Regional Anesthesia Training Program

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Quick Facts

• ACGME Accredited : No
• ABA Certified: No
• Duration of Program: 6 months - 1 year
• Positions Available: 1-2
• Application enrollment date(s) or deadline: Applications July 1st through September 30th
• Applicant Qualifications (i.e. emergency medicine candidates): Completion of an ACGME accredited residency anesthesia program

Overview and Curriculum Goals

The goal of the regional anesthesia rotation is for the residents to develop the skills and knowledge base necessary to perform basic regional anesthetic techniques for surgery. The resident should be able to utilize regional anesthesia as a tool for both intraoperative anesthesia and postoperative analgesia by the end of this rotation.

Objectives

The learning objectives for this rotation are organized by ACGME core competency as follows:

Professionalism
The resident will be expected to:

• Act responsibly and with integrity with their patients, nurses, fellow residents and health care providers.
• Fulfill clinical duties in a timely and appropriate manner.
• Adhere to ethical principles including respect for patient privacy.
• Demonstrate an active interest in learning and participating in the care of patients receiving regional anesthesia.

Interpersonal and Communication Skills
The resident will be expected to interact well and demonstrate cultural sensitivity to patients, nurses, nurse anesthetists, surgeons and the attending anesthesiologist. They should develop skill in educating and preparing patients for the regional block or other procedure they administer.

• Provide effective patient education regarding indications, risks and side effects of procedures.
• Obtain appropriate informed consent from patients.
• Communicate effectively with other members of the team.

Medical Knowledge
During this rotation the resident will acquire the basic scientific foundation and knowledge of the major principles of regional anesthesia. Upon completion of the rotation the resident is expected to:

• Describe the general attributes of local anesthetic pharmacology and its relevance to peripheral nerve blockade.
• Demonstrate an understanding of the dosing and toxicity of local anesthetics.
• Recognize the clinical signs and symptoms of local anesthetic overdose and toxicity and how to intervene in such instances.
• Discuss the principles and indications for local anesthetic adjuvants such as bicarbonate and epinephrine.
• Describe the anatomy of various blocks.
• Describe the selection criteria for regional anesthetic techniques suited for specific clinical situations.
• Describe the steps in the safe preparation of local anesthetic agents for peripheral nerve block.
• Describe the risks and benefits of regional anesthesia compared to general anesthesia.
• Understand appropriate techniques and actions for both the primary anesthesiologist performing a peripheral nerve block as well as the assistant during the placement of such blocks.

Practice-based Learning and Improvement
During this rotation the resident will be expected to demonstrate life-long practice based learning and improvement by reviewing the literature, including use of electronic media, for the regional anesthetic techniques they perform.

• Access relevant literature on issues in regional anesthesiology.
• Critique own performance in procedural skill.
• Seek and apply feedback to improve performance.

Patient Care
Upon completion of the rotation the resident is expected to:

• Conduct the set up and use of a peripheral nerve stimulator and basic troubleshooting of the device.
• Conduct the set up and use of ultrasound for regional and basic troubleshooting.
• Observe, describe, demonstrate working knowledge of, and may perform the following blocks:
  1. Interscalene.
  2. Axillary.
  3. Femoral.
  4. Popliteal (sciatic block at popliteal fossa).
  5. Ankle.
  6. Bier.
  7. Infraclavicular.
  8. Supraclavicular.
  9. Lumbar Plexus.
  10. Sciatic (proximal approaches)
  11. Use continuous catheters at any site.
  12. Other miscellaneous single shot nerve blocks.
• Observe, describe, demonstrate working knowledge of, and may perform the above blocks with ultrasound guidance, neurostimulation, paresthesia, or landmark guidance.

Systems-based Practice
The resident should demonstrate an awareness of and responsiveness to the needs of the large health care system as it relates to the patient receiving regional anesthesia, both as a primary anesthetic and for postoperative analgesia.  They also will understand the rationale for and participate in hospital initiatives to improve quality and efficiency in the operating room as it pertains to regional anesthetic techniques.

• Work effectively as a member of the patient care team.
• Understand basic principles of safety in administering regional anesthesia.
• Identify areas for quality improvement in the administration of regional anesthesiology.
• Understand the documentation of regional anesthesiology procedures.

Assessments:
The resident will receive paper or electronic evaluation (E-value) by the Division of Obstetric & Regional Anesthesia and Acute Pain, as well as verbal feedback informally throughout the rotation.  The case-logs of the resident will also be evaluated periodically by the clinical competency committee for the number and type of nerve blocks or other regional anesthetic techniques to ensure they are obtaining adequate experience.

Reading Requirements:
The resident should read the following chapters while taking the regional anesthesia rotation.

Miller’s Anesthesia, 6th ed:            

• Chapter 14 - Local Anesthetics
• Chapter 43 - Spinal Epidural and Caudal Anesthesia
• Chapter 44 - Nerve Blocks
• Chapter 61 - Anesthesia for Orthopedic Surgery
• Chapter 72 - Acute Postoperative Pain

Educational Resources:
The 8th floor Meyer library has Atlas of Regional Anesthesia by David L. Brown

Online:
Regional Anesthesia and Acute Pain Management, ACCM Intranet Regional Article series, asra.com

Faculty

Christopher Wu, M.D. - Professor. Division Chief – OB, Regional Anesthesia And Acute Pain Medicine

Marie Hanna, M.D. - Assistant Professor

Vineesh Mathur, M.D. - Assistant Professor

Calvin Eng, M.D. - Assistant Professor

E. David Bravos, M.D. - Assistant Professor

J.P. Ouanes, M.D. - Assistant Professor

Contact

Regional Anesthesia Program
Department of Anesthesiology and Critical Care Medicine
The Johns Hopkins Medical Institutions
Sheik Zayed Tower 8120L
1800 Orleans Street
Baltimore, MD 21287
410- 955-5608

Courtney DeRiggs
Program Coordinator
cderigg1@jhmi.edu