American Society of Regional Anesthesia and Pain Medicine August 2018 - 23

checklists are written in the affirmative, asking a mark for each
procedural step that happens, QCB are written negatively, with
errors or "novice behaviors" flagged by the assessor.
A few of the cited studies do not contain specific assessment tools
but include checklists or guides that could be helpful in assessing
regional anesthesia performance or building your own assessments
for clinical practice, simulation, or preparation for Objective
Structured Clinical Exams (OSCE).
The purpose of this article is to highlight some available assessment
tools that readers may incorporate into their practice. The intent is
not to rank one tool over any other. Yet, as you review summaries
and read the actual papers, it is worth asking several questions
about each tool: What is the assessment tool designed to evaluate?
Is the tool broadly applicable or limited to a single type of procedure?
What validity evidence is presented to suggest that the assessment
does what it is intended to do? Is it intended for summative use or
formative use? How many items are included in each assessment?
How feasible is incorporation into clinical practice? What are the
relative merits of one assessment type over another?
PERIPHERAL NERVE BLOCK ASSESSMENT TOOLS
Sites B, Spence B, Gallagher J, et al. Characterizing novice behavior
associated with learning ultrasound-guided peripheral regional
anesthesia. Reg Anesth Pain Med. 2007;32(2):107-115.
Sites et al sought to characterize mistakes by trainees during
ultrasound-guided single injection peripheral nerve blocks. Six
residents were videotaped during performance of 520 blocks.
Their mistakes-which are referred to as novice behaviors or
QCB-were categorized by type and tracked over time. Seven
error types were identified before the study, with five other errors
identified during the study. The 12 types of quality-compromising
behaviors were not designed as an assessment tool but have the
potential to be used as one. The most common novice behaviors
were needle advancement without visualization and unintentional
probe movement.
Number of items: 12; Assessment type: QCB; Clinical use:
ultrasound-guided regional anesthesia (UGRA) single-injection
peripheral block
Cheung JJH, Chen EW, Darani R, et al. The creation of an objective
assessment tool for ultrasound-guided regional anesthesia using
the Delphi method. Reg Anesth Pain Med. 2012;37(3):329-333.
Cheung et al reported on the creation of a 22-item checklist and
9-item global rating scale tool for ultrasound-guided singleinjection peripheral nerve block, developed using a modified
Delphi method. The modified Delphi method is well described in
the study.

Number of items: 31; Assessment type: Checklist and GRS;
Clinical use: UGRA single-injection peripheral block with or
without nerve-stimulation
Burckett-St. Laurent DA, Niazi AU, Cunningham MS, et al. A
valid and reliable assessment tool for remote simulation-based
ultrasound-guided regional anesthesia. Reg Anesth Pain Med.
2014;39(6):496-501.
Burckett-St. Laurent et al tested the checklist developed by
Cheung et al for UGRA single-injection peripheral nerve blocks.
This study provided validity evidence for the tool's use based on
good intraclass correlation, an ability to distinguish novices from
experienced proceduralists, and similar scores in simulated and
patient-care scenarios.
Number of items: 31; Assessment type: checklist and GRS;
Clinical use: UGRA single-injection peripheral block
Wong DM, Watson MJ, Kluger R, et al. Evaluation of a task-specific
checklist and global rating scale for ultrasound-guided regional
anesthesia. Reg Anesth Pain Med. 2014;39(5):399-408.
Wong et al adapted the tool used by Cheung et al into a 31item checklist and 10-item global rating scale for UGRA
single-injection peripheral nerve blocks. In contrast to previous
checklists that were written in the affirmative ("check if an action
did occur"), Wong et al worded items as "QCB." In this tool,
points were given for the absence of an error or QCB. This use of
QCB is reminiscent of the Sites et al study. This study evaluated
30 blocks using the tool and found an intraclass correlation
coefficient of 0.44 for total score. The tool took about 4.5 min
(median) to complete an assessment.
Number of items: 41; Assessment type: QCB and GRS; Clinical
use: UGRA single-injection peripheral block
Watson MJ, Wong DM, Kluger R, et al. Psychometric evaluation
of a direct observation of procedural skills assessment tool
for ultrasound-guided regional anaesthesia. Anaesthesia.
2014;69(6):604-612.
Watson et al adapted the Direct Observation of Procedural Skills
(DOPS) scoring system into a 11+2 item tool for UGRA singleinjection peripheral nerve blocks. Eleven items were graded on a
nine-point scale with behavioral anchors to guide the rating. Two
items were dichotomous. The assessments were done on trainees
who were videotaped performing nerve blocks. An extensive
instruction sheet was used to prompt questioning by supervisors
preprocedure and intraprocedure and to score trainees. Appendix
1 could be very useful to anyone instructing trainees in regional
anesthesia. Intraclass correlation coefficients were low at 0.1-0.49.

American Society of Regional Anesthesia and Pain Medicine
2018

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