{
  "abstract": "Introduction Workplace-based teaching continues to be the foundation of clinical training in anaesthesia, especially in practical, hands-on areas like Regional Anaesthesia (RA). Traditionally led by senior faculty – RA experts, teaching in the clinical setting has long been viewed as a top-down process. Across European countries, RA structured curricula differ from each other in terms of training modalities and national regulations, duty hour limits, number and type of required techniques to acquire RA skills, reflecting disparities in national resources and educational philosophy. Those curricula incorporate training programs, part of which include RA training. Traditional teaching methods, include verification for specific types and numbers of required central neuraxial and peripheral nerve block techniques, documented in a logbook, simulation training and workshops. RA training differences across Europe A landmark European survey on RA practices, published in The European Journal of Anaesthesiology and Intensive Care in 2023, gathered responses across 36 countries, aiming to assess the current landscape of RA practice in Europe, focusing on the use of ultrasound, adherence to guidelines, safety protocols, complication reporting, and training provision. Substantial variability in how RA is taught and supported across different regions was documented. While 70% of responders reported that training was primarily delivered by internal or regional clinical teams, a smaller proportion received training through professional societies (40%) or university-based programmes (28%), reflecting a lack of uniformity in formal education resources. These findings highlight the fragmented nature of RA education and underscore the need for standardised, pan-European training frameworks and teaching resources. The authors of the survey advocated for harmonisation of training delivery and assessment, and targeted support for regions lagging behind in access to modern RA training tools such as ultrasound and simulation. 1 In more details, in the United Kingdom, the 2021 Royal College of Anaesthetists (RCoA) curriculum established RA as a core competency to be developed progressively across all three stages of training. The curriculum follows a competency-based model. Stage 1 (CT1-CT3) trainees are introduced to the foundational principles of RA, including neuraxial techniques, peripheral blocks, and the safe use of ultrasound guidance. Stage 2 (ST4-ST5) focuses on skill consolidation, encouraging increased procedural exposure across a range of blocks in different contexts. By Stage 3 (ST6-ST7), trainees are expected to independently perform RA techniques, while demonstrating the ability to supervise junior colleagues, teach RA techniques, and manage complications.2 Despite these structured goals, survey data revealed inconsistencies in exposure—particularly for chest wall and abdominal wall blocks, with significantly fewer trainees achieving the recommended number of procedures in these areas compared to commonly performed limb blocks. To help standardise RA training and address these discrepancies, Regional Anaesthesia UK (RA-UK) has developed the ‘Plan A’ block list, a national initiative highlighting seven key blocks: interscalene, axillary, femoral, adductor canal, popliteal, rectus sheath, and erector spinae plane. These are considered high-yield, reproducible, safe, and adherent to a broad range of surgeries. Furthermore, the curriculum encourages participation in RA workshops, simulation training, and the pursuit of additional qualifications such as the European Diploma in Regional Anaesthesia (ESRA-DRA) or fellowship programs.2 A 2015 national census on anaesthesia practice in Greece revealed that while a significant majority of consultant anaesthesiologists (94.49%) were familiar with central neuraxial blocks (CNBs), less than half reported familiarity with peripheral nerve blocks (PNBs). The most commonly cited barriers to the broader implementation of RA were a lack of equipment (58.23%) and insufficient education or training (49.29%).3 Although the Greek residency program does not include a dedicated rotation in RA, trainees are nonetheless expected to complete a minimum number of procedures before graduation: 100 epidurals, 100 combined spinal-epidurals, 150 spinal anaesthetics, and 50 peripheral nerve blocks. To standardize and verify procedural exposure, the National Medical Faculty has implemented a formal logbook, which is used nationally to certify that trainees meet the procedural requirements. Despite the high utilization of RA techniques in daily practice, a landmark national survey by ESRA Hellas revealed that fewer than 14% of hospitals routinely performed ultrasound-guided peripheral nerve blocks—highlighting a significant gap in access to modern RA modalities and hands-on ultrasound training. In response, ESRA Hellas introduced a five-day structured hands-on course, aiming to improve trainees’ competence, especially in ultrasound and neurostimulation techniques.4 In Belgium, RA is included within a five-year dual residency and advanced master’s program, documented in a logbook-based system to ensure procedural tracking. The Supreme Council of Physician Specialists mandates that by the end of training, anaesthesiology residents must demonstrate in-depth knowledge and clinical competence in both neuraxial and peripheral RA techniques. While there is no number requirement published for specific RA blocks, candidates must maintain a detailed digital logbook, documenting all RA procedures, teaching sessions, scientific output, and formal