SEA UK Project Grant
ST1 Anaesthetic Recruit Training (START): A randomised, controlled single blinded trial to evaluate simulation enhanced teaching methods for novice anaesthetic trainees
Dr Nicholas Crabtree
Background & Aims: Doctors beginning their training in anaesthetics face one of the steepest learning curves since beginning their medical careers. The specialty requires them to become rapidly familiar with new equipment, medications and techniques. Clinical teaching has traditionally taken the form of an apprenticeship and, consequently, has lacked consistency with training opportunities depending on the trainer and on the caseload encountered. Simulation training for professionals in "high reliability organisations" such as aviation has become a standard part of both initial training and continued competency testing. Recently there has been much interest in the ability of simulation to deliver higher quality training to doctors and The Chief Medical Officer has recommended a greater role for simulation in UK medical education. Anaesthesia shares a number of similarities with aviation - most risk is concentrated within a short period of time around the start and end of the procedure, and when critical incidents occur, they require prompt recognition and intervention for a successful outcome. Anaesthetists need a range of "non-technical" skills to manage themselves and the resources of their team efficiently. This study aims to examine the most effective way of delivering training to novice anaesthetists practicing in the United Kingdom.
Methodology: We have designed a bespoke training course for novice anaesthetists comprising an introduction to theory, practice and non-technical skills. Once the foundations are laid, the course will cover simulated emergencies, and teach strategies to manage them effectively. Study participants will be randomised to receive traditional "on-the-job" teaching or to attend the course. After three months, all new anaesthetists are required by the Royal College of Anaesthetists to pass an "Initial Assessment of Competency" (IAC). This is a standardised assessment required by the Royal College of Anaesthetists, and this study will use candidates' performance as a marker of their learning during their first months of anaesthetic practice. An assessment of their non-technical skills will be made using videos recorded during training sessions using an existing scoring system to objectively measure behaviour in the theatre environment. It is expected that candidates undergoing the course will be more confident in their practice and better prepared to manage emergencies. It is also hoped that course participants will be more successful in their attempts to pass the IToC, take less time to pass the test and that their behaviour and non-technical skills will be more "prosafety" than candidates undergoing traditional teaching. It is hoped that improvements in teaching novice anaesthetists will enhance their experiences when they first join the specialty, improving staff retention. Providing more effective training will improve patient safety and quality of care. More efficient teaching will produce trainees capable of staffing on-call rotas sooner and may both reduce hospitals' reliance on locum doctors and improve European working time directive compliance, with potentially significant financial savings in the long term.
Relating professionalism and conscientiousness to develop an objective, scalar measure of professionalism in anaesthetic trainees
Dr Marina Sawdon
Background: Professional behaviour in clinicians is an important trait, and unprofessional behaviour has been linked to subsequent disciplinary action by state medical boards. The concept of professionalism is complex and subjective and relies on expert judgements. It is thus difficult to define, teach, measure and assess. 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.
Aims: The aim of this study is to develop a quantitative, objective approach to assessing professionalism, a 'Conscientiousness Index' (CI), in anaesthetic trainees of all stages, and relate this to current measures of professionalism in this specialty. It is hoped that this will provide a more reliable and valid method of measuring professionalism in anaesthetists and ultimately improve patient care, satisfaction and indeed safety.
Methodology: Consultant anaesthetists from James Cook University Hospital, Middlesbrough will initially be invited to take part in focus groups to attempt to define professionalism in anaesthesia. A 'Conscientiousness Index' will be developed by collation of routinely collected data from tasks expected to be carried out by anaesthetic trainees. The CI will consist of a sum of points awarded and/or deducted for completion/non-completion of objective and measurable behaviours related to conscientiousness. It will be tailored to the anaesthetic trainees, but is likely to include several components such as punctual submission of holiday requests and completed workplace training assessments. The objective audit data that will make up the CI will be collated by School of Anaesthesia administrative staff and passed on to the research team at Durham University for comparison with consultants' expert, subjective views of professionalism for those trainees. The relationship between these two measures will be explored. The identity of trainees will be anonymised by allocating a unique code to each trainee.
Expected outcomes: The Conscientiousness Index (CI) has previously been adapted for use in surgical, paramedic, clinical psychology, medical and dental training. Recent studies in this area indicate that the CI is a reliable and stable measure of a major component of professionalism; conscientiousness. In addition it has proved a valid measure of professional behaviour when compared to staff and peer views of professionalism, as well as formally assessed measures.
Implications: The implications of this study are that it may result in a more reliable and objective measure of professionalism in anaesthetic trainees; a measure which will not require time and effort from busy expert consultants but simply the collation of already routinely collected audit data by administrative staff.
