Watterson L M, Hyde S, Bajenov S, Kennedy S E
Sydney Medical Simulation Centre, Department of Anaesthesia and Pain and Management, Royal North Shore Hospital, Office of Teaching and Learning in Medicine, University of Sydney, Australia.
Anaesth Intensive Care. 2007 Feb;35(1):38-45. doi: 10.1177/0310057X0703500133.
Junior anaesthetic registrars perform epidural labour analgesia in many Australian hospitals, however data evaluating training and outcomes are scarce. We aimed to describe and evaluate training practices and environments provided for registrars who learn epidural labour analgesia in their first year of training. Twenty-nine registrars audited their epidurals, participated in semi-structured interviews and completed surveys for six months. The median (inter-quartile range) number of epidurals performed by each registrar was 17 (15-25). Fifty percent performed less than 20. Among 216 audited cases, complications were reported in 19% (dural puncture in 1.4%) and technical difficulties in 16%. Direct supervision was provided for a median (range) of 2.5 (6) epidurals per registrar and for a significantly higher proportion of epidurals performed in tertiary hospitals compared with district metropolitan and rural hospitals (35%, 6% and 22% respectively; P = 0.001). Registrars felt senior staff had supportive attitudes, however the onus for initiating supervision appeared to be with the registrars and responses to survey items addressing role clarity and access to supervision showed wide variation. Only 33% of registrars agreed that they received adequate training before their first epidural and 67% reported workplace stress. None received formal assessments designed to ensure adequate supervision and competency. These results suggest that current training practices for these trainees are inadequate and could be improved by audit and structured workplace learning and assessment activities. We have demonstrated the potential value of measuring a range of training outcomes and environmental factors and have provided baseline data for future research.
在澳大利亚的许多医院，初级麻醉住院医生负责实施硬膜外分娩镇痛，但评估培训情况和结果的数据却很匮乏。我们旨在描述和评估为在培训第一年学习硬膜外分娩镇痛的住院医生提供的培训实践和环境。29名住院医生对自己实施的硬膜外麻醉进行了审计，参与了半结构化访谈，并在六个月内完成了调查。每位住院医生实施硬膜外麻醉的中位数（四分位间距）为17例（15 - 25例）。50%的人实施的病例数少于20例。在216例被审计的病例中，报告有并发症的占19%（硬膜穿破占1.4%），技术困难占16%。每位住院医生接受直接监督的硬膜外麻醉中位数（范围）为2.5例（6例），与地区都市医院和农村医院相比，三级医院实施的硬膜外麻醉接受直接监督的比例显著更高（分别为35%、6%和22%；P = 0.001）。住院医生认为高级 staff 态度支持，但启动监督的责任似乎在住院医生身上，针对角色清晰度和监督获取情况的调查项目的回复差异很大。只有33%的住院医生同意在首次实施硬膜外麻醉之前接受了充分的培训，67%的人报告有工作压力。没有人接受旨在确保充分监督和能力的正式评估。这些结果表明，目前针对这些学员的培训实践是不充分的，通过审计以及结构化的工作场所学习和评估活动可能会得到改善。我们已经证明了衡量一系列培训结果和环境因素的潜在价值，并为未来的研究提供了基线数据。
