Oxford Meeting - November 2002

TRAINING IN INTRAVENOUS ANAESTHESIA: PRE AND POST COURSE TESTING IMPROVES TEACHING TECHNIQUES IN FUTURE WORKSHOPS

Fernando S. Nora*, Marcos Aguzzoli, Elaine F. Fortis.

Rua Almirante Abreu, 235 CASA – Porto Alegre – RS – BRAZIL   CEP: 90420-010

Aim: Evaluation of the effectiveness of teaching at scientific events is unusual in Brazil. Recently the SAVA course, involving methods of teaching in the emergency room brought these concepts here. This course includes self-testing before and after the course. Our objective was to show the importance that such tests can have before and after scientific workshops in intravenous anesthesia. 

Methods: We ran two workshops on intravenous anesthesia with a total of 198 participants in two cities in Brazil. Nine questions, each with one correct answer, were asked before each workshop. We calculated the percentage of right and wrong answers. Issues discussed during the workshop included target-controlled infusions in anesthesia and pharmacokinetic aspects of intravenous anesthetic drugs. The same questions were then asked again after each workshop. We compared the percentage of answers that were right and wrong before and after each workshop.

Results: The percentage of correct answers before each workshop was 52 % and 47 %. After the workshops the percentage of correct answers increased to 87 % and 85 %. This showed an average increase of 70 %. Before the workshops we identified three questions as the most difficult questions for participants, because the answers to these questions were most frequently wrong. When we repeated those questions after the workshops, they had an incidence of 90 % of right answers. However, even after the first workshop one question was answered correctly by only 37 % of the participants. We emphasized that subject of that question during the second workshop, and this resulted in a 70 % increase in correct answers to that question after the second workshop. It’s important to say that these workshops were given with a two week break. The most important problems identified by participants asked to explain their difficulties with intravenous anesthesia were:

-          lack of knowledge of the pharmacokinetics of intravenous drugs

-          no possibility of using these pump infusions in their hospitals.

Many people told us that they didn’t know how target-controlled infusions worked. They also told us that it’s difficult for them to change their way of thinking – from mg/kg to mcg/ml.

See Figures I and II for different evaluations in each cities.

Conclusions: The tests before and after the workshops enable the participants to realise what is wrong with their knowledge of intravenous anesthesia. People frequently ask what else they must learn to better use intravenous anesthesia in clinical practice. Some of these questions can be answered. It is also possible to quantify what the participants have learned during the wokshop. In addition, the tests enable the speakers to improve their way of teaching intravenous anesthesia in future workshops.

References:

1) Reves JG - Lessons on learning about learning curves. Anesthesiology, 2000; 91: 1047-8 

2)Joshi GP, Brenda DJ, MF Roizen et al – Is there a learning curve associated with the use of remifentanil? Anesthesiology, 2000; 91: 1049-55

Acknowledgements: To Dr Gavin Kenny for slides and ideas and ASTRAZENECA laboratories for the economic support.