To access the full prerequisites: click here To access the Frequently Asked Questions: click here To access the Code of Conduct: click here To see the list of the ESRA European Diploma of Regional Anaesthesia Accredited Workshops: click here To submit a workshop as an organizer: click here
To access the ESRA-DRA Blocks form template for examination candidates: click here
Part II. The Covid pandemic has caused academic institutions and societies to reconsider how to examine candidates. The ESRA European Diploma of Regional Anaesthesia and ESRA Board has also embraced a new format of online examination for parts of the examinations. Furthermore, the international demand of the 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 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 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.
The Diploma 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 Part II examination will examine the candidates on their practical skills in image acquisition, interpretation, detailed knowledge of anatomy and sono-anatomy, decision making and troubleshooting. This part of the exam will be possible to take at the selected ESRA events (Annual Congress … etc) or other events approved by ESRA each year. All details are located in ESRA-DRA website.
Section B of the Part II examination will consist of a further two questions. The first, will focus on ultrasound demonstration of the core regional anaesthesia techniques on a live model and the second question will focus on ultrasound demonstration of the intermediate or advanced-level blocks also on a live model. Section B of Part II is approximately a 25-minute examination, therefore 10-12 minutes for each demonstration, with two examiners and an observer. Occasionally another observer can be present in the room.
The candidate must pass all 4 questions in section A and B before the 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 Diploma 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 website. Candidates do not have to retake all sections of the Part II examination, only the section that they failed.
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.
Procedure–oriented 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.
> Recommended reading (click here)
The Part II exam is now split into 2 parts, Section A (remote or onsite) and Section B (onsite only). Both parts are mandatory.
Section A:
Section B:
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* The ESRA European Diploma of Regional Anaesthesia Board reserves the right to close the applications if the maximum capacity is reached before the closing date.
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!
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.
The candidate must demonstrate, on a live model, a Core peripheral nerve block or a neuraxial technique using ultrasound.
Core blocks, cover key areas in surgical and acute pain management. Along with neuraxial techniques, they are considered essential competencies for all anaesthesiologists.
The candidate will be assessed on probe handling and orientation, ergonomics (positioning of the candidate and model), surface anatomy, and scanning technique.
The candidate must demonstrate the ability to locate and identify the target structure, surrounding anatomical landmarks, and any structures to avoid or that may cause complications or side effects (e.g., vessels, pleura, other nerves).
The demonstration will include block testing and troubleshooting. Candidates are expected to describe alternative techniques which may include intermediate or advanced blocks, including in-plane and out-of-plane approaches, single-shot versus catheter techniques, and if applicable, use of dual guidance (ultrasound and nerve stimulation), identifying muscle responses relative to the needle tip position.
Discussion will cover block dynamics, choice and volume of local anaesthetic, and needle selection.
Note: Candidates are not required to mention patient consent, history taking, laboratory testing, or aseptic precautions, unless explicitly asked. The ultrasound machine will be pre-set by the examiners and adjusted only if necessary. Use your time wisely and avoid unnecessary steps.
You may visit our list of extended Core and Intermediate / Advanced blocks here
The candidate must demonstrate, on a live model, an Intermediate or Advanced-level blocks, using ultrasound to provide regional anaesthesia / analgesia
These blocks represent advanced skills that all specialists in regional anaesthesia are expected to master, as alternatives or additions to Core techniques, depending on the clinical context.
The demonstration will include block testing and troubleshooting. Candidates are expected to describe alternative techniques, including in-plane and out-of-plane approaches, single-shot versus catheter techniques, and if applicable, use of dual guidance (ultrasound and nerve stimulation), identifying muscle responses relative to the needle tip position.
Exam rating: The candidate must pass all 4 questions of Section A & B for a successful 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!
Click here to download the list of examiners.
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