| Counterbalancing clinical supervision and independent practice: case studies in learning thoracic epidural catheter insertion. | |
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MedLine Citation:
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PMID: 20739323 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Thoracic epidural catheter placement is an example of a demanding and high-risk clinical skill that junior anaesthetists need to learn by experience and under the supervision of consultants. This learning is known to present challenges that require further study. METHODS: Ten consultant and 10 trainee anaesthetists in a teaching hospital were interviewed about teaching and learning this skill in the operating theatre, and a phenomenological analysis of their experience was performed. RESULTS: Trainee participation was limited by time pressure, lack of familiarity with consultants, and consultants' own need for clinical experience. There was a particular tension between safe and effective consultant practice and permitting trainees' independence. Three distinct stages of participation and assistance were identified from reports of ideal practice: early (part-task or basic procedure, consultant always present giving instruction and feedback), middle (independent practice with straightforward cases without further instruction), and late (skill extension and transfer). Learning assistance provided by consultants varied, but it was often not matched to the trainees' stages of learning. Negotiation of participation and assistance was recognized as being useful, but it did not happen routinely. CONCLUSIONS: There are many obstacles to trainees' participation in thoracic epidural catheter insertion, and learning assistance is not matched to need. A more explicit understanding of stages of learning is required to benefit the learning of this and other advanced clinical skills. |
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Authors:
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T Johnson |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-08-25 |
Journal Detail:
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Title: British journal of anaesthesia Volume: 105 ISSN: 1471-6771 ISO Abbreviation: Br J Anaesth Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-18 Completed Date: 2010-12-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372541 Medline TA: Br J Anaesth Country: England |
Other Details:
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Languages: eng Pagination: 772-6 Citation Subset: IM |
Affiliation:
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Manchester and Salford Pain, Salford Royal NHS Foundation Trust, University of Manchester, Eccles Old Road, Salford M6 8HD, UK. tim.johnson@srft.nhs.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anesthesia, Epidural
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standards* Anesthesiology / education* Attitude of Health Personnel Consultants Education, Medical, Graduate / methods* England Humans Interprofessional Relations Learning Medical Staff, Hospital / education* Mentors Professional Autonomy* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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