April 2014 - Newsletter
There are still a few available positions for workshop instructors at 13th Annual NYSORA Symposium, New York, NY September 20-21, 2014. If interested send a cv and list of techniques wanting to present to firstname.lastname@example.org.
- Register early for NYSORA fabled Saturday Cruise on the Hudson. Space is limited this year due to the high demand.
Dr. Shibata Yasuyuki presenting at the first NYSORA Latin America
Dear NYSORA Newsletter Readers,
We have quite the newsletter in store this month! First, we start with a recap on the recent NYSORA Latin America in Florianopolis, Brazil. We will follow this with an interview with Dr. Sanjib Adhikary about his Ultrasound Skill Training Simulator which was featured at the March 20-21, 2014 NYSORA Boutique Workshop. Also in this newsletter, we present a membership offering by the Society of Anesthesia and Sleep Medicine. We wrap up with some highlights from the recent NYSORA Boutique workshop.
There is much in happening for NYSORA in the coming months! Limited spaces available for the June 28th-29th NYSORA Boutique workshop. The NYSORA Boutique Workshops on Ultrasound-guided nerve blocks and vascular access are extremely popular and fill up well in advance; be sure to reserve your spot and bring valuable skills back to your institution. We hope you can come join what has become an in-demand NYSORA event!
There is still space available for the NYSORA Inspire Sessions in December (St. Lucia, Pigeon Causeway) and January (Mont-Tremblant, Quebec). Spend some one-on-one time with some of the best NYSORA instructors. Inspire Seminars may be the most effective way to jump-start the use of ultrasound-guided nerve blocks and vascular access in your practice. The November program additionally features topics and hands-on fiber optic practice by one of NWAC's best airway instructors, Imran Ahmad, MD. The NYSORA Inspire sessions are the perfect blend between education and leisure for busy clinicians. The Inspire programs will also feature a multitude of "surprise" bonus sessions outside of the formal program, such as photography classes, Adobe Photoshop classes or even guitar lessons. So, keep an eye on info at seminars.nysora.com
NYSORA Newsletter Editor
Sunrise over the Costão Do Santinho Resort.
Webster's dictionary defines relaxation as "the act of being calm or free from stress, worry or anxiety." Stress, worry and anxiety are words seldom heard at the Costão Do Santinho Resort in Florianopolis, Brazil. This first NYSORA Latin America has been many years in the making. According to our local hosts, it took some effort for NYSORA to commit to organizing a program in South America. The hard work had certainly paid off. Thanks to the coordination and planning of our local hosts, Dr. Pablo Helayel and Dr. Carlos Bollini, NYSORA Latin America has made itself a permanent fixture in its very first year. The location for the event, the Costão Do Santinho Resort, was baked in sunlight and outlined with beaches turning into mountains then back into beaches again. This setting made diving into lectures much easier.
The four-day event kicked off on Thursday evening with a master class intended for speakers but was heavily attended by delegates, eager for what NYSORA had to offer. The first half of Friday started with a focus on anesthesia in obstetrics moderated by Dr. Alan Santos with lectures presented by Dr. Migdalia Saloum (USA), Dr. Barbara Orlando (USA), and Dr. Monica Siaulys Cardoso (Brazil). The second half of Friday was dedicated to the Comprehensive Ultrasound Guided Nerve Block Workshop led by Dr. Ana Lopez (Spain) and Dr. Catherine Vandepitte (Belgium). Without the help of Pablo Helayel for ensuring models and beds and the Sonosite team for providing the ultrasound machines, the workshop portions of our conference would not have been possible! The signature NYSORA format of lecture followed immediately by application of the knowledge through ultrasound training continues to be a success. Our South American counterparts reinforced this method with words of praise in Portuguese, Spanish and English.
Saturday's lectures focused on creating leaders in regional anesthesia in Latin America with a wide variety of topics for the delegates to digest and discuss. The speakers assembled an excellent set of lectures for which we are still receiving compliments. As the sun-tanned sea of anesthesiologists entered the lecture hall for the finale, Sunday's workshop, it was apparent that few were ready to return home. Some may have been recovering from festivities and Cachaça fueled dancing and singing of Saturday night's social event. Regarding the social event on Saturday night, no one can dance and sing like our South American colleagues. Their energy and love, as well as warm invitation to the dance floor, surpasses the feeling at the best US dance parties.
