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Study on training program for anesthesiologists shows challenges of changing doctor behavior

Simulation RAWith the problem of opioid addiction reaching epidemic proportions, anesthesiologists are pushing for greater use of non-narcotic methods of pain control, according to Edward Mariano, MD, an associate professor of anesthesiology, perioperative and pain medicine at Stanford.

One of those methods is ultrasound-guided nerve blocks, which involves using ultrasound to guide a small catheter next to a nerve to deliver pain relieving anesthesia directly to the site of the injury. The method is particularly effective in procedures like the 700,000 knee replacements that are done yearly, and its use has become somewhat commonplace over the past 10 years since it routinely began to be taught to anesthesiology residents, Mariano recently told me. But any anesthesiologist who entered practice prior to 10 years ago probably hasn't received adequate training in the technique.

"I had to learn on my own," said Mariano, which is what most established anesthesiologists end up doing if they use the procedure at all. Mariano set out to research whether teaching this method of pain control to anesthesiologists in a continuing medical education (CME) course using simulation training with mannequins might increase both the doctors' ability to do the procedure and the use of the procedure when the physicians returned to their practice. Current CME courses are available to teach this procedure, but they don't use simulation training with mannequins.

For the study, Mariano and colleagues recruited 32 anesthesiologists who had been in practice for 10 years or more to participate in the trial. During an eight-hour course, the physicians were taught how to use the procedure receiving both hands on training on mannequins and lectures by faculty.

What they found was that 12 of the participants used the method at least once after training - "however, there were no differences in the monthly average number of procedures or complications after the course when compared to baseline."

In Mariano's words: "Within eight hours we could take any anesthesiologist and train them to be proficient in very advanced ultrasound despite the technique being tough to learn. But sadly, even though we can train them in a day, they generally don't change their practice when they go home."

The researchers acknowledge that this was a small study, and the study sample was perhaps too small to draw firm conclusions. But they also point out that plenty of past research has shown just how difficult it can be to change physicians' behavior in general.

"It's very difficult to have an ongoing practice and to do something brand new," Mariano told me. "Not only is there the pressure and time demands of taking care of patients, there is also a natural hesitancy to try new things."

The results of the study appear in the print edition of the Journal of Ultrasound in Medicine this week.

Photo, of co-investigator T. Kyle Harrison, MD, working in simulation lab, by Edward Mariano

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