Watching anaesthetists work: using the professional judgement of consultants to assess the developing clinical competence of trainees (original) (raw)
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Trainee anaesthetists understand their work in different ways: implications for specialist education
British Journal of Anaesthesia, 2004
Background. Traditionally, programmes for specialist education in anaesthesia and intensive care have been based on lists of attributes such as skills and knowledge. However, modern research in the science of teaching has shown that competence development is linked to changes in the way professionals understand their work. The aim of this study was to de®ne the different ways in which trainee anaesthetists understand their work.
British Journal of Anaesthesia, 2013
† Excellent performance requires a mix of technical and non-technical skills (NTS). † Specialist training programmes pay inadequate attention to NTS. † In Sweden, highly trained anaesthetic nurses work closely with physician anaesthetists. † The investigators have identified groups of NTS associated with excellent performance by anaesthetists, based on structured interviews to elicit the views of experienced anaesthetic nurses. Background. Teaching trainees to become competent professionals who can keep the complex system of anaesthesia safe is important. From a safety point of view, nontechnical skills such as smooth cooperation and good communication deserve as much attention as theoretical knowledge and practical skills, which by tradition have dominated training programmes in anaesthesiology. This study aimed to describe the way excellent anaesthetists act in the operating theatre, as seen by experienced anaesthesia nurses. Methods. The study had a descriptive and qualitative design. Five focus group interviews with three or four experienced Swedish anaesthesia nurses in each group were conducted. Interviews were analysed by using a qualitative method, looking for common themes. Results. Six themes were found: (A) structured, responsible, and focused way of approaching work tasks; (B) clear and informative, briefing the team about the action plan before induction; (C) humble to the complexity of anaesthesia, admitting own fallibility; (D) patient-centred, having a personal contact with the patient before induction; (D) fluent in practical work without losing overview; and (F) calm and clear in critical situations, being able to change to a strong leading style. Conclusions. Experienced anaesthesia nurses gave nuanced descriptions of how excellent anaesthetists behave and perform. These aspects of the anaesthetist's work often attract too little attention in specialist training, notwithstanding their importance for safety and fluency at work. Creating role models based on studies like the present one could be one way of increasing safety in anaesthesia.
How novice and expert anaesthetists understand expertise in anaesthesia: a qualitative study
BMC Medical Education
Background The development of expertise in anaesthesia requires personal contact between a mentor and a learner. Because mentors often are experienced clinicians, they may find it difficult to understand the challenges novices face during their first months of clinical practice. As a result, novices’ perspectives may be an important source of pedagogical information for the expert. The aim of this study was to explore novice and expert anaesthetists understanding of expertise in anaesthesia using qualitative methods. Methods Semi-structured interviews were conducted with 9 novice and 9 expert anaesthetists from a German University Hospital. Novices were included if they had between 3 and 6 months of clinical experience and experts were determined by peer assessment. Interviews were intended to answer the following research questions: What do novices think expertise entails and what do they think they will need to become an expert? What do experts think made them the expert person an...
Professionalism in Anesthesiology training
Revista de la Facultad de Medicina, 2018
En el presente artículo de reflexión se busca definir y establecer los componentes fundamentales del profesionalismo requerido para el óptimo ejercicio de la anestesiología. De este modo, se identifican algunos ejemplos de comportamiento no profesional y de las posibles herramientas positivas que se pueden aprovechar. Se propone, entonces, el profesionalismo como eje fundamental para el desarrollo de la anestesiología como especialidad médica y se evalúa el impacto benéfico derivado de su inclusión en los programas curriculares.
What defines expertise in regional anaesthesia? An observational analysis of practice
British Journal of Anaesthesia, 2006
Background. Published work on knowledge in regional anaesthesia has focused on competence, for instance by identifying numbers of procedures required to achieve competence, or by defining criteria for successful performance of blocks. We aimed to define expertise in regional anaesthesia and examine how it is acquired. Methods. We observed anaesthetists performing 15 regional anaesthetic blocks and analysed the resulting transcripts qualitatively and in detail. Results. Expertise in regional anaesthesia encompasses technical fluency but also includes non-cognitive skills such as handling of the patient (communicating, anticipating and minimizing discomfort) and recognizing the limits of safe practice (particularly deciding when to stop trying to insert a block). Such elements may be underplayed by the experts who possess them. Focusing on a small number of regional anaesthetic procedures in detail (as is standard with such qualitative analytical approaches) has also allowed us to develop a model for the acquisition of expertise. In this model, trainees learn how to balance theoretical and practical knowledge by reflection on their clinical experiences, an iterative process which leads to the embedding of knowledge in the expert's personal repertoire of individual techniques. Conclusions. Expertise in regional anaesthesia extends beyond competence at technical performance; non-cognitive elements are also vital. Further work is needed to test our learning model, and the hypothesis that learning can be enhanced by deliberate promotion of the tacit elements of 'expertise' we have described.
