[Development of a competence catalogue for physicians in training for curriculum creation with respect to delivery room training]. / Entwicklung eines Kompetenzkatalogs für Ärzt:Innen in Weiterbildung zur Curriculumerstellung für die Kreißsaaleinarbeitung.

BACKGROUND: Anesthesiologic expertise is used at various points in the delivery room. The natural turnover of professionals requires continuous education and training for patient care. In a first survey among consultants and trainees, the desire for a delivery room-specific anesthesiologic curriculum has emerged. In order to enable a curriculum with decreasing supervision, a competence-oriented catalogue is used in many medical fields. The gain in competence develops gradually. The participation of practitioners should be obligatory to avoid a differentiation between theory and practice. The structural framework of curriculum development by Kern et al. provides the learning objective analysis after further evaluation. In the sense of specific learning objective definition, the present study aims to describe the competences for anesthetists in the delivery room. METHODS: An expert group (active in the anesthesiology delivery room environment) developed a set of items via a two-step online Delphi survey. The experts were recruited from the German Society for Anesthesiology and Intensive Care Medicine (DGAI). We evaluated the resulting parameters for relevance and validity in a larger collective. Lastly, we used factorial analyses to identify factors that could be used to group items into relevant scales. In total, 201 participants took part in the final validation survey. RESULTS: During the prioritization process of Delphi analyses, competencies such as neonatal care were not followed up. Not all items developed are exclusively delivery room-related, such as managing a difficult airway. Other items are specific to the environment of obstetrics. One example is integration of spinal anesthesia into the obstetric context. Some items are exclusively related to the delivery room, such as in-house standards of care in obstetrics as a basic skill. After validation, a competence catalogue with 8 scales with a total of 44 competence items resulted (Kayser-Meyer-Olkin criterion 0.88). CONCLUSION: A catalogue of relevant learning objectives for anesthetists in training could be developed. It specifies the generally required content of anesthesiologic training in Germany. Specific patient groups, such as patients with congenital heart defects, are not mapped. Competencies that could also be learned outside the delivery room, should be learned before the rotation. This enables the focus on the delivery room items, especially for those to be trained who do not work in a hospital with obstetrics. The catalogue needs to be revised for completeness for its own working environment. Particularly in hospitals that do not have a pediatrician available, neonatal care becomes significant. Didactic methods, such as entrustable professional activities, have to be tested and evaluated. These enable competence-based learning with decreasing supervision and reflect the reality in hospitals. As not every clinic can provide the necessary resources for this a nationwide provision of documents would be helpful.

[Analyses of requirements for curriculum development for the training of anesthesiologists in the delivery room-A nationwide survey]. / Bedarfsanalyse zur Curriculumsentwicklung für die anästhesiologische Kreißsaalversorgung ­ eine deutschlandweite Umfrage.

BACKGROUND: Anesthesiologic activity in the delivery room environment implies the specifics of a 200% lethality, which describes that emergency situations can affect mother and child. A circumstance that impressively underlines the need for special care in employee training and selection. The training situation in the delivery room is characterized by several difficulties. Technical procedures are often performed on the awake patient, who is herself in an exciting situation during childbirth. A detailed description of the necessary competences in this working environment does not exist at the present. The present study aims to describe the further education situation in anesthesiology. The results can represent the first step of a curriculum development according to the concept of Kern et al. in the sense of a needs assessment. MATERIAL AND METHODS: In a multicenter observational study, doctors in further training (AiW) and consultants (FÄ) were asked about methods of familiarization, feedback, activities taken on and the need for a curriculum. The level of supervision and confidence in action during procedures was also elicited. Participants were contacted via the membership database of the German Society of Anesthesia and Intensive Care and could answer the 11-item questionnaire online. RESULTS: A total of 495 questionnaires (329 FÄ; 166 AiW;) were completed. The FÄ and AiW gave different information on the conduct of exit interviews (59.6% vs. 10%) and curriculum support (76.3% vs.17.5%). Independent of the year of training, AiWs perform cesarean sections under on-demand (reactive) supervision. Peridural anesthesia (PDA) is the least frequently performed procedure in the context of the familiarization situation with obstetric anesthesia. The groups have a different confidence of security in the successful implementation of procedures, when AiW are proceeding without direct supervision (FÄ = MD 61; AiW = MD 77; p < 0.001; scale 0 = unsecure-100 = very secure). Practical and technical support is mostly provided immediately by FÄ (> MW 91; scale 0 = never-100 = immediately). Individual values deviate significantly from the average values (outliers). Both groups rate the usefulness or value of describing learning objectives and the availability of a curriculum as high. DISCUSSION: The support of familiarization and continuing support is partly answered differently by consultants and doctors in further training. Individual procedures that are rarely performed, such as administration of a PDA, require special attention in the future. Curricula with workplace-based assessments could provide feedback and assurance to increase confidence in the successful implementation of procedures by AiW. The AiW usually receive immediate professional support. Individual institutions do not seem to have any concepts here and must rethink their processes. This fact is particularly important against the background of the medicolegal significance of the subject. The description of learning objectives and curriculum development is desired both by FÄ and AiW.