As the NYSORA team packed for the trip back home to NYC, stored contacts of new friendships formed, and absorbed the beauty that Florianopolis had to offer, we found ourselves in a whole new state of relaxation. This feeling was inspired not just from the beachside environment with Brazilian delicacies at ones fingertips, but from true bonds grown out of this great collaboration. Dr. Pablo Helayel put it best:
"In my opinion the most remarkable aspect of the conference was the attendee's genuine interest in the program. Nobody left the room until the end of the activities during the entire event, despite the fact that the weather was beautiful. We had a very focused audience who had been waiting for NYSORA come to Latin America for a long time. We all thought it would be a great service to the entire Latin American regionalists' community to bring such a top quality event to our continent. In other words, we wanted to share NYSORA's philosophy and knowledge throughout Latin America. After a couple of talks with Admir [Hadzic] and providing this perspective, I believe he was convinced that Latin America could benefit from NYSORA's expertise in helping inspire new generations of colleagues to improve regional anesthesia standards on research and clinical practice, thus multiplying training opportunities. In exchange, Latin American colleagues could teach NYSORA marines how to improve their dancing skills after some Caipirinhas!!"
Pablo Helayel hard at work
NYSORA Latin America made a commitment to return to spread knowledge of regional anesthesia in the future. Keep an eye on NYSORA.com for future educational offerings in Latin America.
The NYSORA Latin America Instructors, ESOP Scholars and Delegates
Photography Credits: Matthew Becker and Admir Hadzic
What inspired you to develop the simulator?
As we all know, real-time Ultrasound guided regional anesthesia requires not only good knowledge of anatomy but also effective technical skills. During any procedure utilizing real-time ultrasound, the needle-to-image coordination is one of the most vital and difficult skills to master. During these procedures, one has to look at a two dimensional image while working with the hands and probe in three dimensions. Due to the complexity of the process, this task can be challenging even in experienced hands. While teaching at regional anesthesia ultrasound courses and in every day practice as part of resident teaching, I found significant difficulty in transferring these skills from one individual to another. I feel this is mainly due to trainer specific instructions describing required hand and probe movements to keep the needle aligned with the ultrasound beam. The trainees frequently misunderstand the directions. The trainer must often demonstrate a particular movement that is not easily replicated by the trainee. This inspired me to look for different equipment and instruction techniques which could help demonstrate the trainee's own movements providing direct feedback rather than a trainee attempting to learn from another's indirect instruction.
I stumbled across this two-camera technique that was being used by one of my colleagues for teaching and assessing airway skills in medical student and residents. By adding ultrasound feedback to that system, the simulator has developed to its present form.
What are the features of the simulator?
This US skill simulator has four components that can be used as separate teaching modules in various combinations or as a complete unit depending on the focus of the skill training. The components of the system include: a) a portable ultrasound unit, b) a phantom model (MinSim™ Life tech Inc. Stafford, Texas, USA) c) Bi-plane video cameras with monitor and d) a storage and processing unit.
Portable Ultrasound - Any standard portable ultrasound machine with a continuous video output can be used. We initiated training with equipment used clinically in our regional anesthesia service to familiarize the trainees with our equipment.
Phantom Model (MinSim™) - Any standard simulation phantom model can be used. The MinSim™ has a built in feature allowing identification of target nerves with a sound produced when the needle contacts the target. Initially, we used the popliteal fossa model as that block is performed in high volume in our regional anesthesia service. The simulation skills learned were easily transferable to the clinical setting. More technical challenging techniques such as infraclavicular or axillary blocks can also be used before the trainee starts to perform them clinically.
Bi-plane video cameras with monitor - We used a standard home surveillance video system (USD 400.00) adapted to our needs by mounting the cameras on a ring stand. This low cost, readily available and adaptable system makes it affordable by almost any department.
Storage and synthesis unit - This is an add-on to the system offering storage of pictures and/or videos for review. The images can be used for off-line feedback, skill improvement and assessment.
What are the costs of the components?
