The Development of a Basic Procedural Skills Checklist for a Simulation-based Mastery Learning Curriculum for Ultrasound-guided Interscalene Peripheral Nerve Blocks for Novice Residents

Background: Simulation-based medical education is a well-established tool for teaching technical skills to trainees. Simulation-based mastery learning (SBML) consists of pretesting, independent content review, deliberate practice, and posttesting to reach a minimum passing standard (MPS). If the MPS is not reached, the learner repeats the deliberate practice and retakes the test. SBML may be a beneficial approach for teaching regional anesthesia skills to novice residents. To implement such a curriculum, a skills assessment checklist that yields valid and reliable data must be developed for testing trainees. Methods: A checklist was developed for ultrasound-guided interscalene nerve blocks, adapted from available checklists in the literature. The checklist was designed to assess the initial knowledge and skills of novice trainees for the interscalene peripheral nerve block. This checklist was then distributed to an expert panel of regional anesthesiologists who used a modified Delphi technique to reach consensus on content. An MPS was set for the skills checklist using the Mastery Angoff standard-setting technique. Finally, the checklist was piloted; novice anesthesia residents participated in the curriculum and performed video-recorded simulated ultrasound-guided interscalene blocks before beginning their regional anesthesia rotation. Four trained raters scored videos to evaluate interrater reliability. Results: After 2 rounds, expert consensus was reached for all items; the final dichotomous checklist (correct or incorrect/not done) consisted of 19 items. The MPS was set at 18 of 19 items correct. Ten pretests and 10 posttests were reviewed by 4 raters. The average interrater reliability was Kn = 0.73. Conclusion: We developed an interscalene nerve block skills assessment checklist that was shown to produce valid and reliable data in our small pilot study. Future work will further contribute to the validity and reliability of the interscalene nerve block SBML checklist.