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Rafael Blanco 29th November 2006

Why bother training in RA. Why bother training in RA. Why bother training in RA. Why bother training in RA. Why bother training in RA. Evaluation of learning. " how to evaluate your progression as you learn how to do blocks ". Rafael Blanco 29th November 2006. Why bother training in RA.

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Rafael Blanco 29th November 2006

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  1. Why bother training in RA Why bother training in RA Why bother training in RA Why bothertrainingin RA Why bother training in RA Evaluation of learning "how to evaluate your progression as you learn how to do blocks" Rafael Blanco 29th November 2006 Why bother training in RA Why bother training in RA Why bother training in RA Why bother training in RA Why bother training in RA Lewisham University Hospital London Why bother training in RA

  2. How do we assess trainees? Continuous assessment Logbooks Cusum To determine proficiency • As a continuous audit of quality • Personal • Local peer review

  3. But… No data

  4. Cusum is a target value set for the level of performance when the block is successful Three successes, follow by a failure and 2 more successes

  5. If success move along “x” axis If failure move along “y” axis 27/3/07 20/3/07 2/3/07 29/3/07 20/3/07 6/3/07 20/3/07 29/3/07 12/3/07 16/3/07 22/3/07 17/3/07 22/3/07 18/3/07 22/3/07 22/3/07 18/3/07 22/3/07 18/3/07 27/3/07 18/3/07 27/3/07 18/3/07 27/3/07 18/3/07

  6. The Construction of Learning Curves for Basic Skills in Anesthetic Procedures Anesthesia & Analgesia Economics,Education and Health Systems Research Volume 95(2), August 2002, pp 411-416 de Oliveira Filho, Getulio Rodrigues MD There was a wide inter individual variability in the number of procedures before attaining acceptable failure rates. This suggests that performance should be followed on at individual bases

  7. The Construction of Learning Curves for Basic Skills in Anaesthetic Procedures (Spinal) Succesful identification SAE first attempt in 569 procedures(82.70%) A second interspace used in 119 procedures (17.29%)

  8. The Construction of Learning Curves for Basic Skills in Anaesthetic Procedures (Epidural) Successful identification epidural space at interspace first chosen occurred in 275 patients (79.94%) A second interspace was used in the remaining 69 cases ( 20.05%)

  9. How to get really good!!

  10. How do I classify procedures?

  11. www.nysora.com

  12. Which machine? • Most often you will only get one chance • A portable • With Doppler • 8-12/8-13 MHz • Capable of recording and saving “quick” • Sensible company

  13. Phantoms Chicken legs Lamb thighs Jelly pots

  14. McMinn’s Human Anatomy textbook (I am not sponsored by them!)

  15. Suggestions for start up • Do not start on your own • Involve as many collegues as you can • Spend time and effort on informing and educating: • Surgeons • Nursing staff • Use both ultrasound & nerve stimulation • Start with superficial,easy to visualise blocks (e.g.axillary, femoral),stick to the ones you know

  16. Local Breakfast meetings Tutorials Theatre supervision Sonoclub(after 17:00) Projects Courses

  17. In summary • Centers of expertise • Luck • Passion • God • Six sense • Numbers • Determination

  18. www.esraeurope.org/ www.csen.com/anesthesia/ www.asra.com www.lsora.com

  19. The End

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