University of California San Francisco, Department of Emergency Medicine, San Francisco, California.
Zuckerberg San Francisco General Hospital, San Francisco, California.
West J Emerg Med. 2024 Jan;25(1):117-121. doi: 10.5811/westjem.59793.
Despite the inclusion of both diagnostic and procedural ultrasound and regional nerve blocks in the original Model of the Clinical Practice of Emergency Medicine (EM), there is no recommended standardized approach to the incorporation of ultrasound-guided regional anesthesia (UGRA) education in EM training.
We developed and implemented a structured curriculum for both EM residents and faculty to learn UGRA in a four-hour workshop. Each Regional Anesthesia Anatomy and Ultrasound Workshop was four hours in length and followed the same format. Focusing on common UGRA blocks, each workshop began with an anatomist-led cadaveric review of the relevant neuromusculoskeletal anatomy followed by a hands-on ultrasound scanning practice for the blocks led by an ultrasound fellowship-trained EM faculty member, fellow, or a postgraduate year (PGY)-4 resident who had previously participated in the workshop. Learners identified the relevant anatomy on point-of-care ultrasound and reviewed how to conduct the blocks. Learners were invited to complete an evaluation of the workshop with Likert-scale and open-ended questions.
In the 2020 academic year, six regional anesthesia anatomy and ultrasound workshops occurred for EM faculty (two sessions, N = 24) and EM residents (four sessions, N = 40, including a total of five PGY4s, 10 PGY3s, 12 PGY2s, and 13 PGY1s). Workshops were universally well-received by both faculty and residents. Survey results found that 100.0% of all responding participants indicated that they were "very satisfied" with the session. All were likely to recommend this session to a colleague and 95.08% of participants believed the session should become a required component of the EM curriculum.
The use of UGRA is increasing, and and it critical in EM. An interdisciplinary approach in collaboration with anatomists on an interactive, nerve block workshop incorporating both gross anatomy review and hands-on scanning was shown to be well-received and desired by both EM faculty and residents.
尽管在最初的《急诊医学临床实践模型》（EM）中包含了诊断和程序超声以及区域神经阻滞，但在 EM 培训中纳入超声引导区域麻醉（UGRA）教育方面，并没有推荐的标准化方法。
我们为 EM 住院医师和教师开发并实施了一个结构化课程，以在四个小时的研讨会上学习 UGRA。每个区域麻醉解剖和超声研讨会时长为四个小时，采用相同的格式。每个研讨会都以解剖学家主导的相关神经肌肉骨骼解剖学的尸体复习开始，然后由经过超声 fellowship培训的 EM 教师、研究员或已参加过研讨会的研究生四年级（PGY-4）住院医师进行常见 UGRA 块的实操超声扫描练习。学习者在床边超声上识别相关解剖结构，并复习如何进行阻滞。学习者被邀请使用李克特量表和开放式问题对研讨会进行评估。
在 2020 学年，共举办了六次 EM 教师（两次会议，N=24）和 EM 住院医师（四次会议，N=40，包括五名 PGY-4 住院医师、十名 PGY-3 住院医师、十二名 PGY-2 住院医师和十三名 PGY-1 住院医师）的区域麻醉解剖和超声研讨会。研讨会受到教师和住院医师的普遍好评。调查结果发现，所有参与调查的人员中有 100.0%表示“非常满意”该研讨会。所有人都很有可能向同事推荐这个研讨会，并且有 95.08%的参与者认为该研讨会应该成为 EM 课程的必修组成部分。
UGRA 的使用正在增加，并且在 EM 中至关重要。与解剖学家合作，采用互动式神经阻滞研讨会的方法，结合大体解剖复习和实操扫描，这种跨学科方法受到 EM 教师和住院医师的欢迎和需求。
