From Simulation to Bedside: A Hybrid Rapid Cycle Deliberate Practice—Mastery Learning Curriculum for Serratus Anterior Plane Block Training
Nicky Chung, Ariella Gartenberg, Michelle Montenegro, Anjali Cherukuri, Michael Meguerduchian, Dana Trottier, Debayan Guha, Oark Ahmed, Kyle Chin, Adam Billig, Trevor Dixon, Michael Halperin, Nicole Leonard‐Shiu, William Murk, Philip O'Chan, Andrew Restivo, Jeremy Sperling, Maninder SinghABSTRACT
Objectives
The serratus anterior plane block (SAPB) is an effective ultrasound‐guided regional anesthesia technique for anterolateral rib fracture pain. Formal SAPB training in emergency medicine remains limited, contributing to inconsistent adoption and procedural confidence. This study evaluated whether a simulation‐based curriculum improves emergency physicians' confidence, knowledge, retention, and simulated procedural competency.
Methods
A prospective educational intervention was conducted at an urban academic center. Participants completed pre‐ and post‐curriculum surveys assessing SAPB knowledge, procedural confidence, and barriers. Survey content was developed using a three‐round Delphi process by emergency medicine ultrasound and simulation experts. The curriculum included didactic teaching and four simulation stations addressing consent, ultrasound‐guided in‐plane technique, anatomy, and SAPB performance using task trainers. Procedural competency was assessed using an ACEP‐guidelines‐based checklist. Pre‐ and post‐curriculum outcomes were analyzed using paired t ‐tests ( p < 0.05).
Results
Thirty‐six physicians participated, including attendings (19.4%), fellows (8.3%), and residents (72.2%) distributed evenly across PGY1 to PGY4 levels. Two participants (5.6%) had prior ultrasound fellowship training and 5 (13.9%) had previously performed a SAPB. Self‐reported confidence increased significantly following the curriculum (1.81 ± 1.09 vs. 4.00 ± 0.72; p < 0.001), as did willingness to perform the block (3.31 ± 1.60 vs. 4.53 ± 0.70; p < 0.001). All participants achieved simulated procedural competency and demonstrated improved knowledge scores following the curriculum ( p < 0.001). Five clinical bedside SAPBs were performed during the first 6 months following training. Among 32 participants (88.9%) completing the 4–6‐week follow‐up, mean cumulative knowledge scores were 92.9% ± 11.7 immediately after training and 90.9% ± 10.3 at follow‐up. Reported barriers to SAPB performance included time constraints, patient refusal, and limited availability of appropriate patients.
Conclusions
A simulation‐based curriculum improved emergency physicians' self‐reported confidence and knowledge regarding the SAPB, while supporting short‐term stability of knowledge performance. These findings highlight the value of simulation as a scalable pathway to standardize ultrasound‐guided regional anesthesia training and facilitate future evaluation of SAPB adoption in emergency medicine.