oa Southern African Journal of Anaesthesia and Analgesia - The development of a scoring tool for the measurement of performance in managing hypotension and intra-operative cardiac arrest during spinal anaesthesia for caesarean section : research



At level one hospitals in South Africa a high annual number of maternal deaths occur due to the unrecognised/ untreated complications of spinal anaesthesia. The authors developed a clinical scenario and scoring system to measure intern performance in managing hypotension and cardiac arrest during spinal anaesthesia for caesarean section on a human patient simulator. This system was then subjected to tests of validity and reliability.

The simulator-based clinical scenario was developed by two specialist anaesthesiologists. A modified Delphi technique was used to achieve consensus among 10 anaesthetic specialists regarding a standardised scoring system. A total of 20 medical officers with a Diploma in Anaesthesiology and 20 interns completed the scenario and were scored by two senior anaesthesiologists.
Medical officers scored an average of 252 and 246 points, whereas interns scored an average of 216 and 215 points ( = 0.005 and = 0.013, respectively). The scoring instrument demonstrated high inter-assessor reliability with an intra-class correlation coefficient of 0.983.
The scoring tool was shown to be valid and reliable. It offers a standardised assessment process and may be used to refine institutional intern training programmes, with a view to improving anaesthesia skills in community service medical officers.


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