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Ultrasound-Guided Regional Anesthesia Simulation Training: A Systematic Review
  1. Xiao Xu Chen, MD*,
  2. Vatsal Trivedi, MD*,
  3. AbdulHadi A. AlSaflan, MBBS, SBA*,,
  4. Suzanne Clare Todd, MD, MSc, FRCPC*,
  5. Andrea C. Tricco, PhD, MSc,§,
  6. Colin J.L. McCartney, PhD, MBChB, FRCA, FRCAI, FRCPC*∥ and
  7. Sylvain Boet, MD, PhD***
  1. *Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada; †Department of Anesthesia and Pain Medicine, Dammam University, Dammam, Saudi Arabia; ‡Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto; §Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto; ∥Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital; and **Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
  1. correspondence: Sylvain Boet, MD, PhD, Department of Anesthesiology and Pain Medicine and Department of Innovation in Medical Education, University of Ottawa, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9 (e-mail: sboet{at}


Background and Objectives Ultrasound-guided regional anesthesia (UGRA) has become the criterion standard of regional anesthesia practice. Ultrasound-guided regional anesthesia teaching programs often use simulation, and guidelines have been published to help guide URGA education. This systematic review aimed to examine the effectiveness of simulation-based education for the acquisition and maintenance of competence in UGRA.

Methods Studies identified in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were included if they assessed simulation-based UGRA teaching with outcomes measured at Kirkpatrick level 2 (knowledge and skills), 3 (transfer of learning to the workplace), or 4 (patient outcomes). Two authors independently reviewed all identified references for eligibility, abstracted data, and appraised quality.

Results After screening 176 citations and 45 full-text articles, 12 studies were included. Simulation-enhanced training improved knowledge acquisition (Kirkpatrick level 2) when compared with nonsimulation training. Seven studies measuring skill acquisition (Kirkpatrick level 2) found that simulation-enhanced UGRA training was significantly more effective than alternative teaching methods or no intervention. One study measuring transfer of learning into the clinical setting (Kirkpatrick level 3) found no difference between simulation-enhanced UGRA training and non–simulation-based training. However, this study was discontinued early because of technical challenges. Two studies examined patient outcomes (Kirkpatrick level 4), and one of these found that simulation-based UGRA training improved patient outcomes compared with didactic teaching.

Conclusions Ultrasound-guided regional anesthesia knowledge and skills significantly improved with simulation training. The acquired UGRA skills may be transferred to the clinical setting; however, further studies are required to confirm these changes translate to improved patient outcomes.

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  • Author contributions: X.X.C. and V.T. performed screening, data extraction, and evaluation of risk of bias; reviewed the protocol; and revised and finalized manuscript. A.A.A. wrote the protocol; performed literature search; was responsible for coordination of the study and communication with all coauthors, screening, and data extraction; and wrote the first draft of the manuscript. S.C.T. performed data extraction, evaluated risk of bias, and wrote and revised the first draft of the manuscript. A.C.T. reviewed the protocol, provided methodological expertise as needed, and critically reviewed the final manuscript. C.J.L.M. reviewed the protocol and critically reviewed the final manuscript. S.B. is co–principal investigator, supervised all steps of the study, critically reviewed the first draft of the protocol, supervised data screening and abstraction, and critically reviewed the first draft of the manuscript.

    The work should be attributed to the Anesthesiology Department of The Ottawa Hospital, as well as the Faculty of Medicine at the University of Ottawa.

    This research was supported by the Canadian Anesthesia Research Foundation through the Canadian Anesthesiologists' Society Career Scientist Award in Anesthesia awarded to S.B. S.B. and C.J.L.M. were supported by The Ottawa Hospital Anesthesia Alternate Funds Association. A.C.T. is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis.

    The authors declare no conflict of interest.

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