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Determining the Learning Curve for Acquiring Core Sonographic Skills for Ultrasound-Guided Axillary Brachial Plexus Block

Barrington, Michael J. PhD, MBBS, FANCZA; Viero, Laura P. BSci (Hons); Kluger, Roman FANCZA, PGDipBiostat; Clarke, Alexander L. MBBS; Ivanusic, Jason J. PhD; Wong, Daniel M. FANZCA

Regional Anesthesia and Pain Medicine: November/December 2016 - Volume 41 - Issue 6 - p 667–670
doi: 10.1097/AAP.0000000000000487
REGIONAL ANESTHESIA AND ACUTE PAIN: ORIGINAL ARTICLES
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Background and Objectives The objectives of this study were to determine the learning curve for capturing sonograms and identifying anatomical structures relevant to ultrasound-guided axillary brachial plexus block and to determine if massed was superior to distributed practice for this core sonographic skill.

Methods Ten University of Melbourne, third- or fourth-year Doctor of Medicine students were randomized to massed or distributed practice. Participants performed 15 supervised learning sessions comprising scanning followed by feedback. A “sonographic proficiency score” was calculated by summing parameters in acquiring and interpreting the sonogram, and identifying relevant anatomical structures.

Results Between the 1st and 10th sessions, the proficiency scores increased (P = 0.043). Except for one, all participants had relatively rapid increases in their “sonographic proficiency scores.” There was no difference in proficiency scores between the 15th and 10th sessions (P > 0.05). There was no difference in scores between groups for the first session, (P = 0.40), 15th session (P = 0.10), or at any time. There was no difference in the slope of the increase in “sonographic proficiency score” over the first 10 scanning sessions between groups [massed, 1.1 (0.32); distributed, 0.90 (0.15); P = 0.22) presented as mean (SD)]. The 95% confidence interval for the difference in slopes between massed and distributed groups was −0.15 to 0.56.

Conclusions The proficiency of participants in capturing sonograms and identifying anatomical structures improved significantly over 8 to 10 learning sessions. Because of sample size issues, we cannot make a firm conclusion regarding massed versus distributed practice for this core sonographic skill.

Supplemental digital content is available in the text.

From the *Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne; and †Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, ‡Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia.

Address correspondence to: Michael J. Barrington, PhD, MBBS, FANCZA, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Victoria Parade, PO Box 2900, Fitzroy, Melbourne, Victoria 3065, Australia (e-mail: Michael.BARRINGTON@svha.org.au).

Accepted for publication June 17, 2016.

The authors declare no conflict of interest.

Supported by the Australian and New Zealand College of Anaesthetists in the form of scholarship (10/023) and project (14/030) grants. This enabled development of the online interface for data entry.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org).

Copyright © 2016 by American Society of Regional Anesthesia and Pain Medicine.