-
[show abstract]
[hide abstract]
ABSTRACT: Calls for reform to postgraduate medical training structures in the UK have included suggestions that training should foster excellence and not simply ensure competence.
We conducted a modified Delphi-type survey starting with an e-mail request to specialist anaesthetists involved in education, asking them to identify the attributes of an excellent anaesthetist. In focused group interviews, their coded and categorized responses were ranked, and suggestions were made for incorporation into anaesthesia education. We also compared the findings with currently available professional and educational guidance.
Our expert group strongly expressed the view that while superior knowledge and skills, associated with exceptional performance in clinical work, were fundamental to the excellent practitioner, they were not sufficient in themselves. A group of attributes that were personal qualities and functions of personality were also considered essential. The defining characteristic of excellence was, perhaps, the continuing urge to seek challenges and learn from them. Other high-ranking characteristics included clinical skills, interest in teaching, conscientiousness, innovation/originality, communication skills, and good relationships with patients. Knowledge for its own sake (personal involvement in research) was not rated highly, but applied knowledge was judged to underlie many of the most important categories.
The achievement of excellence in anaesthesia is likely to depend on the successful interplay of individuals' personal qualities and the environment in which they work. Thus, not only trainees but also educational supervisors, heads of departments, and those responsible for organizing training systems all have a part to play in the encouragement of excellence.
BJA British Journal of Anaesthesia 01/2011; 106(1):38-43. · 4.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This review presents the background to the development of the anaesthetists' non-technical skills (ANTS) taxonomy and behaviour rating tool, which is the first non-technical skills framework specifically designed for anaesthetists. We share the experience of the anaesthetists who designed ANTS in relation to applying it in a department of anaesthesia, using it in a simulation centre, and the process of introducing it to the profession on a national basis. We also consider how ANTS is being applied in relation to training and research in other countries and finally, we discuss emerging issues in relation to the introduction of a non-technical skills approach in anaesthesia.
BJA British Journal of Anaesthesia 07/2010; 105(1):38-44. · 4.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Situation awareness (SA) is one of the essential non-technical skills for effective and safe practice in high-risk industries, such as healthcare; yet, there is limited research of its significance in anaesthetic practice. In this paper, we review this scant research that focuses on SA as patient monitoring alone and advocate for a more comprehensive view of SA in anaesthetic practice and training that extends beyond monitoring, namely, a distributed cognition approach. We identify further factors influencing anaesthetists' SA and provide a case that resulted in an anaesthetic fatality to illustrate the application of an alternative view of SA in anaesthesia. Distributed SA in anaesthetic practice provides the foundation for further research that may in turn influence the teaching and assessment of this important non-technical skill.
BJA British Journal of Anaesthesia 07/2010; 105(1):83-90. · 4.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Fixation errors occur when the practitioner concentrates solely upon a single aspect of a case to the detriment of other more relevant aspects. These are well recognised in anaesthetic practice and can contribute significantly to morbidity and mortality. Improvement in patient safety may be assisted by development and application of countermeasures to fixation errors. Cognitive psychologists use 'insight problems' in a laboratory setting, both to induce fixation and to explore strategies to escape from fixation. We present some results from a series of experiments on one such insight problem and consider applications that may have relevance to anaesthetic practice.
Anaesthesia 01/2010; 65(1):61-9. · 2.96 Impact Factor
-
Cognition, Technology & Work. 01/2004; 6:165-171.
-
European Journal of Anaesthesiology 11/2003; 20(10):763. · 2.23 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: At present there is no nationwide formal training course at which college tutors in anaesthesia can develop the specific skills required to perform their important role effectively. The purpose of this study was to ascertain whether there is a need for an introductory learning package for college tutors and if so, what learning needs ought to be addressed in such a package. A needs assessment was performed involving the use of individual interviews and the administration of two sequential questionnaires. The questionnaire was completed by 208 college tutors, a return rate of 83%. Most college tutors (93%) said they had had no formal training to perform their role and 94% felt there was a need for an introductory course for college tutors in anaesthesia. Of those, 77% said they would be interested in taking such a course. The study identified a number of learning needs.
Anaesthesia 11/2003; 58(10):1003-7. · 2.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Non-technical skills are critical for good anaesthetic practice but are not addressed explicitly in normal training. Realization of the need to train and assess these skills is growing, but these activities must be based on properly developed skills frameworks and validated measurement tools. A prototype behavioural marker system was developed using human factors research techniques. The aim of this study was to conduct an experimental evaluation to establish its basic psychometric properties and usability.
The Anaesthetists' Non-Technical Skills (ANTS) system prototype comprises four skill categories (task management, team working, situation awareness, and decision making) divided into 15 elements, each with example behaviours. To investigate its experimental validity, reliably and usability, 50 consultant anaesthetists were trained to use the ANTS system. They were asked to rate the behaviour of a target anaesthetist using the prototype system in eight videos of simulated anaesthetic scenarios. Data were collected from the ratings forms and an evaluation questionnaire.
The results showed that the system is complete, and that the skills are observable and can be rated with acceptable levels of agreement and accuracy. The internal consistency of the system appeared sound, and responses regarding usability were very positive.
The findings of the evaluation indicated that the ANTS system has a satisfactory level of validity, reliability and usability in an experimental setting, provided users receive adequate training. It is now ready to be tested in real training environments, so that full guidelines can be developed for its integration into the anaesthetic curriculum.
BJA British Journal of Anaesthesia 06/2003; 90(5):580-8. · 4.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study assessed the accuracy of using capnography with a modified, hollow gum elastic bougie in predicting tracheal intubation, and its effectiveness as a method of apnoeic oxygenation.
Patients were randomly allocated to having the gum elastic bougie inserted, under anaesthesia, in the trachea or the oesophagus. End-tidal carbon dioxide measurements were made at 10 and 20 s. The position of the gum elastic bougie was correctly predicted in 89.2% of patients. We tested the apnoeic oxygenation on an anaesthetic simulator model, which is housed in the Scottish Anaesthesia Simulator Centre, Stirling, UK.
The time taken for the oxygen saturation to fall to 90% was significantly prolonged when the gum elastic bougie was used for apnoeic oxygenation.
The modification of the gum elastic bougie allows a more objective assessment of correct placement than the previous tactile method. The current design of bougie is unsuitable but can be modified.
European Journal of Anaesthesiology 02/2001; 18(1):51-3. · 2.23 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The introduction of patient-controlled analgesia for burn patients is reported. It has been used for 18 postoperative patients and five patients with acute thermal injury. The system has been found to be easy to use. Wide variations in patient morphine consumption have been seen. Patient-controlled analgesia may have a role in the management of pain associated with burns.
Burns 01/1989; 14(6):500-3. · 1.96 Impact Factor
-
-
[show abstract]
[hide abstract]
ABSTRACT: The introduction of patient-controlled analgesia for burn patients is reported. It has been used for 18 postoperative patients and five patients with acute thermal injury. The system has been found to be easy to use. Wide variations in patient morphine consumption have been seen. Patient-controlled analgesia may have a role in the management of pain associated with burns.
Burns.
