Regional anesthesia enhances patient satisfaction and favorable outcomes, especially in obstetrics and acute pain management. Over the past 20 years, the importance of training anesthesiologists in regional anesthesia has become recognized worldwide, but the actual accomplishment of quality training remains a challenge for residents and fellows, as well as practicing anesthesiologists. Quality training in regional anesthesia is necessary to promote not only clinical competence, but also practitioner confidence in their ability to perform the skill proficiently and safely. Surveys of residency programs demonstrate narrowing variability in training, and recent consensus-based regional anesthesia and acute pain medicine fellowship guidelines may further improve training at all levels. Academic programs have employed conventional and unconventional methods to complement the exposure to regional anesthesia opportunities that residents and fellows receive in the operating room, obstetric suite, and pain clinic. In this chapter, such concepts will be discussed as well as future goals for improving regional anesthesia training for all anesthesiologists.
PAST AND CURRENT TRAINING EXPERIENCE
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 to teach the basics to interested practitioners; such teaching influenced many renowned anesthesiologists, 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 Dr. Labat. Yet, prior to the last quarter century, only a few residency programs had officially incorporated regional anesthesia as part of their educational curriculum.
In fact, 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, there was wide variability in regional anesthesia training in residencies. A survey conducted in 1980 showed that regional anesthesia use ranged from 2.8%–55.7% among responding training programs, with approximately 21% of all cases using regional anesthesia.3 Indeed, diplomates of well-respected programs could graduate having performed less than a handful of spinal anesthetic procedures. 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 regional techniques contributing 2.8%–58.5% of 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 77–1 and 77–2), but there was much less disparity in experience between training programs nationwide.5
The use of regional anesthesia in residency training programs compared to general or local anesthesia for cases in 1980 (21.3%), 1990 (29.8%), and 2000 (30.2%).