Background
Ultrasound guidance has become an integral component to procedural and diagnostic practice for the emergency physician. Whereas landmark-guided methods were used for peripheral nerve blocks in the past, the use of ultrasound has made regional anesthesia procedures faster, more successful, and feasible as a pain management modality in the emergency department. Not only the utilization, but also the teaching of ultrasound has become an essential aspect of emergency medicine residency training. Prior studies have found a substantial variation in practice and policies with regard to ultrasound-guided regional anesthesia (UGRA) and this translates to the education of both residents and fellows.

Objectives
The objective was to describe the current state of UGRA education, trends, and barriers in emergency medicine residency and ultrasound fellowship programs in the United States.

Methods
A cross-sectional survey was conducted via the Internet utilizing the Qualtrics software platform. It was distributed to ultrasound directors and program directors of both Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) accredited emergency medicine residency programs and ultrasound fellowships. Data analysis, cross-tabulation, and subgroup analysis were performed utilizing the software.

Results
We received a total of 138 responses (response rate of 66.3%). There was substantial variability with regard to implementing UGRA education. Additionally, there was a trend correlating a greater likelihood of UGRA education among programs with more than two ultrasound faculty members. Faculty training is considered to be the greatest barrier to teaching UGRA to residents and fellows.

Conclusion
Resident and fellow education with regard to UGRA varies significantly among individual programs. Although there are currently no ACGME or AOA guidelines, nearly all residency programs believe that this is a skill that emergency physicians should learn. With the identification of key barriers and the need for an increased number of trained faculty, pain management utilizing UGRA may become an integral part to emergency medicine resident and fellow education.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/aet2.10014

Challenges and Variations in Emergency Medicine Residency Training of Ultrasound-guided Regional Anesthesia Techniques.

Point-of-care ultrasound (POCUS) is a powerful diagnostic tool and provides treatment guidelines in acute critical settings. However, the limitation of using POCUS is operator dependent. Appropriate and validated training for acquiring and using skills in practice must be conducted before using POCUS in clinical settings in order to keep patients safe. Simulation education models have been introduced as a way to solve and overcome these concerns. However, the commercial simulator with sufficiently secured fidelity is expensive and not always available. This review focused on the inexpensive and easily made simulators for education on POCUS in critical specific situations related to the airway, breathing, circulation, and disability. We introduced the simulators that used non-infectious materials, with easily transportable features, and that had a sonographic appearance reproducibility similar to human tissue. We also introduced the recipe of each simulator in two parts: Materials surrounding disease simulators (surrounding materials) and specific disease simulators themselves (target simulators). This review article covered the following: endotracheal or oesophageal intubation, lung (A-lines, B-lines, lung sliding, and pleural effusions such as hemothorax), central vein access, pericardial fluid (cardiac tamponade), the structure related to the eyes, soft tissue abscess, nerve (regional nerve block), and skull fracture simulators.

Review of simulation model for education of point-of-care ultrasound using easy-to-make tools.

Ultrasound-guided nerve blocks are common techniques in several medical specialties. Phantoms are commonly used when teaching these procedures. Commercial phantoms are expensive, and most previously published "homemade" nerve phantoms have a substantial amount of posterior shadowing, making it difficult to visualize the needle posterior to the simulated nerve. We have constructed a simple and easy-to-make nerve block phantom using a hot dog core embedded in a gelatin-psyllium hydrophilic mucilloid fiber mixture that has little to no posterior shadowing.

A Simple, Realistic, Inexpensive Nerve Phantom.

Western Journal Of Emergency Medicine

This ultrasound-guided regional anesthesia elective is designed for emergency medicine residents.The proposed length of this curriculum is over one week.Ultrasound-guided regional anesthesia (UGRA) is a useful tool in the emergency department (ED) for managing painful conditions, and many programs have identified that these are useful skills for emergency providers; however, only about 53% of programs report teaching UGRA as part of their core curriculum, and there currently are no widely available or peer reviewed nerve block curricula designed for emergency medicine residents.To deliver an immersive 1-week elective to provide residents a strong foundation in principles of UGRA and an introduction to 14 nerve block procedures applicable to care provided in the ED.The educational strategies used in this curriculum include: instructional videos, written and online independent learning materials, one-on-one teaching at the bedside with an emergency ultrasound fellow, simulation of nerve block techniques using a femoral nerve block task trainer, and performance of supervised nerve block procedures on patients in the ED.All residents provided feedback through an online survey after completing the elective.Eight residents completed the elective in the first year of implementation. Following completion of the UGRA curriculum, 8/8 (100%) of residents reported increased level of confidence in performing UGRA. In addition, 8/8 (100%) of residents reported they were "likely" or "very likely" to incorporate UGRA into their future EM practice. All 8 (100%) residents responded they were "very likely" to recommend the elective to other trainees. The elective received high ratings for overall quality with an average rating of 9.4 out of 10 (±0.7).An elective in ultrasound-guided regional anesthesia can be successfully incorporated into an emergency medicine training program. The curriculum was successful in providing focused training in UGRA and resulted in increased resident confidence in performing nerve block procedures.Ultrasound-guided regional anesthesia, nerve block, resident, elective, pain. 

An Ultrasound-Guided Regional Anesthesia Elective for Emergency Medicine Residents.

Ultrasound guidance has become an important part of performing peripheral nerve blocks within the emergency department. Real-time ultrasound guidance during nerve blockade decreases the risks associated with improper needle placement. Nerve block simulation training before direct patient practice has demonstrated a reduction in procedural length and improvement of outcomes. However, most low-fidelity nerve block models, although able to simulate the visual appearance of a nerve, are unable to mimic the sonographic findings of the injection of an anesthetic agent. High-fidelity models have demonstrated improved functionality but at significantly increased cost. We sought to create an inexpensive model that could be easily reproduced while still allowing for a realistic sonographic appearance of human nerve anatomy, the performance of the nerve block, and the subsequent hydrodissection. The use of pork or lamb to simulate human tissue in nerve block models has been described previously for nerve block models. The use of chicken breast to simulate human tissue has been described previously in the use of vascular access models, but, to our knowledge, there have been no publications related to its use for nerve–block-related teaching.

/pdf/a-low-fidelity-high-functionality-inexpensive-ultrasound-2qxal7818r.pdf

A low-fidelity, high-functionality, inexpensive ultrasound-guided nerve block model.

Defining a Theory-Driven Ultrasound Curriculum for Prehospital Providers.

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A low-fidelity, high-functionality, inexpensive ultrasound-guided nerve block model.

Defining a Theory-Driven Ultrasound Curriculum for Prehospital Providers.