The reason that education is the core of our RAAPM practices is because regional techniques are almost impossible to learn without a supervised, repeated, and consistent approach. They take time and extra effort to perform and to be learned 'hands on.' Many residency programs cannot make enough use of regional anesthesia techniques during training to allow their residents to leave feeling comfortable performing these techniques on a routine basis. It is this comfort level that will assure continued use of regional anesthesia during an anesthesiologist's career and his or her willingness to try new techniques in the future.

The curriculum resources below are some of those accessible from the networked computers in the RAAPM Area.

• CA-1 Goals and Objectives.pdf
  
  
• CA-2 Goals and Objectives.pdf
  
  
• CA-3 Goals and Objectives.pdf
  
  
• WFU Groove to Toe Guide 2008
  
  
• RAAPM RN Guide to Patient Care.pdf
  
  
• SRNA Goals and Objectives

 

Education is at the Core of our Regional Anesthesia and Acute Pain Management Practices.

In 1922 William Mayo wrote "Regional anesthesia is here to stay." Today, new devices and drugs have made techniques and practices more accessible to the clinician while increasing the utility of regional anesthesia. There is evidence in the literature that 'blocks' can help facilitate patient recovery, save money for hospitals and insurance companies, and improve operating room efficiency. At the same time, patients are becoming more sophisticated consumers of anesthesia care and increasingly expect to have choices. Furthermore, regional anesthesia can be a lot of fun for anesthesiologists and fun is at a premium in health care today.

The growth we have seen at our institution is occurring across the US. Most US residents now actively seek anesthesia programs able to meet the goal of providing for proficiency in regional anesthesia practices upon graduation. These changes have encouraged us to produce residents highly trained in these techniques. Our residents have been successful in bringing with them regional anesthetic techniques to their practices upon graduation. Unfortunately, this growth in regional anesthesia has also created difficulties for practicing anesthesiologists seeking proficiency in regional anesthesia practices new to them.

Education obviously does not end with residency. One response we have had to the need for further education is to start a fellowship in regional anesthesia.  We have consciously limited and timed the start to this fellowship until a time at which we could be assured that our practices and patient volume here could support both resident and fellow training in a complementary, rather than competitive, manner.

However, one of the greatest challenges toward universal application of regional anesthesia is overcoming the understandable difficulty encountered by established clinicians who are motivated to change their practice but who are beyond the point where return for a year long fellowship is likely. The standard approach to overcoming this obstacle has been to conduct lecture-workshops for practicing clinicians. Unfortunately, this venue probably does not work ideally because the setting is, by necessity, an artificial one. The scope of the presentation is therefore necessarily too focused on techniques and not on demonstration of the elements of safe and efficient clinical practices beyond needle placements and drug doses.

We believe visiting clinical preceptorships (VCP) provide a much more useful background because educating clinicians in regional anesthesia must influence practices, not merely teach new techniques. By visiting institutions where regional anesthesia works well, a larger view of the personnel, preparation, and infrastructure needed for regional anesthesia can be appreciated. Here, private practice clinicians can gain first-hand knowledge as to what resources are needed at their local institution, while clinician educators can investigate what they might need to train future practitioners while these practitioners are still residents developing their own clinical practices.

Web-based applications such as the one you are using are a perfect complement to a visiting clinical preceptorship, and to learning regional anesthesia. Regional anesthesia education is well suited for web-based computer media for two principal reasons. First, regional anesthesia clinical practices are evolving faster than textbooks can be written. Second, computer technology can depict anatomic relationships in dimensions beyond that attainable with print media. For example, a video of an appropriate response to nerve stimulation can be viewed at the bedside immediately prior to placing a needle in a patient. Applications of virtual anatomy are also growing and are well suited for web-based education in regional anesthesia. These programs (such as Needleman created by Chris Wiley, Dartmouth Department of Anesthesiology) have the capability to allow viewing of anatomic structures in any dimension from any angle at various depths of dissection.

In the future, web-based applications such as allnumbedup should grow to reach out past clinicians directly to their patients.  Patients are consumers of Healthcare and should have access to better information about regional anesthesia on the web. Patients are more educated and informed about medical advances and expect more information about medical procedures than ever before.  While patient demand for information has increased exponentially, the medical community has not kept pace in developing web-based resources to satisfy demand. This is especially true in the area of patient education in anesthesia. Most patients are not well informed as to their options for anesthetic care in the perioperative period. They may first learn of these options minutes prior to a planned surgical procedure, and are often not given choices when they do in fact exist.

With web-based patient education, the 16,000 patients/ year that are seen in our Pre- Anesthesia Clinic (for example) could use computer kiosks to visually follow the process of care for their planned surgery, gather practical institution-specific information, and educate themselves regarding anesthesia and analgesia. In addition to being viewable within the walls of the institution, the site could be accessible to the public via the Internet serving consumers of healthcare everywhere. This access by patients can be monitored to study the interests and preferences of those who visit. For example, a patient may choose to read descriptions of a general anesthetic, with another click a list of side effects, with another the incidence of these side effects. Another patient might go on to choose to view a video of a patient being intubated during the course of general anesthesia or receiving a peripheral nerve block while sedated. How would access to such information change patient preferences? Other approaches to providing this information and education would require much greater commitment of personnel and resources while remaining globally unavailable. A web site combining these elements will not only be useful to patients, but useful to physicians and their patients wherever the Internet is accessible.

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