Article Text

Download PDFPDF
A Survey of Exposure to Regional Anesthesia Techniques in American Anesthesia Residency Training Programs
  1. Michael P. Smith, M.D., M.Ed.,
  2. Juraj Sprung, M.D., Ph.D.,
  3. Andrew Zura, M.D.,
  4. Edward Mascha, M.S.* and
  5. John E. Tetzlaff, M.D.
  1. *From the Departments of General Anesthesiology Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio.
  1. Reprint requests: Michael P. Smith, M.D., M.Ed., Department of General Anesthesiology, E31, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.


Background and Objectives The American Board of Anesthesiologists and the Residency Review Committee for Anesthesiology do not keep records regarding the individual resident's cumulative exposure to specific peripheral nerve block techniques. Further, little is known about individual trainee confidence in performing regional anesthetic blocks. To improve training and anesthesia practice, such information is necessary. In this nationwide survey, we assessed residents' perceived cumulative regional anesthesia experience and their confidence level.

Methods A survey was distributed to 42 U.S. residency programs in 22 states. Information collected included the resident's clinical anesthesia (CA) training level, estimated number of regional anesthetics performed, and the resident's confidence level in performing these techniques. Confidence was graded on a 3-point scale, as being very confident (1.0), somewhat confident (2.0), or not confident (3.0). We analyzed the estimated cumulative number and type of blocks performed in relation to training level and confidence level; differences were considered significant when P < .001.

Results The response rate was 67.2% (736/1,096); 32% (n = 232) of responders were CA-3 residents. At all training levels, the number of blocks performed varied widely according to type of block, with spinal and epidural blocks being performed most often at all training levels and sciatic, retrobulbar, and femoral blocks being performed least (median = 0 each for CA-1, CA-2, and CA-3 residents). Confidence was high with frequently performed blocks (spinal and lumbar epidural) and low for those performed less than 10 times per resident. The CA-3 residents reported a cumulative experience with a median (interquartile range) of 100 (50–100) spinal anesthestics and 150 (100–200) lumbar epidural blocks with all residents being very confident. The CA-3 residents completed a median of 20 (10–30) axillary blocks but a median of less than 10 for each of these techniques: intravenous regional anes-thesia, ankle, interscalene, femoral, sciatic, and retrobulbar. For interscalene block, 51% of CA-3 residents were not confident; for femoral, 62%; for sciatic, 75%; and for retrobulbar block, 91%, were not confident.

Conclusions Most CA-3 residents are confident in performing lumbar epidural and spinal anesthesia. However, many are not confident in performing the blocks with which they have the least exposure. Changes need to be made in the training processes so that residents can graduate with enough confidence to continue selecting less familiar blocks in postgraduate practice. Reg Anesth Pain Med 1999: 24: 11–16.

  • anesthetic techniques
  • regional anesthesia
  • blocks
  • education
  • residency programs
  • specialty training.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.