An alternative method for USGNB skill acquisition is to take courses offered by various anesthesiology institutions (NYORA, ASRA, etc.). Regional and national EM conferences also offer such courses for novice clinicians that may be more tailored to the emergency physician. We recommend that the hands-on component (either in phantoms or cadavers) be a central aspect of the course, since proper needling technique is an essential skill.

Finally, the champion’s learning can be supplemented and refreshed at any time using numerous online resources and didactics. An online repository of USGNBs that are most useful for EPs, along with material and procedural considerations, can be found at highlandultrasound.com. Other high-yield free open access medical education (FOAMed) resources for USGNBs are Core Ultrasound (coreultrasound.com/), The Pocus Atlas (thepocusatlas.com/), NYSORA (nysora.com/) and Duke Regional videos (youtube.com/@regionalanesthesiology). Guidance is also easily referenced at the bedside on your smartphone via several highly regarded applications, such as the “Nerve Block,” “The POCUS Atlas,” or “NYSORA Nerve Blocks” applications.

Teaching

Once a USGNB champion has acquired the skills to perform blocks, they will need to establish a training pathway for other physicians at their institution. Scaling beyond the superuser is often the most challenging step. The champion should identify one or two high-yield USGNBs based on common injury patterns seen in their ED population. Many centers will likely find the femoral nerve block for hip fractures, the serratus anterior plane block for rib fractures, and forearm nerve blocks for hand injuries to be the easiest to teach and pertinent to their population’s needs. Limiting the number of USGNBs included in the initial training of novice staff will allow learners to focus on the general principles of regional anesthesia as well as good needling techniques. After proficiency is obtained with baseline principles, programs can choose to introduce further USGNBs via continuing educational training modules. We recommend a training pathway that incorporates both lecture-based and hands-on training. Trainers can leverage the large quantity of existing FOAMed resources already available, as referenced above.

Hands-on teaching is a crucial component of learning any procedural technique. Training should be tailored to the learner’s baseline level of experience with procedural ultrasound. Learners with minimal experience performing ultrasound-guided procedures or in-plane needle visualization technique may benefit from the use of needle trainer devices. These devices can either be purchased or created at home using household supplies (intelligentultrasound.com/needletrainer/, simulab.com/collections/regional-anesthesia-trainers).⁴ Programs can also use existing internal hospital simulation centers if available to provide this component of training.