Impact of Wide-Awake Local Anesthesia No Tourniquet Surgery on Education During Surgical Training: A Survey of Residents and Fellowship Directors.

Purpose: Wide-awake local anesthesia no tourniquet (WALANT) surgery is becoming widely popular in the United States, although its impact on resident education remains unclear. We aimed to assess resident experience with WALANT surgery across the country with the goal of understanding benefits as well as identifying areas for improvement. Methods: An electronic survey assessing exposure and experience with the WALANT technique and the perceived impact on education was sent to 213 orthopedic surgery residency programs to be distributed to residents and 94 hand fellowship directors. Survey data were collected using Research Electronic Data Capture. Results: Sixty-five residents (24 females) completed the survey. Although 46 (71%) residents described their overall experience with WALANT as "excellent" or "good," 49 (75%) rated the overall educational value as "lower" or "about the same" as surgeries performed under anesthesia. When asked how to improve training, most responses recommended increased exposure and patient education regarding resident involvement during cases. Approximately half of the fellowship directors endorsed altering their teaching methods and how much they allow either a resident or fellow to perform during a WALANT case. The most common reasons for this included time constraints, patient comfort, and patient being awake during the case. Conclusions: Many orthopedic residents are being exposed to WALANT hand surgery, but it may be less educational compared with procedures under anesthesia. Clinical relevance: To improve education, we recommend increasing exposure, having open communication with patients regarding the trainee's role, and emphasizing discussion between the trainee and surgeon before and after surgery.