Virtual block workshop – digital regional anaesthesia training during COVID-19

In the middle of difficulty lies opportunity - Albert Einstein

Background
Regional anaesthesia has come to prominence during the COVID-19 pandemic, while teaching opportunities have decreased [1, 2]. We have therefore developed a weekly virtual regional anaesthesia teaching session lasting 20 minutes (Boxes 1 and 2), with a live scanning demonstration and interaction with tutors to optimise learning. We overcame the technical challenges for the participants to appreciate probe handling by providing real-time scanning with in-picture probe views.

Box 1.
Virtual Block Workshop – Live Zoom Session

Box 2.
Workshop Outline – Single Block

Online platform
Zoom (Zoom Video Communication Inc.) was chosen because it is user-friendly, with capabilities to live-stream ultrasound images, and permits additional USB camera input.

Logistics
We use: ultrasound scanner (Mindray, TE 5) high frequency linear probe; laptop (Macbook Air, 2016); HDMI to USB converter (HDMI video capture card screen record USB 2.0 1080p 60FPS game capture device); additional camera (Panasonic, HDCSD60); HDMI cables, USB cables and chargers.

Method
A cheap generic HDMI to USB converter displays the ultrasound image on any laptop using OBS (Open Broadcaster Software). We show high quality live ultrasound imaging using the Zoom screenshare functionality. The additional USB camera provides an in-picture view of the hands and probe.

Advantages

• Economical to set up anywhere with minimal new equipment. 
• Short online sessions during lunch time facilitating maximum attendance, including our previous Medical Training Initiative colleagues who joined us from overseas. 
• Weekly sessions to cover RA-UK Plan A blocks and all major blocks in a 3-monthly cycle, enabling catch up. 
• Small group of regular presenters scanning among themselves while wearing face masks, minimising transmission risk. 
• Other faculty joined remotely to aid presentation. 
• Delivered online, greater opportunity for people to join from home as well as from theatres.

Disadvantages 

• Regional anaesthesia learners still require scanning practice to appreciate the delicate nuances needed for image optimisation. We encourage participants to reinforce this online learning by performing hands-on scanning. 
• Internet speed and device used by the participants may result in poor image quality, but because of the interactive nature of the session, this can be explained or repeated.

Going forward
This has been a learning experience for us as much as it has been for the participants. It is a cost-effective method of delivering ‘bite sized’ tutorials that fit with altered and highly-changeable work patterns, while maintaining social distancing. We hope to encourage training opportunities in regional anaesthesia both in local hospitals and further afield, as was the case through our international Medical Training Initiative links.

Umesh Ramesh
ST7 Anaesthetics

Simon Ford
Consultant Anaesthetist
Morriston Hospital, Swansea

References 

1. Macfarlane AJR, Harrop-Griffiths W, Pawa A. Regional anaesthesia and COVID-19: first choice at last? British Journal of Anaesthesia 2020; 125: 243-7. 
2. Uppal V, Sondekoppam RV, Landau R, El-Boghdadly K, Narouze S, Kalagara HKP. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia 2020; 75: 1350-63.

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