Using a Simulated Model and Mastery Learning Approach to Teach the Ultrasound‐guided Serratus Anterior Plane Block to Emergency Medicine Residents: A Pilot Study

Abstract

Background:The serratus anterior plane block (SAPB) is a safe, single-injection alternative for pain control in patients with rib fractures. This pilot study aims to teach the ultrasound-guided SAPB to emergency medicine (EM) residents using a mastery learning approach.Methods: A 19-item checklist was created and mastery was determined to be 17 of 19 items correct. This pass score was established using a Mastery Angoff standard-setting exercise with a group of EM experts. Learners participated in baseline testing on a simulated model and performance was assessed by two raters. Learners then watched an instructional video and participated in an individualized teaching session. Learners underwent deliberate practice followed by posttesting until mastery was achieved. Score differences in baseline testing and posttesting were analyzed using a paired t-test. Pre-and posttesting surveys were also completed by participants.Results: Twenty-eight PGY-1 to -4 residents volunteered to participate in the study. The range of reported SAPBs seen previously was 0 to 5. The mean (AESD) number of items correct on the checklist for initial testing was 8.5 of 19 (AE2.7), while the mean (AESD) final score was 18 of 19 (AE0.6; p < 0.001). All participants met mastery standards after the curriculum intervention. Median self-reported procedural confidence was 2 out of 5 on a 5-point Likert scale before the session and 5 out of 5 after the session (Z = À4.681, p < 0.001).Conclusions: Using a mastery learning approach and simulated model, we were able to successfully train EM residents to perform the SAPB at a level of mastery and increase their overall confidence in executing this procedure.

Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort study

“…Prior to this study, a group of emergency physicians at our institution underwent a training session on SAPB augmented by highfidelity simulation. 17 The ability of these physicians to learn the SAPB during a single training session reflects the relative technical ease of this nerve block and suggests that it is feasible for a diverse group of acute care physicians to master. However, given the relative novelty of the procedure, there remains the possibility of operator-dependent block efficacy.…”

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians

“…In total, 16 articles in total were used in this review concluding that the continuous SAPB was found to be favorable to the single injection method when left in the patient for 3 to 5 days. Rider et al 52 conducted a study of 28 emergency medicine residents to test the efficacy of using simulation-based mastery learning to learn how to perform the SAPB. A mastery checklist was created by faculty familiar with the SAPB to judge residents; a score of 17/19 was deemed mastery.…”

Development of an expert consensus checklist for emergency ultrasound

“…[6][7][8][9][10][11][12] Checklists have previously been proposed for EUS, focused echocardiography by surgical residents, fetal assessment ultrasounds (USs) for obstetrics residents, and abdominal ultrasonography by radiology trainees. 10,[13][14][15][16][17] However, checklists are not widely utilized due partly to remaining gaps in the literature. Prior checklists were often based on local expert opinion at a single institution and lacked reliability and validity evidence.…”

“…Checklists may help guide individualized deliberate practice with mastery learning and better inform competency assessments 6–12 . Checklists have previously been proposed for EUS, focused echocardiography by surgical residents, fetal assessment ultrasounds (USs) for obstetrics residents, and abdominal ultrasonography by radiology trainees 10,13–17 . However, checklists are not widely utilized due partly to remaining gaps in the literature.…”