Teaching RA: Success of model “on wheels” in Portugal for particular scenarios - ESRA

ESRA Updates

December 2023 | Issue 14

Teaching RA: Success of model “on wheels” in Portugal for particular scenarios

Joana Magalhães (Vice-President of CAR/ESRA, Hospital de Guimarães, Portugal) @JoanaMMagalhae

The “CAR on wheels” was an idea conceived by a former board of CAR / ESRA (the Portuguese Regional Anaesthesia Society), with the purpose of bringing tailored education on Regional Anaesthesia techniques to the specific needs of a requesting Anaesthesiology Service, anywhere in Portugal. Thus, the main objective was for team of educators bring the knowledge to the site of education, adjusting it to the local specificities encountered and overcoming and reducing the financial impact of the local attendees. So, after a careful evaluation of those specific requirements of the requesting Anesthesiology Department, the education would be refined, adapted, and specific, allowing for a streamlined implementation of the techniques in loco.

This “CAR on wheels” workshop, finally accomplished marked an important milestone in the national field of regional anaesthesia education. This unique initiative took place at the Simulation Centre of the Hospital of Funchal, Madeira, on June 2nd and 3rd, 2023. Designed as a mobile workshop, it aimed to provide comprehensive training on ultrasound-guided regional anaesthesia (UGRA) techniques to the anaesthesiology department of that institution. By overcoming logistical challenges, such as the geographical constraints of an island, this workshop enabled the delivery of valuable education to a niche audience. In this report, we highlight the success and significance of this “CAR on wheels” model, discuss the integration of simulation-based training and artificial intelligence in UGRA, and emphasize the importance of team development in achieving high-performance outcomes.

Mobile Education: Breaking Barriers

The “CAR on wheels” model represents a breakthrough in regional anaesthesia education, offering a mobile approach that transcends the traditional boundaries of anatomy laboratories, setup workshop stations and typical slide presentations. By leveraging modern technologies, including anatomy apps, ultrasound machines, phantoms, and human models, and with the guidance of experienced facilitators, this innovative model has the potential to revolutionize education for anaesthesiology teams. By reaching out to remote locations and addressing specific scenarios where distance poses challenges, this mobile workshop opens new doors to learning and professional development. It enables the dissemination of knowledge and skills, empowering anaesthesiologists to perform safer and proficient peripheral and central nerve blocks with confidence.

Enhancing Learning Through Simulation and Artificial Intelligence

The Simulation Center at the Hospital of Funchal provided an ideal setting for the workshop, offering simulation-based training and access to specific phantoms. The integration of simulation in regional anaesthesia education has proven to be effective in improving procedural skills, namely the training of eye-needle-ultrasound probe coordination, in-plane or out-of-plane techniques, as well ascatheter insertionin the immediate post workshop period.Drawing from Kolb’s experiential theory from simulation, this immersive learning experience fosters a deeper understanding of UGRA techniques, while providing ample opportunities for practice and immediate feed-back and feed-forward. Additionally, the potential application of artificial intelligence (AI) in UGRA holds promise for boosting safety and anaesthesiologist confidence. AI can assist in the identification of anatomical structures by rearranging the ultrasound image and color-coding potential targets. However, this process should be supervised and involve the presence of, at least, two anaesthesiologists to ensure a safe and accurate learning process.

Team Development: Maximizing Performance

The success of the “CAR on wheels” workshop can be attributed, in part, to the high-performing anaesthesiology department of the Hospital of Funchal. As described by Judith Stein, in the human resources of the MIT website (3), (…) for teams to be high-performing it is essential for them to understand their development as a team.” By bypassing the forming and storming stages of team development, the department swiftly progressed to the norming stage, characterized by consensus and a clear understanding of individual roles within the team. This cohesive and well-aligned team was poised to enter the performing stage, where they maximized productivity and focused on their shared mission of providing exceptional patient care. The workshop, facilitated by the CAR/ESRA team and supported by the Simulation Center, further reinforced the principles of team building and provided a platform for knowledge exchange and mutual support. The workshop’s immersive nature and the commitment of the entire team facilitated the seamless translation of acquired knowledge into clinical practice, benefiting patients immediately.

The “CAR on wheels” workshop represents an innovative and successful model for regional anaesthesia education, especially in specific scenarios where distance poses a challenge. This mobile approach, supported by advanced technologies and simulation-based training, has the potential to transform the way anaesthesiology teams learn and apply regional anaesthesia techniques. The integration of artificial intelligence further enhances safety and confidence in performing central and peripheral nerve blocks. The accomplishments of the “CAR on wheels” initiative exemplify the determination of CAR/ESRA to overcome logistical barriers and provide excellence in regional anaesthesia education. By embracing this mobile model, anaesthesiologists demonstrate their commitment to continuous improvement and their unwavering dedication to patient care.

Mission accomplished, team!


This workshop would not ne possible without the valuable contribution of João Moreira, José Miguel Cardoso, and Raquel Fernandes for their exceptional dedication and expertise as integral members of the team. A special note of gratitude also extends to the CAR/ESRA society for their invaluable support in making this workshop a resounding success. Furthermore, a due recognition and heartfelt appreciation to Filipa Rodrigues and the entire anaesthesiology department of Hospital of Funchal, Madeira, for their enthusiastic participation and commitment to advancing regional anaesthesia education. Special thanks are also due to Eugénio Mendonça, Regina Rodrigues, Pedro Ramos, and Maritza Clemente for their valuable contributions and assistance throughout the workshop.


  1. Bowness JS, El-Boghdadly K, Woodworth G, et al; Exploring the utility of assistive artificial intelligence for ultrasound scanning in regional anesthesia; Regional Anesthesia & Pain Medicine Published Online First: 28 January 2022. doi: 10.1136/rapm-2021-103368
  2. Udani AD, Kim TE, Howard SK, Mariano ER. Simulation in teaching regional anesthesia: current perspectives. Local Reg Anesth. 2015 Aug 11; 8:33-43. doi: 10.2147/LRA.S68223. PMID: 26316812; PMCID: PMC4540124.
  3. https://hr.mit.edu/learning-topics/teams/articles/stages-development
Topics: Residents & Trainees , Training , CAR on wheels , Portugal

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