This expert-driven procedure characterization must then be subjected to a validation process, for example, face and content validity. 9 Collaboration with experienced operators who are proficient in performance of the procedure permits identification of 1) what should be done (the essential steps), 2) how it should be done (effective techniques) and 3) what should not be done (errors). Procedures such as UGRA may be more effectively taught if mastered initially as component parts, subsequently assimilated into an integrated performance of the complete procedure. 7 This approach (in contrast to generic or Objective Structured Assessment of Technical Skills approach) requires detailed characterization of each specific procedure by unambiguous definition of specific events or “metrics”. 6 Disciplines such as surgery have successfully applied a metric-driven proficiency-based progression approach to surgical technical skills training. 5 Assessment of competence could be greatly improved when direct observation with checklists is used. 4 It has been argued that assessment motivates learning and facilitates provision of structured feedback leading to improved procedural skills training. However, characterization and development of assessment tools for anesthesia-related procedural skills are less advanced compared to their surgical counterparts. 3 The current paradigm shift toward competence-based training has led to a demand for objective, valid and reliable assessment tools for procedural skills in general. 2 Competence-based procedural skills training has been endorsed and prioritized by the American and European Societies of Regional Anesthe-sia. Training bodies and groups have endorsed a number of structured training programs to aid skills acquisition during performance of UGRA. Widespread adoption of UGRA by anesthesiologists has created a requirement to teach and learn UGRA-related skills effectively. It is usually performed by anesthesiologists with advanced level of expertise and requires mastery of a wide range of technical and nontechnical skills. 1 UGRA comprises a group of procedures that facilitate provision of anesthesia and analgesia for different surgical procedures (e.g., upper and lower limbs surgery) either alone or in combination with general anesthesia. Ultrasound-guided regional anesthesia (UGRA) has evolved rapidly to become a fundamental skill for anesthesiologists.
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