that anesthesiology training programs are deficient in the training of PNBs1. Acquiring clinical competence with PNBs may require upward of 60 individual block procedures. Acquiring proficiency may require even higher numbers. The purpose of this prospective study was to examine competency and proficiency with PNB amongst the
inexperienced clinical anesthesia year 1 (CA-1) residents in the setting of a structured PNB training program.
Methods: After IRB approval and written informed consent, 11 CA-1 residents were recruited for a study period lasting 9 consecutive months. The structured regional anesthesia rotation at the institution comprises of a dedicated “2 month block rotation” preceded by didactic training emphasizing an extensive review of pertinent anatomy and techniques of PNB via written and visual aids with knowledge competency assessed via a written test. Each trainee was evaluated for 4 extremity blocks: axillary block
(AXNB), femoral nerve block (FNB), interscalene block (ISB), and the sciatic nerve block (SNB) by an independent assessor using a quantitative performance scoring scale for surface anatomy and technical proficiency (Table 1). Faculty completed the block if the trainee failed to complete the block within 3 attempts and/or 7 minutes for ISB/ FNB and 10 minutes for AXNB/SNB. Competency was defined as a successful block completed by the trainee. Proficiency was defined as a successful block performed without physical assistance by faculty within 2 attempts. Overall competency and proficiency in each of
the 4 blocks was determined from the Cusum analysis with an acceptable failure rate of 15% and an unacceptable failure rate of 20%.

Conclusions: In a structured program emphasing didactic and consistent, continuous motor skill training in PNB, the inexperienced trainees achieved 64-98% competency, with a higher competency level with FNB. Despite the large number blocks performed per resident, proficiency was only achieved in more than onehalf of the residents for FNB, suggesting that longer or additional structured exposure to PNB be incorporated into anesthesiology residency training.
References: 1 Konrad C, et al. Anesth Analg. 1998; 56:635-9.

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