Supervision and responsibility: The Royal College of Anaesthetists National Audit
British Journal of Anaesthesia, 2005
Background. The Royal College of Anaesthetists audited consultant supervision and responsibility in anaesthesia in the UK during 2003. Methods. Consultants (supervising) and non-consultants (supervised) were surveyed on their attitudes to supervision, experience of their own hospital system for supervision and of induction for new starters. Local coordination was achieved through anaesthesia audit coordinators who provided information on local policies, induction programmes and anaesthesia charts. Supervision was audited over a 5-day period. Results. 135 departments of anaesthesia took part (43% of 315 departments), questionnaires being returned by 2297 anaesthetists. Anaesthesia record charts in use do not meet criteria considered desirable locally. Most trainees, but less than half staff grade/associate specialists, received an induction programme, often not supported by written documentation. Consultants find conflicting demands of service and supervision difficult. Many work in systems which do not permit providing direct, immediate support to those supervised. Most anaesthetists think supervision is very important. Around half disagree with national guidance that every NHS patient should have a named consultant. Two per cent of non-consultants during the audit period reported assistance from consultants not being obtainable soon enough. Conclusions. This audit found departure from standards and the potential for risk and failure. New standards may be needed regarding anaesthesia record sheets, induction, accountability, when to seek help and care of sick patients. Supervision systems in over 40% of hospitals need review to ensure they provide a named consultant and immediate direct support for elective lists.
Acta Anaesthesiologica Scandinavica, 2002
Background: Assessment in postgraduate education is moving towards using a broad spectrum of practice-based assessment methods. This approach was recently introduced in first-year residency in anaesthesiology in Denmark. The new assessment programme covers: clinical skills, communication skills, organizational skills and collaborative skills, scholarly proficiencies and professionalism. Eighteen out of a total of 21 assessment instruments were used for pass/fail decisions. The aim of this study was to survey consultants' opinions of the programme in terms of the representativeness of competencies tested, the suitability of the programme as a basis for pass/fail decisions and the relevance and sufficiency of the content of the different assessment instruments. Methods: A description of the assessment programme and a questionnaire were sent to all consultants of anaesthesiology in Denmark. The questionnaire consisted of items, to be answered on a five-point scale, asking the consultants' opinions about representativeness, suitability and content of the programme. Results: The response rate was 251/382 (66%). More than 75% of the respondents agreed that the assessment programme offered
Identifying Training Requirements in Perioperative Care for Anaesthetists
Journal of Biomedical Education, 2013
Education and training in anaesthesia have traditionally focused on the preparation and delivery of intraoperative anaesthesia but are evolving to incorporate aspects of perioperative medical care. The expansion of continued professional development and postgraduate courses in this field has gathered pace, with the aim of teaching anaesthetists and allied professionals to improve patients' surgical care. We surveyed a population of UK-based anaesthetists to establish their views on professional development within perioperative medicine, their role as perioperative medical experts of the future, and the training and educational needs of this cohort. The majority of anaesthetists acknowledged their evolving role in perioperative patient care and recognised a need to train for the task. Only 50% of the senior anaesthetists surveyed believed they had sufficient knowledge and skills to undertake perioperative care with the majority believing the current training curriculum must advance to support professional development. In line with other international healthcare systems, UK-based anaesthetic practice is adopting a responsibility for perioperative medical practice, and this survey has demonstrated willingness amongst anaesthetists of all grades to embrace change, recognise training needs, and improve the outcome for surgical patients.
BMC Medical Education
Background: The concept of professionalism is complex and subjective and relies on expert judgements. Currently, there are no existing objective measures of professionalism in anaesthesia. However, it is possible that at least some elements of professionalism may be indicated by objective measures. A number of studies have suggested that conscientiousness as a trait is a significant contributor to professionalism. Methods: A 'Conscientiousness Index' (CI) was developed by collation of routinely collected data from tasks expected to be carried out by anaesthetic trainees such as punctual submission of holiday and 'not-on-call' requests, attendance at audit meetings, timely submission of completed appraisal documentation and sickness/absence notifications. The CI consists of a sum of points deducted from a baseline of 50 for non-completion of these objective and measurable behaviours related to conscientiousness. This was correlated with consultants' formal and informal subjective measures of professionalism in those trainees. Informal, subjective measures of professionalism consisted of a 'Professionalism Index' (PI). The PI consisted of a score developed from consultants' expert, subjective views of professionalism for those trainees. Formal, subjective measures of professionalism consisted of a score derived from comments made by consultants in College Tutor feedback forms on their views on the professionalism of those trainees (College Tutor feedback; CT). The PI and CT scores were correlated against the CI using a Pearson or Spearman correlation coefficient. Results: There was a negative, but not statistically significant, relationship between the CI and formal, subjective measures of professionalism; CT scores (r =-0.341, p = 0.06), but no correlation between CI and consultants informal views of trainees' professionalism; the PI scores (r s =-0.059, p = 0.759). Conclusions: This may be due the 'failure to fail' phenomenon due to the high stakes nature of raising concerns of professionalism in postgraduate healthcare professionals or may be that the precision of the tool may be insufficient to distinguish between trainees who generally show highly professional behaviour. Future development of the tool may need to include more of the sub-facets of conscientiousness. Independently of a relationship with the construct of professionalism, a measure of conscientiousness might be of interest to future employers.