2024 FSA Podium and Poster Abstracts
P034: IMPLEMENTATION OF FORMAL NEURAXIAL ULTRASOUND TEACHING IN ANESTHESIOLOGY RESIDENCY: RESIDENT SURVEY RESULTS
Alexander W Hall, MD; Reine Zbeidy, MD; University of Miami
Background: The utilization of point-of-care ultrasound (POCUS) has become a core competency in anesthesiology residency training [1]. Recently, structured comprehensive curriculum have been developed and implemented across residency programs encompassing: heart, lung, trauma, gastrointestinal, and neuraxial ultrasonography [2].
We implemented structured neuraxial ultrasound education to residents rotating through obstetric anesthesiology. This included formal didactic lectures and subsequent hands-on, directed ultrasonography at the bedside to assist with epidural catheter placement for laboring women. Our goal was to teach techniques to enhance resident ability to provide pain control to patients with challenging epidural placement and improve patient satisfaction.
Methods: 28 Residents were surveyed about their comfort level with neuraxial ultrasound prior to receiving formal didactic and practical experience with the technique. Following training they were asked again about their comfort level with the procedure, if it improved their understanding of the anatomic fundamentals, and if they were likely to apply this skill to challenging cases in the future. Residents were asked to estimate the impact on patient care, and any improvement this had on rapport with patients.
Results: 23 of 28 residents (82%) completed the survey. Pre-implementation, a majority of respondents reported no confidence (14 [60.9%]). Post-implementation, respondents agreed (11 [47.8%]) or strongly agreed (9 [39.1%]) that they feel comfortable using ultrasound to assist with difficult placement. Of respondents with no confidence prior to training, 6 of 13 (46%) and 5 of 13 residents (38%) reported they agree or strongly agree, respectively that they are confident in their ability to use ultrasound to assist with difficult cases after training. 15 (65.2%) respondents stated they were likely to use ultrasound to assist placement in the future. Most respondents (22 [91.2%]) believed their patient care improved and 11 (47.8%) thought they developed better rapport.
Conclusions: To date most POCUS education in anesthesiology focuses on critical care and cardiac anesthesia [3,4]. However, evidence suggests that using ultrasound to assist epidural placement results in improved first-pass success and decreased trauma [5]. Implementation of a neuraxial ultrasound curriculum was undertaken with residents rotating through obstetric anesthesiology. This is the first known survey focusing on the educational benefits of structured neuraxial POCUS training. Results demonstrate greatly improved confidence in the technique, improved understanding of anatomical structures, as well as residents’ perception of improved patient care and rapport. Given the safety of ultrasound, the relative affordability, and evidence of improved outcomes, it is important to continue implementing structured curriculum to teach neuraxial POCUS.