Original articleVanishing experience in training for obstetric general anaesthesia: an observational study
Introduction
As obstetric general anaesthesia has been slowly replaced by regional techniques, trainee experience in obstetric general anaesthesia has declined.1 Training has altered significantly in the UK since 1998, with the implementation of the New Deal in December 2000 and the European Working Time Directive (EWTD) in August 2004.[2], [3] The New Deal in 2000 resulted in a payment banding system for out-of-hours work that awarded high rates of pay for work outside contracted hours. The consequence was a change in working patterns away from ‘on call’ systems towards partial and full shifts. In August 2004 the EWTD reduced the average working week to a maximum of 58 h with maximum shift duration of 13 h. This reinforced the trend towards full shift working patterns.
Because of an impression that training opportunities have worsened since the implementation of training changes during this period, we aimed to review data on obstetric general anaesthesia since 1998. Declining experience in obstetric general anaesthesia has led to concerns for patient safety and raises questions about how to acquire competence in this skill.4 The small increase in the number of direct deaths due to anaesthesia recorded in the 2000-02 Confidential Enquiry into Maternal Deaths led to an expression of concern over the lack of experience attained by some anaesthetists in obstetric general anaesthesia.5 The 2003-05 report again highlighted concern that trainees take longer to acquire experience in laryngoscopy and reiterated the need for better training in intubation skills.6
Section snippets
Methods
This observational study collected data retrospectively from prospective audit information contained within annual reviews collated by the Department of Obstetric Anaesthesia, St James’s University Hospital, Leeds between 1998 and 2006. Original audit data were collected from copies of anaesthetic charts. Each annual review contained information gathered for every anaesthetic intervention on the delivery suite for that year. Data collated from this information included total number and timing
Results
In 1998 the total number of general anaesthetics given within the obstetric department was 108, of these 67 (62%) were for caesarean section. In 2006 the total number of general anaesthetics given was 61, of these 41 (67%) were for caesarean section. Fig. 1 shows the numbers of different types of anaesthesia for caesarean section for the years between 1982 and 2006, combining data from a previous study before 1998.1
During 1998 a total of 23 trainee anaesthetists worked in the obstetric
Discussion
Since 1998 training opportunities in general anaesthesia for caesarean section at St James’s Hospital have continued to decline. This reflects both changing trends in the delivery of anaesthesia for caesarean section and also changes in training hours and trainee numbers.
Since 1982 spinal anaesthesia has become the predominant technique for caesarean section, in contrast to the steady decline in general anaesthesia. In 2006 4.9% of caesarean sections were performed under general anaesthesia,
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