As mentioned earlier, any video surveillance system and ultrasound machine can be used. A phantom model costs around $550 per piece. These can be used multiple times. Stands to hold the cameras are readily available. The monitor used to capture videos can be a simple laptop or any other monitor based primarily on personal preference. The complete system can be put together for less than $1200.
How long did it take you to build one?
Once I acquired all the components, it took me one day to assemble. Acquiring the components is the rate-limiting step.
Do you have a standardized teaching protocol for your simulator?
We are currently evaluating the effectiveness of the simulator in learning needle to image coordination using a randomized controlled trial involving residents, novices and experienced anesthesiologists. We have a standardized video demonstrating its use, which is used for the study.
How is it accepted by your residents?
While we are evaluating the system in a controlled scenario, we have also used this model outside the study environment. Our residents really enjoy using the simulator and are able to practice with it outside the clinical setting on their own time.
Following this interview are three testimonials by the residents who have used this simulator in different capacities
What is your training background?
I was trained in India for my under graduate in Medicine (MBBS) and postgraduate (M.D. Anesthesiology) degrees. After being an attending Anesthesiologist in one of the premier institutions of the country (Christian Medical College Vellore) for about 6 years, I moved to Canada where I was trained at University of Toronto and Western Ontario in Neuroanesthsia as well as Regional anesthesia and pain medicine. I moved to the USA in August 2009 to join Penn State College of Medicine, and from that time have been actively involved teaching Ultrasound guided regional anesthesia clinically and for ASRA (American Society of Regional Anesthesia) and the CAS (Canadian Anesthesia Society). I am also coordinator of an ultrasound guided regional anesthesia cadaver course held annually at Penn State Hershey Medical Center. I am privileged to be an instructor at this year’s NYSORA workshop. I am truly looking forward to sharing my simulator with different regional anesthesia enthusiasts through this meeting.
What are your plans at Hershey, vision for regional anesthesia, your cadaver workshops, etc.?
At Hershey Medical Center we are presently in the process of establishing a curriculum for training of regional anesthesia using simulation. In the curriculum, we are planning to use the simulator to train our residents on all blocks in a simulation scenario before performing them on patients. We plan to validate the curriculum soon. We also plan to incorporate the simulator in our annual cadaver course. This course, which is open to physicians at any level of training, uses fresh cadavers as specimens giving participants a realistic experience of needle to image coordination when practicing block techniques. We hope our innovative teaching techniques will improve the effectiveness of regional anesthesia education and, over time, improve the efficacy and safety of regional anesthesia.
Dr. Sanjib Das Adhikary, M.D.
Testimonials from users of the Ultrasound Skill Training Simulator
As an Anesthesiology resident I personally have used Ultrasound in a wide variety of settings including in intensive care unit, operating room, perioperative areas, and also in the pain clinic. One thing that I have noticed is that most of the times there is some hesitation to pick up the ultrasound for whatever reason when people have not had proper training. I have noticed that most of us struggle with identifying and maintaining proper needle and probe alignment. Maintaining this proper alignment is crucial to allow proper visualization of the needle whether it is obtaining vascular access or preforming a peripheral nerve block. The great thing about the training system is that it gives you multiple ways to identify proper positioning and ultrasound alignment. I liked being able to see my needle probe alignment in multiple planes with the cameras and then have instant feedback with the image on the ultrasound. I noticed that when I had the best visualization of my needle on the ultrasound screen I would stop and look at the camera and I was in plane in entirely in all axes. Another cool feature of the training system was that it also provides auditory feedback so that when you come into contact with the structure it provides feedback. This is very nice because if your needle is slightly out of plane you may not be seeing your needle tip and you may have already entered the structure which in clinical practice may result in harm. I enjoyed using this system and would recommend its use to all ultrasound users especially those who are just beginning and even for those who are regular user who would like to become more confident.
The ability to correlate the spatial orientation of the needle with direct visualization of my hand holding the ultrasound probe on a simultaneous screen, allowed me to better understand and conceptualize the angles and vectors of the ultrasound probe beam when correlated with my hand orientation when try to localize and direct the needle. The proprioceptive concept of the needle tip in relation to the needle shaft and the position of my hand were well demonstrated with these visual tools. I find this to be a useful tool when first trying to get familiar with ultrasound and regional anesthesia techniques.
