Ultrasound reliance and landmark-based proficiency in vascular access training: a multicenter cross-sectional survey of anesthesia trainees and teaching faculty in Eastern China

Ultrasound guidance has substantially changed vascular access practice, but increasing reliance on ultrasound may be associated with reduced emphasis on landmark-based skills, particularly in resource-limited settings. If reliance on ultrasound is not matched by maintained landmark-based competence, trainees may be inadequately prepared for clinical situations in which ultrasound is unavailable and timely vascular access is critical. We evaluated reliance on ultrasound among anesthesia trainees and examined whether initial training exposure was associated with current technique preference. In this multicenter cross-sectional survey, anesthesia trainees and teaching faculty in Eastern China completed questionnaires assessing confidence, technique preference, and training attitudes regarding internal jugular vein (IJV) and radial artery (RA) cannulation. Binary logistic regression was used to identify factors independently associated with technique preference. This study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement for cross-sectional studies. A total of 682 valid responses were analyzed, including 454 trainees and 228 faculty members. Trainees reported greater confidence with ultrasound-guided than with landmark-based techniques (P < 0.001). Initial learning method was the factor most strongly associated with current technique preference: trainees who first learned vascular access using ultrasound were more likely to prefer ultrasound guidance for both IJV cannulation (adjusted odds ratio (aOR) = 6.83; 95% confidence interval (CI), 3.85–12.11) and RA cannulation (aOR = 5.54; 95% CI, 3.13–9.79). This pattern persisted despite 90.53% of trainees acknowledging the importance of landmark-based skills. In addition, 43.17% reported anxiety about performing vascular access without ultrasound, and 73.25% of faculty perceived declining landmark-based competence among recent graduates. Principal component analysis supported distinct landmark-based confidence constructs for IJV and RA cannulation, whereas ultrasound-guided confidence appeared more generalizable across access sites. Anesthesia trainees showed substantial reliance on ultrasound guidance for vascular access, and initial training exposure was strongly associated with current technique preference. Training programs should maintain structured teaching and assessment in both ultrasound-guided and landmark-based techniques to improve preparedness across varied clinical settings. Does the method used in initial vascular access training (ultrasound‑guided versus landmark-based technique) show an association with long-term technique preference among anesthesia trainees and teaching faculty? In this multicenter survey of 682 anesthesia providers, trainees who first learned vascular access using ultrasound were nearly seven times more likely to prefer ultrasound for internal jugular cannulation (aOR 6.83) and more than five times more likely to prefer it for radial artery cannulation (aOR 5.54) than those who initially learned landmark-based techniques. In this cross-sectional sample, early training exposure was strongly associated with long-term clinical preferences. These findings suggest, but do not prove, that structured instruction in both ultrasound and landmark-based methods may better prepare trainees for diverse practice environments. Prospective studies are needed to confirm any causal relationship.