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Does an Epidural Precision Checklist, Scoring Tool, and Direct Feedback Enhance Resident Education?
Abstract Number: F-17
Abstract Type: Original Research
Epidural teaching methods and feedback vary greatly not only from institution to institution but also from person to person leading to learner confusion and a potential delay in acquisition of competency (1). There is no standard of care or benchmark for the evaluation or education of resident skills during the placement of a lumbar epidural. One study reported that only 33% of initial residents felt prepared before their first epidural and 67% reported having workplace stress (2). We hypothesize that using a procedural checklist, using a grading scale for epidural placement, and providing direct feedback will help improve, enhance, and accelerate epidural competency for trainees.
We created a step-by-step checklist and guide on how to perform an epidural and distributed the checklist to residents before their OB rotation. We used a seven-domain global rating scale (GRS) for the assessment of residents performing the lumbar epidural. After being evaluated with the GRS tool, residents were given a post-epidural debriefing session. All residents were sent a pre and post-rotation survey to assess the value of each education component at the beginning and end of the rotation.
24 GRS assessments and debriefing sessions have been completed to date; recruitment is ongoing. 12 of the 18 residents (67%) completed the pre-rotation survey and 7 of the 18 residents (39%) completed the post-rotation survey. Interim results showed that 71% of the residents felt that debriefing after performing an epidural was helpful . The most helpful method of teaching was real-time feedback while performing the epidural. The least helpful method of teaching was Medhub evaluation and comments. Post-study survey results also demonstrated that the GRS and debriefing feedback methods sped up learning of procedural skills and is considered a fair way to evaluate residents (Table 1).
Our preliminary results indicate that the epidural checklist, GRS, and debriefing sessions are valuable educational tools. They provide immediate and direct objective feedback to trainees as opposed to the usual subjective feedback. Trainees can then focus on improving specific points on the grading scale and have a better understanding of the procedure, thereby, also, reducing their anxiety and stress while performing procedures.
1. Analg.2016 May;122(5):1516-23.
2. Anaesth Intensive Care. 2007 Feb;35(1):38-45.