|Year : 2008 | Volume
| Issue : 3 | Page : 297-300
Training and Confidence Level of Junior Anaesthetists in CPR- Experience in A Developing Country
Desalu Ibironke1, O Oyedepo Olanrewaju2, J Olatosi Olutola3
1 Senior Lecturer, Department of Anaesthesia, College of Medicine University of Lagos, Nigeria
2 Consultant, Department of Anaesthesia, University of Ilorin Teaching Hospital, Kwara State, Nigeria
3 Lecturer, Department of Anaesthesia, College of Medicine University of Lagos, Nigeria
|Date of Acceptance||26-Apr-2008|
|Date of Web Publication||19-Mar-2010|
Department of Anaesthesia, College of Medicine, University of Lagos,P.M.B 12003, Lagos
Source of Support: None, Conflict of Interest: None
Training in resuscitation is done worldwide by a dedicated council who is responsible for training and frequent recertification. Nigeria has no Resuscitation council and training is the responsibility of individual health institutions. There is no mandatory law on resuscitation training or recertification. This study sought to investigate how much training in CPR occurs, how effective this training is and how confident our anaesthetic trainees are in implementing present guidelines.
A detailed questionnaire was anonymously filled by trainee anaesthetists who attended a revision course prior to postgraduate examinations. They answered questions on their length of training in anaesthesia, CPR training received, confidence in implementing existing guidelines and suggestions for improvement.
Thirty -six trainees responded. Mean length of anaesthetic training was 3.55 ±2.39 years. 55.6% of trainees had received some CPR training. 75% of this was conducted by their anaesthetic department. Eleven trainees (30.6%) were confident in their ability to perform CPR according to 2005 guidelines, twelve (33.3%) had ever defibrillated a patient and only ten (27.8%) were confident in their ability to interpret ECG
There is low confidence among junior anaesthetists in Nigeria in performance of CPR, poor knowledge of ECG interpretation of cardiac arrest rhythm and little practice in defibrillation. The establishment of a Resuscitation council would ensure adequate and frequent training which would improve knowledge, boost confidence and result in better patient care.
Keywords: Cardiopulmonary resuscitation; Training, Guidelines
|How to cite this article:|
Ibironke D, Olanrewaju O O, Olutola J O. Training and Confidence Level of Junior Anaesthetists in CPR- Experience in A Developing Country. Indian J Anaesth 2008;52:297-300
|How to cite this URL:|
Ibironke D, Olanrewaju O O, Olutola J O. Training and Confidence Level of Junior Anaesthetists in CPR- Experience in A Developing Country. Indian J Anaesth [serial online] 2008 [cited 2020 May 25];52:297-300. Available from: http://www.ijaweb.org/text.asp?2008/52/3/297/60637
| Introduction|| |
Training in Cardiopulmonary resuscitation (CPR) worldwide is predominantly carried out by a resuscitation council. Anaesthetists are in the forefront of cardiac arrest teams and adequate knowledge and skills make them confident and competent in their ability to manage patients in cardiac arrest. The West African sub-region is faced with the problem of inadequate training due to financial constraints and a dearth of teaching personnel. Nigeria has no Resuscitation council and training in resuscitation is not mandatory. An earlier study from Lagos the economic centre of Nigeria demonstrated that anaesthetists were not applying proper guideline in the management of patients in cardiac arrest  . This paper sought to investigate how much teaching of CPR occurs and how confident our trainees are in implementing CPR guidelines.
| Methods|| |
This study was conducted one year after the release of the 2005 Resuscitation guidelines. A structured questionnaire was issued to trainee anaesthetists from teaching hospitals all over Nigeria who attended a revision course as part of their pre-requisite before the Parts 1 and 2 postgraduate examinations. The trainees voluntarily filled in the questionnaire anonymously. Most of the questions were yes/no based. Questions involving suggestions for improvement were left as open ended responses.
