EDRA Part 2 - ESRA

EDRA Part 2

Prerequisites

To access the full prerequisites: click here
To access the Frequently Asked Questions: click here

How it works: Please note the changes to the format of the EDRA Part II examination.

EDRA Part II. The Covid pandemic has caused academic institutions and societies to reconsider how to examine candidates. The EDRA and ESRA board has also embraced a new format of online examination for parts of the EDRA examinations. Furthermore, the international demand of the EDRA diploma and the number of candidates required to be examined at the annual congress has dramatically increased. It would therefore be impossible and impractical to examine 150 candidates at the annual congress for a 45-minute examination. The logistics would be very challenging for both the examiners and candidates.

Therefore, the EDRA Part II examination will be split into two sections:

Section A will consist of an on-site or online viva examination which will involve two questions: Firstly, the discussion of a clinical case question and secondly the discussion of a regional anaesthesia related complication question and management thereof. Section A of the Part II examination can be done online at scheduled examination dates as notified on the EDRA website. The section A of Part II examination will be an estimated 30 minutes, therefore allowing 15 minutes per question from two examiners and occasionally an observer.

Section B of the Part II examination will consist of a further two questions. The first, relating to the anatomy and landmark demonstrations of a block on a live model and the second question will be an ultrasound demonstration of a commonly performed block on the live model. The EDRA and ESRA boards, both felt strongly that the society could not award a diploma in regional anaesthesia to a candidate without examining the practical elements of block performance. Therefore, section B of EDRA Part II examination will only be possible to take at the ESRA annual conference each year. Section B of EDRA Part II is approximately a 20-minute examination, therefore 10 minutes for each demonstration, with two examiners and occasionally an observer.

The candidate must pass all 4 questions in section A and B before the EDRA diploma can be awarded. If a candidate fails either section A or B of the Part II examinations, they will have the opportunity to retake only the section that they failed at the next available opportunity. For example, if a candidate fails section B of the examination at the annual congress, they may have to wait until the next year to retake section B of the part two examination at the next annual congress. The ESRA and EDRA boards are exploring potential alternative venues for section B of the Part II examination. All venues and dates for the different sections of the examination will be advertised on the EDRA website. Candidates do not have to retake all sections of the Part II examination, only the section that they failed.


Syllabus

Anatomy, physiology, and pathophysiology related to regional anaesthesia (including common concomitant diseases such as diabetes, chronic lung disease, bleeding disorders, etc.).

Pharmacology of drugs commonly used in regional anaesthesia and acute pain management.
Methods and strategies in regional anaesthesia and pain therapy for:
gynaecology / obstetrics, children, elderly, trauma, acute and perioperative pain.

Procedureoriented regional anaesthesia and postoperative pain management.

Application of regional anaesthesia for surgically oriented procedures.

Performance of neural blockades, including neuraxial and peripheral nerve blocks and catheter techniques using landmark, neurostimulation, and ultrasound techniques.

Advantages / disadvantages, risk / benefits and indications / contraindications for regional techniques.

Management of complications and side effects of neuraxial and peripheral nerve blocks, including management of a failed block.

Sedation in regional anaesthesia.

Surgical site analgesia technique.

Equipment, e.g., nerve stimulator, ultrasound, needles, and perineural catheters.

Attitudes and behaviour of the examinee performing regional anaesthesia.

 

> Extended syllabus

> Recommended reading (click here)


EDRA part II 2022

The EDRA part II is now split into 2 parts, Section A (remote or onsite) and Section B (onsite only). Both parts are mandatory.

Section A:

  • When? Sunday 26 afternoon & Monday 27 June 2022
    Where? Thessaloniki, Greece after the ESRA annual congress
    Applications: now closed

Section B:

  • When? Sunday 26 & Monday 27 June 2022  – please note that the exam is now fully booked on the 26 but slots are still available on the 27 June
    Where? Thessaloniki, Greece after the ESRA annual congress
    Applications: now closed

* The EDRA Board reserves the right to close the applications if the maximum capacity is reached before the closing date. 


