RA Training during COVID-19: UZ Leuven

UZ Leuven has been member of the ESRA Approved Training Institutions for quite some time.
ESRA Approved Training Institutions – ESRA (esraeurope.org)

We have had the pleasure to train young locoregional enthusiasts from all over the globe, ranging from Greece, Bulgaria, South-Africa, The Philippines, Italy, Ireland, Lebanon up to Belgium itself.

Leuven is a small university city of about 100 000 inhabitants and more than 30 000 students. The university of Leuven is one of the oldest in the world, dating back to 1425.
Andreas Vesalius the founder of modern day anatomy and graduated in the University of Leuven before moving around Europe and writing his famous “De humani corporis fabrica libri septem” We all know that RA is simply applied anatomy. With such a famous alumni, it can be no coincidence that regional anesthesia has become very important in UZ Leuven.
The university hospital is one of the biggest in the Benelux and has around 2000 beds. A whopping 45 operating theatres, 5 separate block rooms in the main operating centre and 4 more in the ambulatory operation unit.
The rotation usually consists of covering the main OR block rooms during the first few months, then moving to ambulatory regional blocking and adding a few weeks of maternity ward as well to get some obstetric Combined Spinal Epidural practice as well.

Figure 1: Mohammed Bashraheel and Jacky Corpuz in Covid times

Roughly 4500 nerve blocks are performed annually. We still have about 2000 thoracic epidurals a year, making it an excellent place to train this slowly disappearing art. About the same amount of neuraxial blocks are performed in obstetrics. Routinely a fellow of regional anesthesia will perform roughly 1000 to 1500 blocks themselves. This case-load makes our facility quite unique and we have a waiting list for foreign fellows up to 2025 at this moment.

Currently we have two fellows. Mohammed Bashraheel from Saudi Arabia and Jacky Corpuz from the Philippines. The effect of the COVID has been profound on both fellows and the fellowship. Although some electives cases have been postponed throughout this year of tribulation we only saw a 4% drop rate in regional block cases. This small insignificant decrease have minimally influenced their regional block progress and skill development. We believe this slight reduction was due to a reduction of airway manipulation, combined with a limited decline in cases due to the tertiary referral role of the UZ Leuven. (fig 1)

In our hospital vascular access with ultrasound is a valued skill and as anesthesiologists we were asked to routinely provide this service on COVID wards. Midline catheters and other lines were one of the main tasks at the end of the block day. This is quite a challenge in the protective gear on these wards, however our fellows have excelled at this essential task.

We take in observers and have had a few ESRA grant observers. Margarita (Margo) Borislavova planned visit collided with the first viral wave in 2020. She courageously helped us during these difficult times, being more involved than any other observer ever had been. Frequent were our visits to Covid unites. You can see her and me admiring our PPE gear stripes like so many people did at that time. (fig 2)

Figure 2: Margo and the PPE stripes

One of the most profound difference with previous fellowships has been the absence of possible networking.
A yearly recurring exchange event were regional fellows from Duke University North Carolina visit our hub and our close allies at NYSORA Belgium Genk was brutally interrupted. Of course this leaves the fellows with a lot of missed opportunities to form bonds, friendships and open up possible collaborations in the future. Jeff Gadsden, Admir Hadzic and me sorely missed having our fellows enjoy this beautiful project.

The Belgian Association of Regional Anesthesia BARA – BARA (bara2001.be) is the biggest society of RA in Europe with most members even leading big countries like the UK and France. The BARA organizes cadaver workshops every year and the fellows in the UZ Leuven get the possibility to visit the dissection room and even enjoy the hands-on opportunity with anatomical dissections themselves. This unique opportunity again also had to be cancelled. This was my biggest regret because these dissections offer unparalleled understanding of anatomy.

Workshops organized by the regional team in hospital and lead by the instructors and the fellows are also a great way for our residents to present the inspiring progress our fellows have made. By giving them the chance to pass on the knowledge and experience they gained throughout the year, we support the bond between residents and fellows to make our regional program even stronger. Covid-19 again stripped us of the possibility of organizing these workshops and these were greatly missed by everyone.

Our fellows try to give basic teaching in a one to one safer environment, without models, but with our multitude of phantoms, simulators and other teaching equipment (fig 3)
Improvising to fill up the teaching gap has also inspired us to come up with novel ideas and unique solutions to the problems due to the social distancing requirements.

Figure 3: Mohammed giving an improved one-to-one teaching “workshop”

Of course new opportunity’s also appear with the pandemic. Thanks to Jacky Corpuz and his excellent colleagues in the Philippines we were able to set up a workshop and lecture live broadcasted to the far east. (fig 4) Mohammed Bashraheel is also a tech wizard and he helped with camera setup and technical support. It was a huge success, with more than a 100 delegates joining in!

The possibilities of visiting other centres like our neighboring NYSORA colleagues in Genk was also not available, however good and close relationships were preserved and I hope I can still offer the fellows a visit to some of our friendly neighbors if they visit us again in the future.

Figure 4: Turning one of our block rooms into a live workshop/lecture area

Traditionally we also indulge in a lot of social events. The UZ Leuven Winter-symposium and its festivities were unfortunately cancelled for an online congress. Leuven is a nice medieval town and beautifully decorated during the Christmas time, was strangely quiet with no parties organized this year. (fig 5) Drinks, get togethers, dinners…. Almost all these fantastic bonding events had to be dropped. I really feel so bad for our fantastic team. I know we will welcome them again once this nightmare pandemic is over, to come and celebrate the friendship which has blossomed even during difficult times.

Though these covid times have been a mix of hits and misses, limited opportunities and new developments, I am sure that both fellows and trainers will look back at these days quite favorable in general as time progresses. The bonds that were formed were in my opinion even stronger than they usually are in a fellowship program. The few times we did have some drinks or socializing when new covid rules applied and lockdowns eased were even more intense than usual and they are and will stay engraved deep in my soul as extremely memorable.

Figure 5: Christmas time is magical in city of Leuven

Nothing intensifies the feeling of this mutual struggle as much as doing covid rounds with the ultrasound placing vascular access on demand. Nothing will make me forget the genuine respect I have for these people leaving their loved ones, friends and family behind to go on adventure in Europe and then ending up lonely in lockdown.
Nothing will make me forget their courage, devotion and enthusiasm during their special and challenging time with us in Leuven.
NOTHING…