Over the past three months I have been taking medical professionals of all levels through a research study in order to evaluate this new training model for ultrasound guided regional anesthesia. Participation in the study includes a pre-test, practice phase, and post-test. Throughout this process, it is apparent that a certain percentage of participants do benefit from training with the modified ultrasound machine. Participants in the experimental group with little to no experience in ultrasound-guided regional anesthesia do in fact improve more from pre to post-test. We are waiting to analyses the study results but in my experience it mostly will demonstrate a usefulness of this model in inexperienced medical professionals.
Society of Anesthesia and Sleep Medicine Department Membership for $1000
The Society of Anesthesia and Sleep Medicine (SASM) is a multidisciplinary group of clinicians and researchers who have an interest in topics concerning many aspects of perioperative care that are at the heart of anesthesiology practice and education, including the basic science and clinical aspects of sleep disordered breathing, airway management, pulmonary medicine as well as patient safety.
Sleep medicine has recently been accredited by the American Board of Anesthesiology (ABA) as a board certifiable sub-specialty in anesthesiology, thus opening up tremendous opportunities to our specialty and its trainees in the practice of perioperative medicine.
A membership in SASM for all anesthesiology faculty/staff/residents would not only be of great educational and academic interest, but would offer valuable information in respect to career development. One of SASM’s goals is to promote scholarly activities for residents and junior faculty. Each year SASM recognizes best abstracts in clinical and basic science research by giving out six abstract awards. In addition, SASM is offering a $20,000 research grant in 2014.
Realizing the large role that SASM can play in the education of anesthesiologists through its online and in print educational material, as well as information presented during its annual conference immediately preceding the ASA annual meeting, SASM has a Departmental universal membership covering all staff (including anesthesiologists, CRNAs, AAs and other physician extenders) for a much reduced fee of $1,000, and all residents for an additional fee of $600, to cover basic administrative costs.
Some of the membership benefits include:
Receive discounted registration fees for SASM Annual CME Meeting
Learn of collaborative research projects
Access to educational material, featured articles, literature updates
A forum to evaluate and discuss the latest research
Education and clinical practices pertaining to sleep-disordered breathing
Advice and counsel from members regarding various practice paradigms
Enhance your network of regional, national and international colleagues
Access to the SASM newsletter
Membership can be signed up online, please visit the SASM website http://sasmhq.org/
After joining, please contact Marie Marinello at info@SASMhq.org or call SASM at 414-389-8608 to register your staff and resident member information for future communications.
With only a few months in existence, the NYSORA boutique workshops have become some of the most popular NYSORA educational programs. All three sessions to date have been fully booked and spaces are filling rapidly for the upcoming sessions in June, as well as the fall and winter of 2014. Keep an eye on NYSORA's CME offerings, as due to the high demand, we may introduce additional sessions. What makes NYSORA boutique workshops unique is a total focus on practical, hands-on, interactive teaching where the delegates have the opportunity to scan with all instructors, on all models and get their hands on anatomy. Moreover, models with larger BMI are also provided to better reflect actual clinical practice. A multitude of teaching tools are utilized - from live models to meat models, injection pressure models, peripheral vein access models, central vein access models to needle nerve guidance simulators. All practice sessions are preceded by an introduction highlighting the most pertinent functional regional anesthesia anatomy. After, the delegates are led through step-by-step process on how to obtain, reproduce and utilize sonographic images to guide the needle placement in the six most common peripheral nerve block procedures. Delegates with more expertise are also able to interact with our top international instructors and exchange experience and tips on how to improve efficiency, efficacy and safety of peripheral nerve blocks. Short focused sessions are also presented on the safety aspects of peripheral nerve blocks and monitoring. In particular, the NYSORA teaching model focus is on utilizing the concept of depositing local anesthetic in the tissue space that contains the nerves while avoiding the controversies of intraneural, perineural etc. A full range of new teaching models are being developed for the June workshop dates aimed at substantially simplifying the techniques to allow a speedy transition from the beginner/analyses to an expert regionalist.
Enjoy some of the March Session Highlights!
|01/19/2017 (+ 2017 Dates)|
|06/20/2017(+ 2017 Date)|
|02/18/2017(+ 2017 Dates)|