Details of the EDRA Part II exam:

Section A:

  • Exam duration: 30 minutes
  • Type of exam: On line Viva (oral)
  • Questions 1 & 2: Randomly assigned standardised questions
  • Number of examiners: 2 (with the possibility of examiner candidates) and an observer for supervision of the exam or exam records afterward

Section B:

  • Exam duration: 20 minutes
  • Type of exam: Viva and demonstration on live model.
  • Questions 3 & 4: Randomly assigned standardised questions
  • Number of examiners: 2 (with the possibility to have additional experts present as examiner candidates: EDRA Vice-Chair responsible for EDRA part II, EDRA Chair or inspectors of International Educational Committees)
  • Additional equipment: Live model, ultrasound machine
  • Types of graduation: Pass or fail (see below for details)
  • Exam structure: 4 Question examination

Question 1: Discussion of a clinical case

A common clinical case will be discussed (e.g., management of a hip fracture in an ASA IV patient: discuss anaesthesia and different perioperative analgesia techniques). The candidate must show competence in evaluating the basic patient risks and the risks deriving from surgery. Different plans for anaesthesia and perioperative analgesia (including both systemic and regional techniques) must be presented and the advantages and disadvantages of each must be discussed.

Please note: It is not required to mention patient consent, laboratory and patient history check prior to an anaesthesia block, nor hygiene precautions if not explicitly requested. Only ask for a coagulation laboratory if the history mentions the use of anticoagulants or if a neuraxial block is performed.

Do not waste examination time!

Question 2: Problem-solving of a regional anaesthesia-related complication

A typical regional anaesthesia-related case will be discussed, ranging from nerve damage to local anaesthetic systemic toxicity. The candidate must be able to recognise the problem from the case presented, make a differential diagnosis, and present the strategies for problem-solving including a treatment plan and an outcome estimation.

Question 3: Anatomy, landmark techniques on a live model. (no actual needling of the model)

The candidate must demonstrate on a live model the surface anatomy of an assigned technique and answer questions related to anatomical structures and block performance. The candidate must show different approaches for single-shot and continuous regional anaesthesia techniques. The candidate must be able to discuss indications and contraindications for, and the advantages, disadvantages, complications and side effects of the explained techniques for both ultrasound and neurostimulation. Candidates should know the required muscle response for a successful block and how to interpret other muscle responses. They must also demonstrate knowledge of how to change the needle position according to the muscle stimulation present and the one desired. Block dynamics, choice and volume of local anaesthetics, and needle choice will also be discussed.

Peripheral and central nerve blocks will be examined.

Please note: It is not required to mention patient consent, laboratory, and patient history check prior to block nor hygiene precautions if not explicitly asked. Do not waste demonstration time!

Question 4: Ultrasound techniques

The candidate must demonstrate on a live model a nerve block using ultrasound. Probe handling / orientation, scanning ergonomics (positioning of candidate and model), and scanning conduct will be evaluated. The candidate must demonstrate how to locate and recognise the structures to be blocked, the anatomical structures around the target structure, as well as the structures to avoid, or that may cause complications or side effects (vessels, other nerves, pleura, etc.). The candidate can describe different block techniques for the same nerve using in- or out-of-plane techniques, single-shot, and catheter techniques. For the use of double guidance, the candidate must be able to recognise / describe the muscle response according to the needle tip position relative to the nerve in the ultrasound image.

Commonly used blocks excluding neuraxial and paravertebral blocks will be evaluated.

Please note: It is not required to mention patient consent, laboratory, or patient history check prior to a block nor hygiene precautions if not explicitly requested. The ultrasound setting will be performed by the examiners and only adjusted if necessary. Do not waste demonstration time!


Exam rating: The candidate must pass all 4 questions of Section A & B for a successful EDRA Part II examination.

Cardinal mistakes that pose a permanent or life-threatening danger to the patient (e.g., transfixing the central cord) will result in a failed examination.

The candidate must accumulate sufficient points during each question of the examination in order to gain an overall pass mark.

PART II Section B: Wasting examination time by not answering or discussing the problem, adjusting settings on the ultrasound machine, or talking about steps like informed-consent, previous history, etc., when not asked to do so, will only lead to reduced examination time and a consequent low score.

Examiners will provide you with the information you need for your case and ask specifically if they want you to talk about a certain topic. They will guide you through the examination process and move to the next question when your allocated time is finished. You can assume that the patients agree to your regional anaesthesia technique and that you are blocking the correct site and that aseptic hygiene precautions are in place. Do not waste examination time!


Examiners

Click here to download the list of examiners.