# A Phantom-Based Curriculum for Teaching and Assessing Ultrasound Neuraxial Skills in Pediatric Anesthesia Trainees: Development and Implementation

## TL;DR

A simulation-based training program using a pediatric spine phantom improved ultrasound-guided neuraxial skills in anesthesia trainees, with lasting knowledge and skill gains.

## Contribution

A novel, phantom-based curriculum for teaching pediatric ultrasound-guided neuraxial techniques, showing durable learning outcomes and educational impact.

## Key findings

- Trainees showed significant improvement in knowledge and skills after the workshop.
- Knowledge retention and comfort with ultrasound use were sustained at follow-up.
- The curriculum was effective across different training levels (residents and fellows).

## Abstract

Introduction

Opportunities to practice ultrasound-guided/assisted (USGA) neuraxial techniques in pediatric patients are limited due to the high-risk nature and anatomical variability of this population. Simulation-based education offers a safe and effective method for trainees to develop competence in these challenging procedures.

Methods

We developed a curriculum using a previously validated, shelf-stable pediatric spine phantom designed to replicate sonographic anatomy. Pediatric anesthesiology trainees participated in a structured workshop that included pre-workshop online content, a hands-on scanning session, and a three-minute skills assessment. Participants completed identical pre-, post-, and six-month or more follow-up quizzes consisting of 14 knowledge-based questions and items assessing comfort and practice behavior. Paired-samples t-tests were used to compare mean percent correct scores between pre- and post-intervention and between pre- and follow-up assessments. To control for multiple comparisons, a Bonferroni correction was applied (adjusted α=0.025). Analyses were verified using R software (version 4.4.0). Descriptive statistics evaluated shifts in comfort and behavior.

Results

Twenty-six trainees (13 fellows, 13 residents) enrolled; 20 completed the full curriculum, and 18 completed follow-up assessment. Participants demonstrated significant improvement from pre- to post-workshop (t(27)=−5.72, p<.001, d=1.15, large), with sustained knowledge retention at follow-up (t(27)=−4.15, p<.001, d=0.63, medium); similar trends were observed among fellows and residents, indicating consistent learning gains across training levels. All workshop attendees demonstrated proficiency in obtaining six critical neuraxial ultrasound views. Self-reported comfort and frequency of ultrasound use increased across all groups, with positive trends sustained at follow-up. Participant feedback was uniformly favorable.

Conclusions

A phantom-based, simulation-enhanced curriculum significantly improved and sustained pediatric regional anesthesia knowledge, technical skills (based on end-of-workshop assessment), comfort, and reported use of ultrasound for neuraxial procedures in pediatric anesthesia trainees, demonstrating durable learning gains and strong educational impact. This low-risk, reproducible educational model may help institutions implement structured training in USGA neuraxial techniques and promote broader adoption of ultrasound in pediatric regional anesthesia. Future multicenter validation should evaluate its generalizability across diverse training environments.