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.contributor.funder	University College Cork	en
dc.date.accessioned	2019-09-09T16:16:06Z
dc.date.available	2019-09-09T16:16:06Z
dc.date.issued	2018-10-15
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.description.status	Peer reviewed	en
dc.description.version	Published Version	en
dc.format.mimetype	application/pdf	en
dc.identifier.articleid	e020099	en
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.doi	10.1136/bmjopen-2017-020099	en
dc.identifier.eissn	2044-6055
dc.identifier.endpage	9	en
dc.identifier.issued	10	en
dc.identifier.journaltitle	Anaesthesia	en
dc.identifier.startpage	1	en
dc.identifier.uri	https://hdl.handle.net/10468/8495
dc.identifier.volume	8	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

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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