DIFFERENT WAYS TO IMPROVE SUCCESS RATES FOR PERINEURAL CATHETER TECHNIQUES

DIFFERENT WAYS TO IMPROVE SUCCESS RATES FOR PERINEURAL CATHETER TECHNIQUES:

Will Certifying Examination Become Necessary?

Andre Van Zundert

Catharina Hospital – Brabant Medical School

Eindhoven, The Netherlands

For full text in pdf form click here.

 

Once a medical student successfully passes all medical exams, he/she is awarded with the doctor’s diploma, approved by the national registry of each country. This medical diploma is a guarantee for patients that the doctor in question is not a charlatan, but that he has acquired sufficient medical skills to perform medicine according to an ethical code. Doctors οα the other hand, are also protected from non-certified persons, who are not allowed to perform the profession.

If the doctor wants to specialize in a particular medical specialty, again a number of years of training under supervision are required, together with one or more exams to qualify as a specialist. Even postgraduate studies can lead to diplomas, most often obtained when the candidate proofs proficiency in the required theory and skills. Again the successful examinee is awarded with a diploma or certificate.

The doctor gets a lot of freedom in his approach of a patient, allowing often – within limits and according to medical standards – carte-blanche in applying diagnostic tools and the choice of therapies. Indeed, doctors are allowed to perform acts, which normally are forbidden to other people. Α doctor can incise the skin (with the goal to cure a patient) without fearing legal consequences, provided he acts lege artes. Α ‘Medical Board’ in each country looks carefully whether doctors act and behave according the standards set by the Medical Board and the Board of the different specialties and often checks the competencies of their members ου a regular base. In several countries every five year the status of the doctor is verified. Those who show continuous and consistent input in their medical practice and knowledge (e.g. attending medical courses, congresses, …) will be granted with a prolongation of their medical license. Again the general population of a country expects continuous qualified doctors. Governmental institutions grant the national Medical Boards to check.

Special focus group societies too provide recommendations for ‘good clinical practice’. Any society that respects itself organizes meetings, congresses, workshops, courses, … to update colleagues to further medical knowledge. They also set standards, guidelines, provide protocols, … all to provide tools for the medical practitioner to perform his specialty to the highest standards, in the best interest of the patient. Expertise, responsibility and a specific identity (symbols, culture) are characteristics of such a professional group.  

The European Society of Regional Anaesthesia and Pain Therapy (ESRA) is also such a special interest group society, stimulating research and skills in central and peripheral nerve blocks in order το alleviate perioperative, acute and chronic pain.

Since 2006 ESRA organizes exams το test competencies in regional anesthesia. This exam consists of two parts: a written test (100 multiple choice questions) and an oral test, which can be taken by anesthesiologists and trainees in anesthesia during the annual ESRA congress. The exam tests the ability to apply regional anesthesia in clinical practice, covering practical, technical and theoretical knowledge and expertise in regional anesthesia. The oral exam can be taken once the written exam has been passed successfully, at the earliest one year after successfully passing the written exam.

Α successful oral exam results in a diploma, awarded by the Board of Directors of ESRA: Certificate of Fellowship in Regional Anaesthesia. ESRA initiated this exam because it felt there was a necessity to prove skills others not yet did acquire. The written exams (now organized for the third time) show a gradual increase, due to better spread of this opportunity to acquire such a diploma.

The success of regional anesthesia depends largely on a good knowledge of anatomy, a specific position of the patient for each regional anesthesia block and finally a skilled anesthesiologist. The scope of regional anesthesia focuses on several regional blocks all over the body, using techniques such as nerve stimulation and ultrasound to locate peripheral nerves. Ultrasonography certainly has expanded the scope of practice of regional anesthesia. There is general agreement that a better skilled anesthesiologist improves outcome of our patients undergoing operations under regional
anesthesia.

Other specialties also recommend for training in specific aspects of anesthesia: e.g. ΤΕΕ (transesophageal echography) courses and exams, jointly organized by the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists are a good example of a Board Certified exam. They set a minimum of ultrasound examinations by the student in a supervised environment. ESRA has to decide the optimal number of central and peripheral nerve blocks in order the candidate to achieve proficiency in regional anesthesia.

Regional anesthesiologists should become the experts of interventional – ultrasound guided and/or guided by a nerve stimulator – regional anesthesia. As such it may expand the reach of an anesthesiologist. The awardee obtains a valuable degree, which can be valuable in obtaining a job, he otherwise would not get. Competition is good, as in the end better qualified doctors will perform according to the state-of-the art and consequently provide better care for their patients.

It is the duty of an anesthesiologist to acquire all kind of skills in providing the best choice of anesthesia, including regional anesthesia. It is ESRA’s duty to check whether an anesthesiologist can be certified by organizing good quality congresses and exams. Βy setting the standard, regional anesthesia will be improved in Europe and beyond and aims that all those involve speak the same ‘language’.

ESRA hopes that this Diploma further helps in encouraging people to study regional anaesthesia techniques. The Diploma shows profound knowledge of science and proficiency, making regional anaesthesia safe for providing surgical and obstetrical anaesthesia.

This Fellowship in Regional Anesthesia Diploma inherits both safety and dangers. Ιn the end it might result that only those who show sufficient proficiency in regional anaesthesia, will be allowed to practice regional blocks, making it inevitable to take part in such an examination.

CERTIFIED ESRA DIPLOMA ΟΝ REGIONAL ANAESTHESIA – Qualifying Criteria

Requisites for attendance:

Please note these will be requested for verification prior to your final confirmation of participation in the exam.

Written candidate’s certification: performance of at least

(Certification should be written by your program director / head of department)

100 central blocks

50 upper limb blocks

50 lower limb blocks

ESRA membership

Certificate of Attendance of at least two ESRA workshops (National or European) during the last three years: cadaver workshop (mandatory); hands-on; ultrasound; animal

How it works

Α.

First Υear Written Exam

100 Multiple Choice Questions

2 hours examination

Topics: anatomy, pharmacology, central blocks, peripheral blocks, obstetric regional anaesthesia, paediatric regional anaesthesia, acute pain, material e.g. basic knowledge of the use of a nerve stimulator, ultrasound

Β.

Second year Practical Exam (only after passing the written exam)

20 minutes examination

Οn Simulator and/or Models

When and Where

ESRA Annual Congress

Participants wishing to take the Part 1 Written ΕΧΑΜ and meet the qualifying requisites as outlined above and those participants whom successfully pass this year’s written exam and wish to complete the Part 2 Practical Exam may do so at the XXVIII Annual ESRA congress scheduled to take place in Salzburg, Austria, September 9-12,2009

Fee 100 Euro (50 Euro/Year)

What if you fail?

Unsuccessful participants of either the written or practical part can retake the next year- fees will be applicable again in order to retake.