From Simulation to Bedside: A Hybrid Rapid Cycle Deliberate Practice-Mastery Learning Curriculum for Serratus Anterior Plane Block Training.

OBJECTIVES: The serratus anterior plane block (SAPB) is an effective ultrasound-guided regional anesthesia technique for anterolateral rib fracture pain. Formal SAPB training in emergency medicine remains limited, contributing to inconsistent adoption and procedural confidence. This study evaluated whether a simulation-based curriculum improves emergency physicians' confidence, knowledge, retention, and simulated procedural competency. METHODS: A prospective educational intervention was conducted at an urban academic center. Participants completed pre- and post-curriculum surveys assessing SAPB knowledge, procedural confidence, and barriers. Survey content was developed using a three-round Delphi process by emergency medicine ultrasound and simulation experts. The curriculum included didactic teaching and four simulation stations addressing consent, ultrasound-guided in-plane technique, anatomy, and SAPB performance using task trainers. Procedural competency was assessed using an ACEP-guidelines-based checklist. Pre- and post-curriculum outcomes were analyzed using paired t-tests (p < 0.05). RESULTS: Thirty-six physicians participated, including attendings (19.4%), fellows (8.3%), and residents (72.2%) distributed evenly across PGY1 to PGY4 levels. Two participants (5.6%) had prior ultrasound fellowship training and 5 (13.9%) had previously performed a SAPB. Self-reported confidence increased significantly following the curriculum (1.81 ± 1.09 vs. 4.00 ± 0.72; p < 0.001), as did willingness to perform the block (3.31 ± 1.60 vs. 4.53 ± 0.70; p < 0.001). All participants achieved simulated procedural competency and demonstrated improved knowledge scores following the curriculum (p < 0.001). Five clinical bedside SAPBs were performed during the first 6 months following training. Among 32 participants (88.9%) completing the 4-6-week follow-up, mean cumulative knowledge scores were 92.9% ± 11.7 immediately after training and 90.9% ± 10.3 at follow-up. Reported barriers to SAPB performance included time constraints, patient refusal, and limited availability of appropriate patients. CONCLUSIONS: A simulation-based curriculum improved emergency physicians' self-reported confidence and knowledge regarding the SAPB, while supporting short-term stability of knowledge performance. These findings highlight the value of simulation as a scalable pathway to standardize ultrasound-guided regional anesthesia training and facilitate future evaluation of SAPB adoption in emergency medicine.