Assessment Tools for the Evaluation of Simulation-Based Competency In Ultrasound-Guided Regional Anesthesia: An Integrative Review.

Ultrasound-guided regional anesthesia (UGRA) requires the interaction of technical skills, manual dexterity, and cognitive knowledge which many novice anesthesia providers find challenging. Although simulation improves clinical competency and enhances patient safety, there is no standard tool for assessing UGRA competency in the simulation setting. Therefore, this integrative review aims to determine the most accurate, reliable, and feasible method of evaluating UGRA competency in a simulation environment. Strict inclusion and exclusion criteria were used to conduct this review, yielding 19 articles. The primary objective was the evaluation of validity and reliability outcomes of tools used to assess provider skill level. Secondary objectives were the evaluation of multirater agreement, internal and external reliability, and feasibility. Hand motion analysis and eye motion tracking demonstrated promising results, however, expense and training requirements limit widespread accessibility of those tools. The Regional Anesthesia Procedural Skills tool and McLeod checklist possessed discriminate ability of skill level, high interrater agreement, and feasibility in assessing psychometric competency in simulation. The Naik Global Rating Scale allows for assessment of nontechnical professional attributes. Based on the evidence of this review, the validity and reliability of these tools have the most utility as simulation-based competency tools compared with other tools reviewed.