Regional Anesthesia in the Combat Setting: Are ACGME Requirements Enough?

Area of Science:

• Anesthesiology
• Military Medicine
• Surgical Training

Background:

• Updated Clinical Practice Guidelines (CPG) emphasize regional anesthesia and pain management (RAAPM) for combat casualty care.
• The adequacy of RAAPM training for military anesthesiology residents remains uncertain.
• This study evaluates resident-performed combat-relevant regional anesthesia procedures.

Purpose of the Study:

• To assess the frequency and adequacy of combat-relevant regional anesthesia procedures performed by military anesthesiology residents.
• To identify potential gaps in resident training compared to CPG requirements for battlefield pain management.

Main Methods:

• Extracted resident-performed procedure data from a military anesthesiology residency program database over a 1-year period.
• Analyzed procedure frequencies and the proportion of residents meeting pre-defined experience criteria.
• Examined differences in meeting experience criteria across training years.

Main Results:

• Forty-one residents performed various procedures, with simple blocks (e.g., saphenous nerve blocks) more frequent than complex ones (e.g., thoracic epidurals).
• The majority of residents met experience criteria for only 4 out of 8 combat-relevant blocks.
• No significant differences were found in meeting experience criteria across different training levels.

Conclusions:

• A potential gap exists between the Military Health System's needs in conflict and current residency training in RAAPM.
• Further investigation into the reasons for this training gap and potential solutions is warranted.
• Ensuring adequate RAAPM proficiency is crucial for effective combat casualty care.