The Ultrasound-Guided Regional Anesthesia (UGRA) Education and Clinical Training Portfolio is a joint initiative from ASA and the American Society of Regional Anesthesia and Pain Medicine (ASRA) designed for anesthesiologists who wish to distinguish themselves in the field and provide evidence of training and experience to share with employers. The program guides participants through specific criteria to demonstrate knowledge and achievement in UGRA procedures. The program requires participants to progressively build knowledge through participation in specific CME activities and validate experience via case log documentation. The completed portfolio contains data that defines all UGRA achievements, the criteria required to meet the achievement and evidence of how those criteria were met.

The portfolio does not intend to restrict the practice of UGRA, nor does participation ensure competency or certification in the performance of UGRA techniques.

I. Portfolio Eligibility

• Valid license to practice medicine at the time of application.
• Applicants with a temporary medical license and enrolled in a training program accredited by the Accreditation Council for Graduate Medical Education (ACGME) must submit a letter from their program director attesting to and verifying this information. The letter must be on appropriate letterhead and include the ACGME program number.
• Non-North American trained physicians must provide equivalent documentation of permission to practice medicine in the country of principal residence. All documentation must be provided in English.

II. Portfolio Components

A. Knowledge Base (Didactics: 10 hours of AMA PRA Category 1 Credits™)*

Didactic objectives (and suggested CME hours) should include:

• Physics of ultrasound (1 hour)
• Ultrasound artifacts, pitfalls, complications (1 hour)
• Upper extremity sonoanatomy (1 hour)
• Lower extremity sonoanatomy (1 hour)
• Clinical applications (4 hours)
• Evidence-based medicine in ultrasound (2 hours)

*Credit will be given to pre-determined lectures provided by (or endorsed by) the American Society of Regional Anesthesia and Pain Medicine or the American Society of Anesthesiologists.

B. Technical Skills (Workshops: 6 hours of AMA PRA Category 1 Credits™)*

Workshop objectives should include:

• Clinical applications
• Human scanning
• Sonoanatomy
• Image acquisition
• Phantom model needling
• Cadaver/anatomy lab

*Credit will be given to pre-determined workshops provided by (or endorsed by) theAmerican Society of Regional Anesthesia and Pain Medicine or the American Society of Anesthesiologists.

Additional Application details or lists of approved Didactic & Technical Skills courses can be found here.

C. Clinical Experience (case log)*

• N = 40 ultrasound-guided nerve blocks (self-performed)†
• Certified by department chair/practice chair/ultrasound-guided regional anesthesia (UGRA) practice coordinator
• Cases must be performed and submitted within 1 year of completing the knowledge-based examination

*Self-performed case log should be submitted after attending preapproved didactic sessions, participating in preapproved technical skills workshops, and passing the knowledge-based examination (see below).

The case log must be accompanied with a letter from the department chairman, practice chair, or ultrasound-guided regional anesthesia (UGRA) practice coordinator attesting to the candidate’s clinical experience.

†Cases within the case log must be available for confirmation and random audit.

III. Portfolio Evaluation

A. Knowledge-Based Examination (50 questions)

Examination topics will include:

• Physics of ultrasound
• Ultrasound artifacts
• Needle-probe orientation
• Sonoanatomy
• Image acquisition and optimization
• Ultrasound-guided regional anesthesia (UGRA) techniques
• Complications of UGRA

IV. Portfolio Application Process

1. Review portfolio requirments
2. Register, attend, and acquire CME credit for pre-determined didactic sessions and technical skills workshops at ASRA, ASA, or other pre-approved meetings. *If you do not see UGRA sessions that you attended that meet the content criteria, call the sponsoring organization to submit those sessions for approval in the UGRA Portfolio program. Tell them it is free to submit.
3. Submit preliminary application
4. Complete knowledge-based examination (pass rate: 70%)
5. Submit final application, case log of self-performed UGRA nerve blocks (N=40) and certified letter by department chair, practice chair, or ultrasound-guided regional anesthesia (UGRA) practice coordinator to the ASA office.
6. Receive certificate of completion of the ASRA-ASA Ultrasound-Guided Regional Anesthesia Education and Clinical Training Portfolio upon confirmation that all required components of participation have been satisfactorily completed.

UGRA Review Committee:
John Antonakakis, M.D., Richard Brull, M.D., Joseph M. Neal, M.D., Brian D. Sites, M.D., Francis V. Salinas, M.D., Ban Tsui, M.D., Steven R. Clendenen, M.D., J.C. Gerancher, M.D., James R. Hebl, M.D., Dan Kopacz, M.D., Sandra L. Kopp, M.D., Spencer S. Liu, M.D. and Anahi Perlas, M.D. have reported no financial relationships with commerical interests.

Vincent W.S. Chan, M.D. reported that he received material support from SonoSite, GE, Ultrasonix and BK Medical.

David B. Auyong, M.D. reported that he received funded research from Sonosite, and honoraria from Sonosite and Kimberly Clark.

Jean-Louis Horn, M.D. reported receiving Consulting Fees from I-Flow.
Dolores Njoku, M.D. reported receiving royalties from McGraw-Hill Publishing Company.

Brian C. Spence, M.D. has provided no disclosure information.

Robert S. Weller, M.D. has reported receiving material support from I-Flow Corp.

The American Society of Anesthesiologists remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the American Society of Anesthesiologists to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the American Society of Anesthesiologists to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair to ensure that such situations are properly evaluated and, if necessary, resolved. The American Society of Anesthesiologists educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all American Society of Anesthesiologists CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available for all educational activities.

Windows system requirements: Minimum 1-gigahertz (GHz) 32-bit (x86) processor or 1-GHz 64-bit (x64) processor; 1 GB RAM or higher; Microsoft Windows XP, Windows Vista, or Windows 7 or newer. Macintosh platform system requirements: Intel processor; 1 GB RAM or higher; Mac OS X 10.5 (Leopard) or newer. Recommended minimum Web browsers: Internet Explorer 8, Firefox 25.0, Safari 6, and Google Chrome 30. Your browser will also need to have JavaScript enabled. Adobe® Reader® 7.0 or higher is also required. Minimum bandwidth: 512 kbps.