Proficiency-based progression training: an ‘end to end’ model for decreasing error applied to achievement of effective epidural analgesia during labour: a randomised control study

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dc.contributor.author Kallidaikurichi Srinivasan, Karthikeyan
dc.contributor.author Gallagher, Anthony
dc.contributor.author O'Brien, Niall
dc.contributor.author Sudir, Vinod
dc.contributor.author Barrett, Nick
dc.contributor.author O'Connor, Raymund
dc.contributor.author Holt, Francesca
dc.contributor.author Lee, Peter
dc.contributor.author O'Donnell, Brian
dc.contributor.author Shorten, George
dc.date.accessioned 2019-09-09T16:16:06Z
dc.date.available 2019-09-09T16:16:06Z
dc.date.issued 2018-10-15
dc.identifier.citation Srinivasan, K.K., Gallagher, A., O’Brien, N., Sudir, V., Barrett, N., O’Connor, R., Holt, F., Lee, P., O’Donnell, B. and Shorten, G., 2018. Proficiency-based progression training: an ‘end to end’model for decreasing error applied to achievement of effective epidural analgesia during labour: a randomised control study. BMJ open, 8(10), e020099. DOI:10.1136/bmjopen-2017-020099 en
dc.identifier.volume 8 en
dc.identifier.issued 10 en
dc.identifier.startpage 1 en
dc.identifier.endpage 9 en
dc.identifier.uri http://hdl.handle.net/10468/8495
dc.identifier.doi 10.1136/bmjopen-2017-020099 en
dc.description.abstract Background: Training procedural skills using proficiency-based progression (PBP) methodology has consistently resulted in error reduction. We hypothesised that implementation of metric-based PBP training and a valid assessment tool would decrease the failure rate of epidural analgesia during labour when compared to standard simulation-based training.Methods: Detailed, procedure-specific metrics for labour epidural catheter placement were developed based on carefully elicited expert input. Proficiency was defined using criteria derived from clinical performance of experienced practitioners. A PBP curriculum was developed to train medical personnel on these specific metrics and to eliminate errors in a simulation environment. Seventeen novice anaesthetic trainees were randomly allocated to undergo PBP training (Group P) or simulation only training (Group S). Following training, data from the first 10 labour epidurals performed by each participant were recorded. The primary outcome measure was epidural failure rate.Results: A total of 74 metrics were developed and validated. The inter-rater reliability (IRR) of the derived assessment tool was 0.88. Of 17 trainees recruited, eight were randomly allocated to group S and six to group P (three trainees did not complete the study). Data from 140 clinical procedures were collected. The incidence of epidural failure was reduced by 54% with PBP training (28.7% in Group S vs 13.3% in Group P, absolute risk reduction 15.4% with 95% CI 2% to 28.8%, p=0.04).Conclusion: Procedure-specific metrics developed for labour epidural catheter placement discriminated the performance of experts and novices with an IRR of 0.88. Proficiency-based progression training resulted in a lower incidence of epidural failure compared to simulation only training. en
dc.description.sponsorship UCC (ASSERT Centre) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Publishing Group en
dc.relation.uri https://bmjopen.bmj.com/content/bmjopen/8/10/e020099.full.pdf
dc.rights © Author(s) (or their employer(s)) 2018 en
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/ en
dc.subject Epidural analgesia en
dc.subject Labour en
dc.subject Proficiency-based progression (PBP) en
dc.subject Anaesthetic en
dc.title Proficiency-based progression training: an ‘end to end’ model for decreasing error applied to achievement of effective epidural analgesia during labour: a randomised control study en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Niall O'Brien, Department of Anaesthesia, University College Cork, Cork, Ireland. +353-21-490-3000 Email: niall.obrien@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder University College Cork en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Anaesthesia en
dc.internal.IRISemailaddress niall.obrien@ucc.ie en
dc.identifier.articleid e020099 en
dc.identifier.eissn 2044-6055


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© Author(s) (or their employer(s)) 2018 Except where otherwise noted, this item's license is described as © Author(s) (or their employer(s)) 2018
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