evaluations. To supplement training and develop advanced expertise, a dedicated 1-year fellowship in RA is available post-residency in several academic centers. These fellowships offer focused clinical exposure, often including teaching roles, research, and preparation for Part 2 of the ESRA-DRA.5 Near Peer Teaching in RA To improve teaching models, literature findings suggest a novel model of teaching in the workplace, placing increasing value on trainee-delivered teaching—particularly through near-peer teaching. Near-peer teaching (NPT) is becoming an increasingly popular tool in health professions education. The term involves experienced trainees in the role of teacher to guide their junior counterparts. NPT is a formal relationship in which more qualified students guide immediate junior students. It is an innovative approach to increase students’ engagement from varied backgrounds and cultures in the health profession, giving space and voice to trainees, rather than been passive recipients.6 This reflects a broader recognition that trainees are not only capable of delivering high-quality teaching, but may be uniquely positioned to do so. Trainee teachers often have a clearer understanding of their peers’ learning needs, share similar clinical experiences, and can provide a more relatable learning environment. In fields like RA—where timely access to expert supervision, hands-on learning, and ultrasound-guided techniques is critical—trainee-led initiatives may help close training gaps, promote standardization, and build a more sustainable teaching culture.6 A 2016 study published in the Journal of Clinical Anesthesia explored the impact of a peer-designed selective in anesthesiology, critical care, and perioperative medicine for medical students, based on peer collaboration between them and faculty to create a relatable, learner-centered experience. By aligning content delivery with student interests and needs, the selective fostered a supportive environment where participants could build foundational knowledge, gain hands-on procedural skills, and explore career pathways in anesthesiology. The curriculum’s structure enabled students to engage meaningfully with complex clinical concepts early in their training, an experience benefited both learners and peer designers: students reported improved understanding and confidence, while the student designer honed leadership and curriculum development skills. A collaborative and engaging experience was created, highlighting the potential of peer-driven initiatives to enrich preclinical medical education.7 A systematic review published in 2023 investigated the learning outcomes for student-teachers involved in near-peer teaching (NPT) in undergraduate medical education. The review highlighted that NPT not only benefits learners but significantly enhances the development of peer tutors. By taking on formal teaching roles, student-teachers reinforced their subject knowledge, gained teaching and communication skills, and developed leadership and confidence. The shared educational context between tutors and learners created a psychologically safe and relatable learning environment. The review also emphasized that structured training and institutional support are critical for maximizing these benefits.8 In agreement, an interview study published in 2023, among peer teacher and peer learners, revealed that NPT in medical education leveraged the proximity in experience between senior and junior students. It fosters a comfortable learning environment due to cognitive and social congruence, making complex concepts easier to understand. NPT benefits both groups—learners gain approachable guidance, while tutors reinforce their own knowledge and develop essential teaching and leadership skills. This model also promotes motivation, engagement, and a collaborative learning culture among students.9 Focusing on RA, another study published in BMC Medical Education, this year, explored the experiences of junior doctors serving as tutors in a near-peer teaching program at an Australian clinical school. The program explored the cognitive and social closeness between junior doctors and medical students. Despite clinical responsibilities occasionally interfering with teaching, participants reported high levels of enjoyment and perceived improvements in communication, clinical knowledge, feedback skills, and professional development. abovementioned not only enhanced job satisfaction and reduced burnout risk but also strengthened tutors’ motivation to pursue future roles in education.10 Emerging new initiatives ESRA Residents & Trainees (ESRA R&T) Committee Survey The ESRA R&T Committee has already launched a survey for trainees across Europe to gather feedback on trainees’ confidence levels, skill development, and educational needs regarding RA, when training is being delivered by fellow trainees. Whether formally structured or not, it explores procedural exposure, theoretical knowledge, practical skills, and areas where additional support may be needed. Insights from this survey can identify differences in teaching, help improve training programs and better prepare trainees in RA across Europe. Results are under review and will be presented in the Annual ESRA Congress. ESRA Instructor’s Course: The refined version The ESRA Instructor’s course, originally initiated by Jessica Wegener offered a unique opportunity to develop teaching skills and instructional techniques focusing first on how to teach, rather than what to teach. The revived version, chaired by Peter Merjavy since 2023, marks a significant initiative by opening participation