Mohamed H, McAuliffe N, O'Connor R, Ceballos Salazar A, Zohaib Aslam M, Kallidaikurichi Srinivasan K, Iohom G, Shorten G
Department of Anaesthesia and Intensive Care, Faculty of Medicine, Cairo University, Cairo, Egypt; Department of Anaesthesia and Intensive Care, Leeds Teaching Hospitals, Leeds, UK.
Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Ireland.
Int J Obstet Anesth. 2021 Nov;48:103213. doi: 10.1016/j.ijoa.2021.103213. Epub 2021 Aug 17.
Epidural insertion is a challenging anaesthetic procedural skill to learn and may require up to 75 attempts to achieve competency. Proficiency-based progression (PbP) training based on unambiguously defined metrics was associated with a 53% reduction in epidural failure rate. The aim of this observational study was to examine the feasibility of implementation of innovative PbP training for labour epidural insertion performed by novices in a busy tertiary hospital.
All trainees who were scheduled to commence their obstetric anaesthesia training were invited to participate. Novices undertook intensive PbP training with one-to-one supervision by an anaesthetist trained in PbP. Trainees proceeded to the clinical phase only after attaining the pre-defined proficiency benchmark. All subsequent attempts at labour epidural catheter placement were evaluated.
All 12 novice trainees who were scheduled for their initial exposure to obstetric anaesthesia completed PbP training in epidural catheter insertion successfully. The average duration of the training courses was 70 (SD 11) min. Trainee characteristics were broadly similar. They performed a total of 180 labour epidural catheter placements with an overall epidural failure rate of 12.2% (22/180). The proportion of supervisor takeover was 6% (11/179). The incidence of complications was 4% (8/180) and difficulty in epidural catheter insertion due to patient factors was 16% (29/180). Patient satisfaction rates were 80% (satisfied or very satisfied), with 20% unsatisfied with their experience of epidural insertion.
In our experience, PbP training in epidural placement is feasible within existing departmental resources in a busy tertiary teaching hospital setting.
硬膜外穿刺是一项颇具挑战性的麻醉操作技能，学习时可能需要多达75次尝试才能达到熟练水平。基于明确定义指标的基于熟练度的进阶（PbP）培训使硬膜外穿刺失败率降低了53%。这项观察性研究的目的是检验在一家繁忙的三级医院中，新手进行分娩硬膜外穿刺时实施创新型PbP培训的可行性。
邀请所有计划开始产科麻醉培训的学员参与。新手在接受过PbP培训的麻醉医生一对一监督下进行强化PbP培训。学员只有在达到预先定义的熟练基准后才进入临床阶段。对随后所有分娩硬膜外导管置入尝试进行评估。
所有计划首次接触产科麻醉的12名新手学员均成功完成了硬膜外导管置入的PbP培训。培训课程的平均时长为70（标准差11）分钟。学员特征大致相似。他们共进行了180次分娩硬膜外导管置入，总体硬膜外穿刺失败率为12.2%（22/180）。上级医生接管的比例为6%（11/179）。并发症发生率为4%（8/180），因患者因素导致硬膜外导管置入困难的比例为16%（29/180）。患者满意度为80%（满意或非常满意），20%对其硬膜外穿刺体验不满意。
根据我们的经验，在繁忙的三级教学医院环境中，利用现有科室资源进行硬膜外穿刺的PbP培训是可行的。
