Evaluation of a Task-Specific Checklist and Global Rating Scale for Ultrasound-Guided Regional Anesthesia

Wong, Daniel M.; Watson, Mathew J.; Kluger, Roman; Chuan, Alwin; Herrick, Michael D.; Ng, Irene C. L.; Castanelli, Damian; Lin, Lisa; Lansdown, Andrew; Barrington, Michael J.

doi:10.1097/aap.0000000000000126

Cited by 26 publications

(30 citation statements)

References 22 publications

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“…As there is no gold standard for defining expertise in regional anaesthesia, we used a surrogate measure of the trainee's volume of practice at the time of video recording to quantify experience. In the clinical validation study of an UGRA-specific checklist by Wong et al [17], trainees were divided into inexperienced and experienced practitioners based on a cut-off of 30 previous blocks at the time of video recording. Using this same definition, this study showed that the RAPS checklist, GRS and overall pass or fail items were equally able to discriminate trainees based on experience.…”

Section: Discussionmentioning

confidence: 99%

Design and validation of the Regional Anaesthesia Procedural Skills Assessment Tool

et al. 2015

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SummaryThe aim of this study was to create and evaluate the validity, reliability and feasibility of the Regional Anaesthesia Procedural Skills tool, designed for the assessment of all peripheral and neuraxial blocks using all nerve localisation techniques. The first phase was construction of a 25-item checklist by five regional anaesthesia experts using a Delphi process. This checklist was combined with a global rating scale to create the tool. In the second phase, initial validation by 10 independent anaesthetists using a test-retest methodology was successful (Cohen kappa ≥ 0.70 for interrater agreement, scores between test to retest, paired t-test, p > 0.12). In the third phase, 70 clinical videos of trainees were scored by three blinded international assessors. The RAPS tool exhibited face validity (p < 0.026), construct validity (p < 0.001), feasibility (mean time to score < 3.9 min), and overall reliability (intraclass correlation coefficient 0.80 (95% CI 0.67-0.88)). The Regional Anaesthesia Procedural Skills tool used in this study is a valid and reliable assessment tool to score the performance of trainees for regional anaesthesia.

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Section: Discussionmentioning

confidence: 99%

Design and validation of the Regional Anaesthesia Procedural Skills Assessment Tool

et al. 2015

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“…Small patient sample sizes and lack of practitioner randomization with respect to level of training and regional anesthesia technical expertise as drawbacks to global evaluation of procedural proficiency has been reported in prior assessments of these skills [8,25]. Small numbers of procedural observations on large numbers of trainees have been reported as a source of methodological bias [26]. Reduction of the bias effects of small sample size, nonrandom selection of practitioner and nerve block technique, and trainee cohort variability in training has been attempted by the employment of multiple standard observers and protocols [27].…”

Section: Preop -Preoperative Intraop -Intraoperative Pacu -Immediatmentioning

confidence: 99%

Postoperative Analgesia Following Sciatic Nerve Blockade Administered by Nurse Anesthetists Supervised by Regional Anesthesia Faculty in an Academic Hospital

Lollo

Stogicza²

2015

BJMMR

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Introduction: Assessment of expertise in regional anesthesia techniques is traditionally based upon quota fulfillment of procedures during training. Validation of practitioner proficiency in performing procedures in surgical specialties has moved from simple measurement of technical skills to evaluation of global patient outcomes. Complete absence of pain as a result of nerve blockade is the most important clinical endpoint but patient, technical and procedural factors influence results. The purpose of this study was to measure the postoperative pain scores and Lollo and Stogicza; BJMMR, 10(6): xxx-xxx, 2015; Article no.BJMMR.19502 2 associated analgesic medication requirements for patients administered sciatic nerve blockade by nurse anesthetists and determine patient or procedural factors that influenced this outcome. Methods: Either nerve stimulator or ultrasound guided sciatic nerve blockade was administered by nurse anesthetists under the supervision of regional anesthesia faculty. Patient demographic data that was collected included gender, body mass index, surgical procedure, and pre-existing chronic pain with associated opioid use. Patient self-reported pain scores and opioid analgesic dosages in the preoperative, intraoperative, immediate postoperative and 24 hour post procedure intervals were recorded. Results: 22 nurse anesthetists administered sciatic nerve blockade to 48 patients during a 36 month interval. Transition from a nerve stimulator to ultrasound guided sciatic nerve block technique resulted in lower mean pain scores. Patients reporting chronic opioid use were observed to have elevated perioperative opioid analgesic requirements and pain scores compared to opioid naïve patients. Conclusion: Effective analgesia is a prime measure for assessing expertise in regional anesthesia and continuous evaluation of this outcome in everyday practice is proposed. Short Communication

