Defining competence in obstetric epidural anaesthesia for inexperienced trainees

Area of Science:

• Medical Education
• Anesthesiology
• Statistical Analysis

Background:

• Cumulative sum (CUSUM) analysis is a statistical tool for evaluating trainee skill acquisition.
• A limitation of CUSUM is the need to predefine acceptable and unacceptable success rates.
• This study focused on monitoring trainee competence in obstetric epidural anesthesia.

Purpose of the Study:

• To assess the development of competence among trainees new to obstetric epidural anesthesia.
• To evaluate the utility of CUSUM analysis in this specific clinical skill acquisition context.

Main Methods:

• Prospective collection of obstetric epidural data from January 1996 to December 2011.
• Retrospective calculation of success rates for inexperienced trainees, considering overall, consecutive attempts, and individual rates.
• Generation of CUSUM graphs for each trainee after defining acceptable (65%) and unacceptable (55%) success rates.

Main Results:

• The overall mean success rate for inexperienced trainees was 76.8%.
• A learning curve was observed, with initial success rates around 58% on the first attempt, plateauing after 10 attempts.
• CUSUM analysis indicated that 76 out of 81 trainees achieved competence after an average of 46 attempts.

Conclusions:

• Cumulative sum (CUSUM) analysis is a valuable tool for assessing trainee competence in performing obstetric epidurals.
• Trainees require approximately 50 attempts, as determined by CUSUM analysis, to reach a defined level of competence.