to trainees, acknowledging their untapped potential as future educators in RA. This forward-thinking program combines structured discussion on leadership, nonverbal communication skills, and simulation-based complication management to deliver a comprehensive, hands-on teaching experience. Designed and led by expert instructors, the course cultivates essential teaching and communication skills. By involving trainees early in the teaching process, the course fosters a deeper understanding of the educator’s role, building both confidence and competence. This initiative reflects society’s commitment to developing the next generation of clinician-educators and strengthening the culture of peer-led learning and mentorship in anesthesiology. Conclusion In conclusion, NPT approaches represent a valuable and evolving component of regional anaesthesia (RA) education in Europe. By enabling trainees to teach their peers and juniors in supervised clinical settings, these models not only reinforce core procedural knowledge but also cultivate leadership, communication, and teaching skills—critical attributes for the next generation of anaesthesiologists. Such approaches can also contribute to greater consistency in RA exposure across institutions, particularly in settings where consultant-led teaching may be limited. A coordinated, Europe-wide expansion of such initiatives could help to harmonize training standards, enhance teaching quality, and ensure that all trainees gain equitable, high-quality RA education.References Konijn A, Aldecoa C, Benhamou D, Frkovic V, Kessler P, Marhofer P. Regional anaesthesia practices: insights from a European survey. European Journal of Anaesthesiology and Intensive Care 2023;2(4):e0026. https://doi.org/10.1097/EA9.0000000000000026Bellew S, Boyne H, et al. Regional anaesthesia training in the UK – a national survey. BJA Open. 2024;8:100241. https://doi.org/10.1016/j.bjao.2024.100241Argyra E, Moka E, Staikou C, Vadalouca A, Raftopoulos V, Stavropoulou E, Gambopoulou Z, Siafaka I. Regional anesthesia practice in Greece: a census report. Journal of Anaesthesiology Clinical Pharmacology 2015;31(1):59–66. https://doi.org/10.4103/0970-9185.150545Theodoraki K, Moka E, Makris A, Stavropoulou E, on behalf of ESRA Hellas Working Group. A survey of regional anesthesia use in Greece and the impact of a structured regional anesthesia course on regional techniques knowledge and practice. Journal of Clinical Medicine 2021;10(21):4814. https://doi.org/10.3390/jcm10214814Tavernier Q, Scholliers A, Vanhonacker D, Bruneel B. Anesthesia education in Belgium: pathways, processes, and perspectives. Journal of the Portuguese Society of Anesthesiology 2024;33(2). https://doi.org/10.25751/rspa.36247Khapre M, Deol R, Sharma A, et al. Near-peer tutor: a solution for quality medical education in faculty constraint setting. Cureus 2021 July 16;13(7):e16416. https://doi.org/10.7759/cureus.16416Tien M, Aiudi CM, Sviggum HP, Long TR. A peer-designed selective in anesthesiology, critical care, and perioperative medicine for first- and second-year medical students. Journal of Clinical Anesthesia 2016;31:175–181. https://doi.org/10.1016/j.jclinane.2016.02.006Tanveer MA, Mildestvedt T, Skjærseth IG, Arntzen HH, Kenne E, Bonnevier A, Stenfors T, Kvernenes M. Peer teaching in undergraduate medical education: what are the learning outputs for the student-teachers? A systematic review. Advances in Medical Education and Practice 2023;14:723–739. https://doi.org/10.2147/AMEP.S401766Chan EHY, Chan VHY, Roed J, Chen JY. Observed interactions, challenges, and opportunities in student-led, web-based near-peer teaching for medical students: interview study among peer learners and peer teachers. JMIR Medical Education 2023;9:e40716. https://doi.org/10.2196/40716Medveczky D, Mitchell A, Leopardi E, Dawson A. Benefits of a near-peer program from the tutors’ perspective: a survey of Australian junior doctors in a regional teaching program. BMC Medical Education. 2025;25:318. https://doi.org/10.1186/s12909-025-06762-2.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesiology, General Hospital of Athens KAT, Athens, Greece"
      ],
      "name": "Fani Alevrogianni"
    },
    {
      "affiliations": [
        "None, Glasgow, UK"
      ],
      "name": "Alan Mac Farlane"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Universitair Ziekenhuis Leuven, None, Leuven, Belgium"
      ],
      "name": "Steven Coppens"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, University Hopsitals of Leuven, None, Leuven, Belgium"
      ],
      "name": "Marie-Camille VanderHeeren"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Copenhagen University Hospital – North Zealand Hospitals, None, Hillerød, Denmark"
      ],
      "name": "Mathias Maagaard"
    },
    {
      "affiliations": [
        "Clinical Department of Anaesthesiology and Surgical Intensive Care of University Medical Center Ljubljana, None, Ljubljana, Slovenia"
      ],
      "name": "Ludvik Drobne"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Clinic Floridsdorf Hospital Vienna, None, Vienna, Austria"
      ],
      "name": "Daniel Weber"
    },
    {
      "affiliations": [
        "Anaesthesiology, General Hospital of Athens KAT, Athens, Greece"
      ],
      "name": "Evmorfia Stavropoulou"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Aristotle University of Thessaloniki, None, Thessaloniki, Greece"
      ],
      "name": "Eleni Moka"
    }
  ],
  "title": "FT19 Trainee delivered teaching in the workplace: from traditional methods to new initiatives",
  "uid": "e2be220a-eb64-52b1-a06e-8d9f06c49996"
}