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“…2-5 Out of more than 30 elements in 1 recent assessment tool, only 1 element focuses on recognizing anatomic structures, with 2 reserved for recognizing proper needle and injectate location. 3,4 The remainder of the instrument centers around procedural steps like patient positioning, probe selection, needle alignment, and injection technique. Mastery of UGRA requires reliable performance of all these steps and moreincluding adherence to sterile technique, anatomic knowledge, 2-hand 3-dimensional coordination, patient communication, and monitoring vigilance.…”

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confidence: 99%

Assessment Tools

Allen

Sandberg

2015

Regional Anesthesia and Pain Medicine

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I n this issue, Woodworth et al 1 detail the multistep development of an ultrasound interpretation examination capable of distinguishing ultrasound-guided regional anesthesia (UGRA) providers of varying skill levels. Initially, they defined knowledge and skills relevant to the most salient regional anesthesia techniques, surveyed residency programs to confirm the importance of those skills, and narrowed focus to the important content. Thereafter, the authors defined important anatomy and anatomic relationships using observations of faculty/resident teaching. They then created and refined an assessment tool, eliminating questions regional anesthesia experts could not correctly answer. Finally, they administered the examination to participants across all skill levels, eliminating the few questions that did not aid in distinguishing between test takers at different levels of training. Each study phase was cross-checked against external controls. Sound psychometric principles were applied to develop this assessment. In fact, an excellent concise review of how to establish assessment tool validity and reliability is presented in the Methods section. The main oversight appears to be exclusion of brachial plexus blocks below the clavicle, which could be added at a later date using the same test-design roadmap established in this initial study.With this well-designed tool in hand, several questions arise. Where does this test fit within the context of other UGRA assessments? How could it be integrated into existing skill assessment regimens? What is the purpose of UGRA performance and knowledge assessments?This research effort complements the existing literature well. Multiple performance assessment tools have been developed for UGRA, yet they attend only lightly to ultrasound interpretation. 2-5 Out of more than 30 elements in 1 recent assessment tool, only 1 element focuses on recognizing anatomic structures, with 2 reserved for recognizing proper needle and injectate location. 3,4 The remainder of the instrument centers around procedural steps like patient positioning, probe selection, needle alignment, and injection technique. Mastery of UGRA requires reliable performance of all these steps and moreincluding adherence to sterile technique, anatomic knowledge, 2-hand 3-dimensional coordination, patient communication, and monitoring vigilance. No single instrument tests all these skills.Technical performance metrics should not serve as surrogates for anatomic knowledge; skills and knowledge are not necessarily linked. Other studies have shown that disparate skills required for a procedure may not improve at the same rate or impact block success rate. Friedman et al 6 showed that, even as trainees became facile with epidural catheterization, adherence to sterile technique did not improve, suggesting performance on these skills is not linked. In that study, a separate asepsis checklist was ultimately added to a technical skills checklist to scaffold good performance in both domains. It should not, therefore, be surprisin...

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Evaluation of a Task-Specific Checklist and Global Rating Scale for Ultrasound-Guided Regional Anesthesia

Cited by 26 publications

References 22 publications

Design and validation of the Regional Anaesthesia Procedural Skills Assessment Tool

Design and validation of the Regional Anaesthesia Procedural Skills Assessment Tool

Postoperative Analgesia Following Sciatic Nerve Blockade Administered by Nurse Anesthetists Supervised by Regional Anesthesia Faculty in an Academic Hospital

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