The grade of the respondents and the length of anaesthetic training were documented. The trainees filled the questionnaire in 3 main parts -
Data collected was analysed with Statistical Package for Social Studies (SPSS® 10.1 Inc. Chicago, Illinois). Numerical data was expressed as mean ± standard deviation (SD). All categorical data were expressed as frequency tables. A P value of < 0.05 was considered statistically significant.
- Questions relating to CPR training received.
- Questions relating to confidence in ability to perform CPR.
- Questions relating to suggestions for improvement.
| Results|| |
Thirty-six anaesthetists responded (response rate of 90%). The mean length of anaesthetic training was 3.55 ± 2.39 years (Range 0.3 - 10 yrs). The grade of respondents were Senior House Officer, within the first year of training 3 (8.3%), Registrar, after success in primary examination 20 (55.6%) and senior registrar; at least 2 ½ years of training 13 (36.1%) [Table 1].
Twenty respondents (55.6%) had received some form of CPR training, 75% of these were organized by their anaesthetic department, 10% during hospital grand round and 5% each by the postgraduate college, regional anaesthetic society and an international association respectively. Only one trainee (2.8%) had an internationally recognized certification. The last training attended by respondents was held at a mean time of 23.63 ± 5.76 months previously. The length of training ranged from 1 hour - 3 days. CPR training included demonstrations in 85% of cases, practice on manikins in 45% and training films in 45%.
Twenty-six trainees (72.2%) were confident in their ability to perform CPR, 7 (19.5%) were not and 3 (8.3%) were unsure. When further questioned as to their ability in performing CPR according to current guidelines, only 11 (30.6%) were confident of this. Only 12 trainees (33.3%) had ever defibrillated a patient and they were confident in their ability to do so. Ten respondents (27.8%) expressed confidence in interpreting ECG, 14 (38.9%) were not and 12 (33.3%) were unsure. Majority of trainees (94.4%) were confident of their airway management skills [Figure 1]. The grade of the trainee was significant in their confidence in performing CPR (P=0.047)
Fifty percent of trainees indicated that the department of anaesthesia was responsible for CPR training in their hospital.
Twelve trainees (33.3%) correctly stated that new guidelines were introduced in 2005, 4 (11.2%) gave an incorrect answer, 3 (8.3%) indicated that they were unsure while 17(47.2%) did not respond. Only one trainee could list 5 correct guideline changes while 6 trainees (16.7%) were unable to list any.
Over 70% of the trainees felt that improved aids for CPR training and practice would bolster their confidence and that training should be made mandatory for all health personnel and re-training done more frequently.
| Discussion|| |
This study demonstrated that the confidence of anaesthetic trainees in their ability to perform CPR in Nigeria (a developing country) is low. An earlier study had shown that anaesthetists in this sub-region adhered poorly to current resuscitation guidelines 2 . One of the reasons proffered was inadequate training which is likely to have led to this lack of confidence observed within the anaesthetic trainee cadre.
We have demonstrated that indeed training in resuscitation in Nigeria is inadequate. Barely 50% of respondents had received formal training which was given almost 2 years prior to our study and the length of training was short. As we have no Resuscitation council of our own, most training is left to individual anaesthetic departments. It is recommended that training should be conducted by facilitators with skills in training and resuscitation and experience in the learner's primary occupational roles  . The consensus is that training should be repeated frequently as knowledge and skills deteriorate with time. Hands-on practice with simulators is known to improve perceived ability to prioritise tasks and gain confidence  but these computeraided technology is expensive. With the added burden of financial constraints, training materials are not readily available thus a fair percentage of training in our study involved demonstrations only.
Although majority of trainee anaesthetists (72%) were confident in their ability to perform CPR, further questioning as to their ability to perform CPR according to current guidelines was very low and only one trainee could list 5 correct guideline changes. This poor level of awareness can be traced to the irregular and non standardization of training in our environment. .In Europe, it is recommended that residents are given regular mandatory hands-on ALS training frequently, preferably using European oriented guidelines  . Some researchers have demonstrated that anaesthetists who had attended ACLS training obtained better scores than those who had not during resuscitation simulation exercise  yet others have shown that neither the seniority of anaesthetists nor their post graduate qualifications correlated with their performance level during CPR  .A deteriorating knowledge of CPR with increasing seniority has been reported as junior doctors are more likely to commit the guidelines to heart because of examinations, while consultants are poor at maintaining and re-certifying their advanced resuscitation skills , .Though all our respondents were trainees preparing for postgraduate examinations, those with longer training in anaesthesia exhibited more confidence in performing CPR.
