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Over the past 20 years, the importance of training anesthesiologists in regional anesthesia has become recognized worldwide. More practitioners use regional anesthetic blocks for their patients and choose regional anesthesia for themselves when they undergo surgery. Documented improved outcomes (eg, obstetric anesthesia, acute pain management, ambulatory surgery, etc) have also contributed to the increase in popularity and use of regional anesthesia in the recent years. Despite this trend, the quality of training in regional anesthesia is less than needed for residents and fellows, as well as for practicing anesthesiologists. Quality training in regional anesthesia is necessary to promote not only clinical competence but also practitioner confidence in the ability to perform the skill proficiently and safely. Surveys of residency programs demonstrate narrowing variability in training, and recent consensus-based regional anesthesia fellowship guidelines may further improve training at all levels. Academic programs have employed conventional and unconventional methods to compliment the exposure to regional anesthesia opportunities that residents and fellows receive in the operating room, obstetric suite, and pain clinic. In this chapter, these teaching concepts will be discussed as well as future goals for improving regional anesthesia training for all anesthesiologists.


Evolution of Regional Anesthesia Training


As early as the 1920s, there were dedicated teachers of regional anesthesia. In the United States, both Gaston Labat and John S. Lundy offered 3-month courses in the basics to interested practitioners. Of note, such teaching influenced many renowned anesthesiologists of the time, including Ralph Waters and Emery Rovenstine.1 At that time, a few experts promoted regional anesthesia, including the members of the first American Society of Regional Anesthesia, which was founded by Labat. Nevertheless, prior to the last quarter century, only a few residency programs had officially incorporated regional anesthesia as part of their educational curriculum.


It was not until 1996 that the Anesthesiology Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME) formally listed a minimal number of regional anesthetic blocks as a requirement of training in anesthesiology.2 Prior to that time, regional anesthesia training varied widely in residency programs. For instance, a survey conducted in 1980 showed that regional anesthesia use ranged from 2.8 to 55.7% among responding training programs, with approximately 21% of all cases using regional anesthesia.3 Indeed, students of well-respected programs could graduate having performed fewer than a handful of spinal anesthetics. These numbers improved somewhat by 1990, but although regional anesthesia was utilized in more cases (29.8%), primarily reflecting increases in obstetric and pain management applications of regional techniques, the large discrepancy continued, with 2.8 to 58.5% total caseload experience.4 By the year 2000, the number of surgical cases with regional anesthetics did not significantly increase (30.2%) nor did the distribution of the types of anesthetics (Figures 81–1 and 81–2), but there was much less disparity in usage by training programs nationwide.5


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