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Development and Validation of an Assessment of Regional Anesthesia Ultrasound Interpretation Skills
  1. Glenn E. Woodworth, MD*,
  2. Patricia A. Carney, PhD*,
  3. Joshua M. Cohen, MD,
  4. Sandy L. Kopp, MD,
  5. Lindsey E. Vokach-Brodsky, MD§,
  6. Jean-Louis E. Horn, MD§,
  7. Andres Missair, MD,
  8. Shawn E. Banks, MD,
  9. Nathan F. Dieckmann, PhD** and
  10. Robert B. Maniker, MD††
  1. From the *Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR; †University of California at San Francisco, San Francisco, CA; ‡Department of Anesthesiology, Mayo Clinic, Rochester, MN; §Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA; ∥Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL; **Statistics Core, School of Nursing, Oregon Health and Science University, Portland, OR; and ††Department of Anesthesiology, Columbia University, New York, NY
  1. Address correspondence to: Glenn E. Woodworth, MD, Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (e-mail: woodworg{at}


Background Interpretation of ultrasound images and knowledge of anatomy are essential skills for ultrasound-guided peripheral nerve blocks. Competency-based educational models promoted by the Accreditation Council for Graduate Medical Education require the development of assessment tools for the achievement of different competency milestones to demonstrate the longitudinal development of skills that occur during training.

Methods A rigorous study guided by psychometric principles was undertaken to identify and validate the domains and items in an assessment of ultrasound interpretation skills for regional anesthesia. A survey of residents, academic faculty, and community anesthesiologists, as well as video recordings of experts teaching ultrasound-guided peripheral nerve blocks, was used to develop short video clips with accompanying multiple choice–style questions. Four rounds of pilot testing produced a 50-question assessment that was subsequently administered online to residents, fellows, and faculty from multiple institutions.

Results Test results from 90 participants were analyzed with Item Response Theory model fitting indicating that a 47-item subset of the test fits the model well (P = 0.11). There was a significant linear relation between expected and predicted item difficulty (P < 0.001). Overall test scores increased linearly with higher levels of formal anesthesia training, regional anesthesia training, number of ultrasound-guided blocks performed per year, and a self-rating of regional anesthesia skill (all P < 0.001).

Conclusions This study provides evidence for the reliability, content validity, and construct validity of a 47-item multiple choice–style online test of ultrasound interpretation skills for regional anesthesia, which can be used as an assessment of competency milestone achievement in anesthesiology training.

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  • This work was funded in part by a grant from the Foundation for Anesthesia Education and Research, Rochester, MN, and Oregon Health and Science University, Department of Anesthesiology and Perioperative Medicine, Portland, OR.

    This work was presented as an abstract/moderated poster at the 39th Annual Regional Anesthesia and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine, April 5, 2014, in Chicago, IL.