A survey of anaesthesia registrars’ experience and perspectives on epidural training in the WITS Anaesthesia circuit, Johannesburg

Abstract

Background Insertion of epidurals, in particular thoracic epidurals, is a challenging procedure that is considered one of the most difficult technical skills in which to develop proficiency. Internationally, there is a lack of objective recommendations pertaining to epidural insertion education and skill acquisition. The aim of this study was to describe anaesthetic registrars’ experience and perspectives of epidural training at the University of Witwaterstrand. Method A cross-sectional, contextual, descriptive study was performed using a self-administered electronic questionnaire. A validated questionnaire on this topic developed by Isaacs et al was used with permission as a guide for the development of our questionnaire, which was then adapted to ensure its relevance to the local environment. Results Eighty-nine participants responded to the survey giving a response rate of 80.9%. Despite disagreement with respect to observation and feedback on enough cases to feel confident when performing the procedure alone (47, 52.8%), most participants still perceived they had a good understanding of spinal anatomy (73, 82%) and complications of epidural insertion (70, 78.7%). Participants could easily call for help if struggling (53, 59.5%), and knew when it was appropriate to do so (54, 60.7%). Almost all the participants (87, 97.8%) had never used an epidural simulator before, yet 67 (75.3%) participants indicated that it should be recommended to teach junior colleagues. Regarding the use of ultrasound pre-puncture, a large number of participants (75, 84.3%) had never used it, however, 55 (61.8%) participants recommend it being used as part of a teaching strategy. Conclusion Our study found that a more formal teaching program, as well as a minimum number of supervised epidural insertions has been recommended to improve the current training program, as registrars continue to face challenges in developing th