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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

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March 1, 2013 Volume 77, Number 3
Ultrasound-Guided Regional Anesthesia Education and Clinical Training Portfolio James R. Hebl, M.D., Chair Committee on Regional Anesthesia


ASA and the American Society of Regional Anesthesia and Pain Medicine (ASRA) have recently created a joint educational product referred to as the Ultrasound-Guided Regional Anesthesia (UGRA) Education and Clinical Training Portfolio. The portfolio project was developed by a joint task force of ASA and ASRA members in response to a recent initiative of the American Institute of Ultrasound in Medicine (AIUM) to develop practice standards and training needs for neural imaging during ultrasound-guided regional anesthesia. In addition, ASA and ASRA leadership were receiving isolated feedback from society members that local hospitals and medical facilities were beginning to request validation of “competency” of anesthesiologists for local accreditation and privileging. In fact, some ASA members were being challenged within their local institutions that ultrasound guidance was not within their scope of practice.

In response to this feedback, the joint ASA-ASRA task force was charged with creating and distributing a survey to ASA and ASRA members to a) quantify the number of members experiencing local accreditation or privileging difficulties associated with point-of-care ultrasound use in anesthesia practice; and b) to assess the perceived value among ASA/ASRA membership in establishing an educational portfolio or validation training for ultrasound-guided regional anesthesia. The survey was sent to ASA and ASRA members in 2011 and identified the following results:

Therefore, based upon the results of the survey and ongoing feedback from ASA and ASRA members, the joint ASA-ASRA task force created the educational portfolio described below. The portfolio has been endorsed and approved by both societies, including the ASA House of Delegates (October 2012).

The UGRA Education and Clinical Training Portfolio is intended to provide applicants with a comprehensive educational and training experience that is based upon previously published recommendations from ASRA and the European Society of Regional Anesthesia (ESRA) and fulfills current training recommendations for ultrasound-guided regional anesthesia. The portfolio does not intend to restrict the practice of UGRA, nor does participation ensure competency or certification in the performance of UGRA techniques. Its primary intent is to serve as an educational guide for this unique component of anesthesia care.

UGRA Education and Clinical Training Portfolio Components
The following components are required for completion of the UGRA Education and Clinical Training Portfolio:
I. Knowledge-based Didactics: Participants will be required to complete 10 hours of AMA PRA Category 1 Credits™. Didactic courses must include objectives that focus on: the physics of ultrasound; ultrasound artifacts, pitfalls and complications; upper-extremity sonoanatomy; lower-extremity sonoanatomy; clinical applications of ultrasound; and evidence-based medicine in ultrasound. Qualifying didactic lectures will be provided by ASA, ASRA and other qualifying meetings, societies or organizations that register their didactic courses with the UGRA Education and Clinical Training Portfolio project.

II. Technical Skills Workshops: Participants will be required to complete six hours of AMA PRA Category 1 Credits™. Workshop objectives must include human ultrasound scanning, instruction on upper- and lower-extremity sonoanatomy, image acquisition, clinical applications and phantom model needling. Qualifying workshops will be provided by ASA, ASRA and other qualifying meetings, societies or organizations that register their regional anesthesia workshops with the UGRA Education and Clinical Training Portfolio project.

III. Knowledge-based Examination: Participants will be required to complete a knowledge-based examination (50 questions) that focuses on the physics of ultrasound, ultrasound artifacts, needle-probe orientation, upper- and lower-extremity sonoanatomy, image acquisition and optimization, UGRA techniques and complications of UGRA.

IV. Clinical Experience: Participants will be required to submit a case-log of 40 self-performed ultrasound-guided regional anesthesia nerve blocks within one year of successfully completing the knowledge-based examination.

Upon successful completion and confirmation of participation in all four components, participants will receive a certificate of completion of the UGRA Education and Clinical Training Portfolio project. The online application for both portfolio participants and external societies or organizations that wish to provide qualifying didactics and workshops will soon be available on the Education Center portion of the ASA website http://education.asahq.org/UGRA. Updates on this new educational product will be posted on the website as additional details become available.


March 2013 ASA Newsletter




James R. Hebl, M.D. is Associate Professor of Anesthesiology, Vice-Chair, Clinical Practice, Department of Anesthesiology, Mayo Clinic, Rochester.


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