Learning more US regional skills as an attending

[Colba55o]

I'm a relatively new (< 1yr) attending in private practice with a small 6 MD group. I got good regional training during residency in certain blocks including upper extremity and femorals and pop sci. We didn't however get any exposure to fascia iliaca or adductor canal blocks, both of which would be really useful in our practice setting.

What would be a good way to go about learning these? It seems like a lot of the ultrasound regional courses out there cover all the main blocks over a course of a weekend, but I'm skeptical that I would learn the blocks well enough over an hour or two to do them on my own unsupervised. None of my colleagues are familiar with these particular blocks either and I can't find any courses that are focused on particular blocks which would be ideal.

Have any of you attended these courses and gotten enough training to go back to your practices and start doing them right away? Thanks in advance

---

Members don't see this ad.

 

[dhb]

I'm a relatively new (< 1yr) attending in private practice with a small 6 MD group. I got good regional training during residency in certain blocks including upper extremity and femorals and pop sci. We didn't however get any exposure to fascia iliaca or adductor canal blocks, both of which would be really useful in our practice setting.

What would be a good way to go about learning these? It seems like a lot of the ultrasound regional courses out there cover all the main blocks over a course of a weekend, but I'm skeptical that I would learn the blocks well enough over an hour or two to do them on my own unsupervised. None of my colleagues are familiar with these particular blocks either and I can't find any courses that are focused on particular blocks which would be ideal.

Have any of you attended these courses and gotten enough training to go back to your practices and start doing them right away? Thanks in advance

If you are proficient in US regional you can learn these blocks in 5min on youtube. I would certainly not pay for a course for these basic blocks but to each their own...

 

[gasdoc77]

You are in luck! Our group has decided to offer a fellowship in adductor canal and fascia iliaca blocks. It is not accredited, but you will get lots of great experience and, in an effort to maintain your skills, we will allow you to also be a part of the regular OR/call schedule.

 

[chocomorsel]

What is the pay gasdoc? I may be interested LOL. My skills are getting real crappy lately from lack of use and that is not a joke!!!

 

[Consigliere]

neuraxiom.com

 

[BLADEMDA]

http://www.blockjocks.com/

Everything you need to succeed in Private Practice and more.

 

[pgg]

Youtube, NYSORA's web site, neuraxiom. Gel up and spend 10 or 15 minutes ultrasounding yourself and that nurse or housekeeper over there. Go for it on the next patient. You'll get it. You have the basic skills, the rest is just details.

 

[Colba55o]

Thank you for that clever post gasdoc77. God forbid I come here for some genuine advice without instead getting sarcastic commentary from the peanut gallery.

I have watched several youtube videos, most of them seem to be on ideally unrealistic thin models with good anatomy. How would you like knowing that your anesthesiologist was performing a block on you, that he just learned on youtube 5 minutes before? I don't think good US regional skills are easily self taught, if they were then why do people make such a fuss over CRNAs doing them? Why not train surgeons to do them themselves? Its as easy as watching a video on youtube!

Has anyone else gone to a course they actually found really helpful? Has anyone just cold called other institutions that do the blocks you want to learn and ask if you can hang out and observe them for a day?

 

[pgg]

Thank you for that clever post gasdoc77. God forbid I come here for some genuine advice without instead getting sarcastic commentary from the peanut gallery.

Aw, c'mon, it was funny. 🙂

I have watched several youtube videos, most of them seem to be on ideally unrealistic thin models with good anatomy. How would you like knowing that your anesthesiologist was performing a block on you, that he just learned on youtube 5 minutes before?

Agree the online videos always show ideal anatomy. You've got to pick and choose the patients you do new-to-you blocks on. Don't do your first on a 160 kg patient.

I wouldn't like to know that, but I would assume my anesthesiologist wouldn't bring it up. There's nothing wrong with a doctors reviewing a text or looking something up prior to a procedure.

I don't think good US regional skills are easily self taught, if they were then why do people make such a fuss over CRNAs doing them? Why not train surgeons to do them themselves? Its as easy as watching a video on youtube!

Well, back up a bit.

Acquiring good US regional skills is easier with instruction. But once you've got some proficiency, it's easily extended to other blocks. Holding the probe right, fiddling with buttons on the machine, getting a good view of the needle in plane, yeah at first it takes some practice and some guidance helps. But anyone CAN pick up these skills, and fairly quickly. Just like any med student can learn to suture. The monkey skill needle driving is not what makes any of this stuff the practice of medicine though. Knowing the indications, good risk/benefit assessment, anticipation of complications (both related to the procedure and not), ability to manage complications ... THAT'S what makes what we do difficult and dangerous.

Not putting a needle next to a nerve and squirting in some local. You can learn that bit on Youtube, if you have a reasonable foundation.


From a purely technical standpoint, for anyone who's ever done any block with ultrasound, an adductor canal block is the easiest thing in the world. Watch a video or two, scan your own leg for a few minutes (not in front of the patient), and do it.


And now, I will incise.

 

[Consigliere]

How would you like knowing that your anesthesiologist was performing a block on you, that he just learned on youtube 5 minutes before?

Yeah, so what?! Your anesthesiologist also has 12 years of training under his belt and perhaps many years of experience. We are trained as physicians to know the complications of said blocks and how to deal with them. It doesn't matter if you watched videos on YouTube 5 minutes prior or went to 22 courses, read 3 regional anatomy texts, and had several beers with the Block Jocks. The end result is the same: at some point, SOMEONE is going to be your first patient. With US guided regional anesthesia you just gotta do it.

 

[BLADEMDA]

Thank you for that clever post gasdoc77. God forbid I come here for some genuine advice without instead getting sarcastic commentary from the peanut gallery.

I have watched several youtube videos, most of them seem to be on ideally unrealistic thin models with good anatomy. How would you like knowing that your anesthesiologist was performing a block on you, that he just learned on youtube 5 minutes before? I don't think good US regional skills are easily self taught, if they were then why do people make such a fuss over CRNAs doing them? Why not train surgeons to do them themselves? Its as easy as watching a video on youtube!

Has anyone else gone to a course they actually found really helpful? Has anyone just cold called other institutions that do the blocks you want to learn and ask if you can hang out and observe them for a day?

Go back to your residency program for a day and watch the block. Alternatively, go to the outpatient center and watch blockjocks do their thing in person. As for me, I was already skilled in landmark regional anesthesia so moving to u/s was like turning on a light in a familiar but dark room. Doing regional has never been easier than it is today.

 

[nimbus]

Maybe as a new grad you are used to having everything spoon fed to you. After you are out of training for a few years you will realize that you will have to take a more active approach and do things you've never done before without anyone holding your hand. This is not only true for regional. Use your clinical experience and judgement. Be safe and conservative, but bite the bullet and proceed.

 

[Impromptu]

On the rare occasions that I am free when they are doing a block I have been helping some of my new partners to do blocks with our new ultrasound machine. It is nice to have that second set of eyes helping you to visualize the nerves the first few times. They are picking it up quite quickly.