How to Enhance Competency in Regional Anesthesia for Emergency Medicine Residents?

Recently published research paper aimed to define elements of competency for a residency program in a large academic tertiary center and create a protocol for resident training in regional anesthesia, particularly focusing on the fascia iliaca compartment block (FICB) in emergency medicine. The paper addressed the increasing prominence of regional anesthesia as an alternative treatment for acute pain in emergency medicine due to the opioid crisis in the United States. The study set out to improve resident comfortability with the FICB and increase the frequency of nerve blocks performed in the emergency department (ED). However, it also demonstrated a loss of retention of knowledge at six months, indicating the need for further curriculum refinements.

The fascia iliaca compartment block (FICB), a well-established nerve block, was introduced as an effective modality for pain control in injuries to the hip and femur, such as femoral neck and peri-trochanteric femur fractures. The study focused on defining competency in FICB for emergency medicine residents and assessed the number of FICBs performed after initial training.

The study involved a prospective cohort review of emergency medicine residents at a level-one trauma center. The residents underwent simulation-based training, standardized patients, didactics, and real-time practice over needle guidance and anatomical recognition. A pre- and post-survey was administered to evaluate the residents' baseline knowledge and retention, along with a repeat session to assess competency in anatomical recognition and needle guidance. The curriculum resulted in an increase in the number of FICBs and total nerve blocks performed in the ED. However, it was noted that residents seeking opportunities to conduct the block retained knowledge better than those who did not.

Some limitations of the study were identified, such as a decrease in the number of FICBs performed due to time limitations in the ED and the need for emergency medicine faculty education to make residents feel comfortable supervising the procedure. The study concluded that a single brief educational workshop was not sufficient to gain sustained FICB procedural competence at six months for emergency medicine residents and further interventions would be needed to ensure knowledge retention.

Key Points

- The research paper focused on defining competency elements for a residency program and creating a protocol for training emergency medicine residents in the fascia iliaca compartment block (FICB), a nerve block used for pain control in hip and femur injuries.

- The study involved simulation-based training, standardized patients, didactics, and real-time practice for the residents, resulting in an increase in the number of FICBs and total nerve blocks performed in the emergency department. However, there was a loss of retention of knowledge at six months, indicating the need for further curriculum refinements.

Reference –

Brewer J H, Rupp J, Boyd J S (April 17, 2024) Implementing a Fascia Iliaca Compartment Block Curriculum in an Emergency Medicine Residency Program. Cureus 16(4): e58472. DOI 10.7759/cureus.5847