Structural training solutions in regional anaesthesia

Coppack and Whiteman present a compelling case for a standardised regional anaesthetic sign-off process for Stage 1 trainees [1]. However, I have several concerns about the implementation of such a system, starting with the potential risk of worsening the training bottlenecks in an already strained system without addressing the root causes of trainee underconfidence: clinical volume and training opportunities. Their comparison with general and obstetric Stage 1 sign-offs is misjudged. The initial assessments of competence exist because they gatekeep the ability of a resident doctor to hold the on-call bleep safely. They assess basic anaesthetic skills and the management of immediate, life-threatening crises. Regional anaesthesia, while a crucial skill, is an elective component of a wider anaesthetic plan. Failing to execute a peripheral nerve block successfully does not compromise immediate patient safety in the same manner. A 2023 national survey highlighted that trainees feel underconfident in regional anaesthetic techniques due to a lack of structured teaching time and hands-on training opportunities, not a lack of assessment [2]. Adding a mandatory assessment framework does not create more clinical cases or free up consultant time. In fact, it does the opposite. By mandating that assessors administer formal, simulated and workbook-based summative sign-offs, we divert finite trainer time away from hands-on teaching. We must not mistake increased assessment for increased training. Rather than introducing another rigid, tick-box exercise at Stage 1, efforts should be directed towards structural training solutions. We should advocate for dedicated regional anaesthesia clinical blocks in Stage 2, the appointment of funded departmental educational leads and the integration of simulation into existing regional teaching days, all without the additional burden of a mandatory initial assessment.