Expert Behaviors USGRA

Study Overview
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Brief Summary
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Expert-performance begins by focusing specifically on the end-product of training and experience in the hands of the expert. By defining expert behaviors and techniques, investigators can guide learners and non-expert practitioners by offering them models to emulate. At Toronto Western Hospital (TWH), there are more than ten expert attending regional anesthesiologists who routinely provide clinical patient care in the block room. The primary objective of this study is to qualitatively and quantitatively examine behavior of experts performing ultrasound guided regional anesthesia techniques to identify those which are consistent and unique, and which may underpin expert performance.

Official Title
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Expert Behaviors in Ultrasound Guided Regional Anesthesia A Mixed-Methods Study

Conditions
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Anesthesia Education

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All elective patients coming to the regional BR at TWH aged 18-80 Exclusion Criteria: Any contraindication to USGRA (LA allergy, patient refusal, infection at injection site, etc.) Inability to read or speak or comprehend English fluently

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Qualitative behaviors of experts performing UGRA techniques during pre-procedural discussion | Reviewers will identify behaviors exhibited by the expert operators during pre-procedural discussion | 1 hour before procedure | 
| Qualitative behaviors of experts performing UGRA techniques during patient and equipment preparation | Reviewers will identify behaviors exhibited by the expert operators during patient and equipment preparation | 0.5 hour before procedure | 
| Qualitative behaviours of experts performing UGRA techniques during ultrasound scanning of the target area; | Reviewers will identify behaviors exhibited by the expert operators during ultrasound scanning of the target area; | 10 minutes before procedure | 
| Qualitative behaviours of experts performing UGRA techniques during needle advancement and local anesthetic deposition around the target nerve(s) | Reviewers will identify behaviors exhibited by the expert operators during needle advancement and local anesthetic deposition around the target nerve(s). | during procedure | 
| Quantitative data on block effectiveness defined by blocks requiring top-up | number of top-up will be collected | 0-1 hour after procedure | 
| Quantitative data on block effectiveness defined by blocks requiring conversion to GA | Incidence will be documented in case conversion to GA is needed | 0-1 hour after procedure | 
| Quantitative data on time to surgical anesthesia | defined by final needle removal to surgical anesthesia | 0-1 hour after procedure | 
| Quantitative data on time to block completion | defined by needle insertion to final needle removal | 0-1 hour after procedure |