Education in Regional Anaesthesia in Slovenia

Undergraduate education in regional anesthesia

In Republic of Slovenia the study at the faculty of medicine takes 6 years to complete. In recent years Department of Anaesthesiology and Reanimation at The Faculty of Medicine at the University of Ljubljana and University of Maribor established new subjects – some of them obligatory for all students and some of them optional. During undergraduate study medical students get familiar with basic anesthesiology, reanimatology, intensive care treatment and pain management. Reanimatology is part of curriculum from the 1^st year of study with the upgrade

throughout to the 6^th year of the study. Obligatory perioperative medicine subject in the 4^th year of the medical study includes the field of regional anesthesia, where local anesthetics, neuraxial and regional techniques with the use of ultrasound, as well as complications are presented. Also, lectures dedicated to acute and chronic pain management, including obstetric pain are part of the program. Lectures are followed by observation of  practical skills in the operating theatres.

«During undergraduate study medical students get familiar with basic anesthesiology, reanimatology, intensive care treatment and pain management.»

Additionally, for all interested students optional subject of anesthesiology is available, which offers in depth insight into anesthesia techniques and complications, regional anesthesia techniques, enhanced recovery after surgery programs, patient blood management. Besides, pain management optional subject offers an insight into pain pathophysiology, acute and chronic pain management, including drugs, regional techniques and non-pharmacological possibilities and treatment of cancer pain. Students spend a few days in pain office observing pain management techniques and during this period they also prepare a seminar.

Both above mentioned departments at medical faculties run optional Emergency medicine program, usually in the 3^rd or 4^th year of study. It includes medical emergencies, periarrest conditions and resuscitation, including different trauma patients.

Postgraduate education in regional anesthesia

The residency in Anesthesiology, reanimatology and perioperative intensive care medicine takes 6 years in total to become a full specialist. The trainees experience their first contact with regional anesthesia at the beginning of the process at the Medical Simulation Centre at University Medical Centre in Ljubljana, where basic neuraxial and peripheral nerve techniques are practiced on the manikins, including complications. After 2 weeks of Anesthesiology beginner course residents start working in the operating theaters with their mentors. They get the experience in regional techniques at different anesthesia units (primarily in traumatology, orthopedics, and obstetrics, but also in plastic surgery, ENT, urology, abdominal surgery, emergency department…). Trainees are guided from the basic single shot and catheter technique blocks, such as: femoral, proximal sciatic, popliteal, saphenous, scalp block, axillary, interscalene, blocks around clavicle, subcostal TAP block and posterior TAP block, to more advanced blocks, such as: psoas compartment, quadratus lumborum, paravertebral, stellate ganglion block, ultrasound guided epidurals etc. The focus of teaching is on safe regional anesthesia techniques with the use of ultrasound, neurostimulation and using low injection pressure. In order to promote obstetric regional anesthesia techniques, trainees are assigned to resident night shifts at obstetric departments, where they practice epidural catheters, TAP and QL blocks. The circulation at each unit is completed with oral and/or practical exam. After approximately 6 months of residency trainees attend the regional anesthesia exam in the Medical Simulation Centre at UMC Ljubljana, where they perform a scenario with regional anesthesia complication, followed by a debriefing and an oral exam in regional anesthesia and acute pain management. During the residency, a certain number of anesthesia procedures has to be performed (neuraxial procedures, peripheral nerve blocks, pain management procedures…), the record of which is kept in the trainee’s logbook. As the logbook is not absolutely precise in the number of specific skills a mentor assesses the competency of a trainee in a specific area. Three months of residency are dedicated to acute postoperative and chronic pain management, where education is provided by an interdisciplinary team of anesthesiologists, psychiatrists, physical therapists, and pain nurses. During this time regional anesthesia techniques for chronic pain management are acquired.

Trainees have to attend 12 modules during residency, which cover the majority of areas of anesthesiology, reanimatology, perioperative intensive care and pain management. One of the modules is dedicated to regional anesthesia. During this module residents listen to lectures, refresh their knowledge of the nerve anatomy on cadavers and practice the use of ultrasound on live models in small groups. Module concludes with a written test. Many of our trainees also take part in ESRA Cadaver Workshops and ESRA Congresses.

In Slovenia, trainees of all surgical specialties have to spend 2 months of training in anesthesiology. During this time, they get familiar with regional anesthesia techniques and their application in clinical practice.

For many years in Slovenia regional anesthesia has been the mainstay of patient management during anesthesia and pain treatment and became even more popular after the introduction of ultrasound in 2008. To refresh the knowledge in regional anesthesia a School of ultrasound guided regional anesthesia has been established in 2018 and repeated in 2019. Due to pandemic the 3^rd school will only take place in 2023. The school is attended by consultants as well as trainees. Through this school and other educational activities, the knowledge of regional anesthesia techniques has spread throughout all Slovenian hospitals and regional anesthesia has been promoted in all surgical fields.

As an ESRA accredited teaching institution, at University Medical Centre Ljubljana we are happy to accept EU and non-EU trainees and specialists to take part in our teaching program in regional anesthesia and pain therapy. All foreign physicians are registered by The Medical Chamber of Slovenia and this way they are allowed to work hands on with our patients.