Competence in the management of CPR requires a broad range of skills, from diagnosis of cardiopulmonary arrest, knowledge of ECG interpretation and the use of electrical defibrillator.
From this study we found that the knowledge of interpretation of ECG among trainee anaesthetists was generally poor and few trainees had ever defibrillated a patient or were confident in their ability to do so. These combined deficiencies would lead to a delay in diagnosis and prompt defibrillation if required. As early defibrillation is the single most important determinant of survival from cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) this deficiency would adversely influence patient outcome .A report by Desalu et al  carried out in the same environment showed that none of the cardiac arrest victims who were defibrillated survived. One reason for their non-survival was attributed to difficulty in rhythm recognition due to poor knowledge on ECG interpretation resulting in delay in defibrillation. This deficiency should encourage the use of Automated External Defibrillators (AED) which do not require knowledge in ECG interpretation while steps are taken to ensure adequate training in rhythm recognition. Proficiency in the use of AED has been documented to have improved after only one hour condensed training programme  .Confidence in airway management among resident anaesthetists was high as expected.
In conclusion our study revealed low confidence among anaesthesia trainees in Nigeria in performance of CPR, poor knowledge of ECG interpretation of cardiac arrest rhythms and little practice in defibrillation. This has stemmed from inadequate resuscitation training. The Resuscitation council being proposed should urgently be put into place and the assistance of other well established programmes should be sought especially in the area of training materials and facilitators. Other developing countries have established training links with established programmes with good results  Training in CPR should be made mandatory for all medical and nursing personnel to improve their knowledge and confidence and most importantly, patient outcome.
| References|| |
|1.||Soyannwo OA, Elegbe EO. Anaesthetic manpower development in West Africa. Afr J Med med Sci 1999; 28:163-165. [PUBMED] |
|2.||Desalu I, Kushimo O, Akinlaja O . Adherence to CPR guidelines during perioperative cardiac arrest in a developing country. Resuscitaion 2006; 69: 517 - 520. |
|3.||Chamberlain DA. Education in resuscitation. Resuscitation 2003; 59:11-43. |
|4.||Niemi-Murola L, Makinen M, Castren M : ECCE Study group. Medical and Nursing students' attitudes toward cardiopulmonary resuscitation and current practice guidelines. Resuscitation 2007; 72 : 257-263. |
|5.||European Resuscitation Council. Guidelines for basic advanced life support. Resuscitation 1992; 24: 103-123. [PUBMED] |
|6.||Kurrek MM, Devitt JH, Cohen M Cardiac arrest in the OR: how are our ACLS skills Can J Anaesth 1998; 45: 130-2. |
|7.||Bell JH. Resuscitation skills of trainee anaesthetists. Anaesthesia 1995;50:694-6. |
|8.||Cook B. Resuscitation skills of trainee anaesthetists (Corresp). Anaesthesia 1995; 50: 1094. [PUBMED] |
|9.||Broster S, Cornwell L, Kaptoge S, Kelsall W. Review of resuscitation training amongst consultants and middle grade paediatricians. Resuscitation 2007; Apr 27: (Epub before print). |
|10.||Kelley J, Richman PB, Ewy GA, Clark L, Bolloch B, Bobrow BJ. Eighth grade students become proficient at CPR and use of an AED following a condensed training programme. Resuscitation 2006; 71: 229-236. |
|11.||Kelly A, Hunyadi-Anticevic S, Hew R. Emergency medicine training for Croatia: A Croatia-Australia partnership. Resuscitation 2007; 72: 252-256. |