A survey of exposure to regional anesthesia techniques in American anesthesia residency training programs

Background and Objectives. The American Board of Anesthesiologists and the Residency Review Committee for Anesthesiology do not keep records regarding the individual resident's cumulative exposure to specific peripheral nerve block techniques. Further, little is known about individual trainee confid ence in performing regional anesthetic blocks. To improve training and anes thesia practice, such information is necessary. In this nationwide sun ey, we assessed residents' perceived cumulative regional anesthesia experience and their confidence level. Methods. A survey was distributed to 42 U.S. re sidency programs in 22 stares. Information collected included the resident' s clinical anesthesia (CA) training level, estimated number of regional ane sthetics performed, and the resident's confidence level In performing these techniques. Confidence was graded on a 3-point scale, as being very confid ent (1.0), somewhat confident (2.0), or not confident (3.0). We analyzed th e estimated cumulative number and type of blocks performed in relation to t raining level and confidence level; differences were considered significant when P<.001. Results. The response rate was 67.2% (736/1,096); 32% (n = 23 2) of responders were CA-3 residents. At all training levels, the number of blocks performed varied widely according to type of block, with spinal and epidural blocks being performed most often at all training levels and scia tic, retrobulbar, and femoral blocks being performed least (median = 0 each for CA-1, CA-2, and CA-3 residents). Confidence was high with frequently p erformed blocks (spinal and lumbar epidural) and low for those performed le ss than 10 times per resident. The CA-3 residents reported a cumulative exp erience with a median (interquartile range) of 100 (50-100) spinal anesthet ics and 150 (100-200) lumbar epidural blocks with all residents being very confident. The CA-3 residents completed a median of 20 (10-30) axillary blo cks but a median of less than 10 for each of these techniques: intravenous regional anesthesia, ankle, interscalene, femoral, sciatic, and retrobulbar . For interscalene block, 51% of CA-3 residents were not confident; for fem oral, 62%; for sciatic, 75%; and for retrobulbar block, 91%, were nor confi dent. Conclusions. Most CA-3 residents are confident in performing lumbar e pidural and spinal anesthesia. However, many are not confident in performin g the blocks with which they have the least exposure. Changes need to be ma de in the training processes so that residents can graduate with enough con fidence to continue selecting less familiar blocks in postgraduate practice .