Defining Ultrasound-Guided Nerve Block Competency for Emergency Medicine: A Delphi-Method Consensus Statement

Ultrasound-guided nerve blocks (UGNBs) are increasingly incorporated into multi-modal analgesia in the Emergency Department (ED). Despite their growing adoption, there is no consensus defining when an Emergency Medicine (EM) clinician is competent to perform UGNBs. Training methods, assessment approaches, and credentialing standards remain highly variable across institutions. The objective of this study was to define competency in UGNBs for EM physicians through a modified Delphi method that included national experts in EM and Anesthesia.

A comprehensive librarian-assisted literature review informed the development of a 123-item questionnaire covering four domains: defining competency, teaching methods, assessment methods, and ongoing professional practice evaluation. Twenty-seven experts (23 EM, 4 anesthesiology) representing 24 institutions participated in two rounds of electronic voting and discussion. Consensus was defined a priori as 80% agreement.

All 27 panelists (100%) completed both rounds. Of 123 items, 61 achieved consensus: 33 items related to defining competency, 14 to teaching methods, 8 to assessment methods, and 6 to ongoing professional practice evaluation related to UGNBs. There was significant debate regarding the minimum number of UGNBs to determine competency and whether UGNBs should be included as a core ultrasound privilege.

This multidisciplinary modified Delphi provides the first national consensus defining competency in UGNBs for both practicing and EM physicians in training. The 61 consensus items offer a structured framework for residency curricula, faculty development, clinical privileging, and quality assurance. These recommendations may help guide forthcoming ACGME requirements and support safe, effective integration of UGNBs into emergency medicine training.