Development and Validation of Metrics Lumbar Labor Epidural Catheter Placement
Condition: Labor Pain
MeSH terms: Labor Pain
Study type: Observational

Summary: 
      Procedural skills play an important role in anaesthetic expertise. More focused training and
      assessment of procedural skills will be needed in the future as training moves from an
      apprenticeship based training system to competency based assessment.

      Currently various techniques exists to assess procedural skills of anaesthetist. For epidural
      catheter placement, task specific check list, global rating scales and cumulative sum
      techniques have been developed and validated. These techniques aim either for better
      qualitative outcome sacrificing objectivity or rely on self-reporting. A decrease in
      objectivity in turn hampers inter-rater reliability which is an essential component of a
      valid assessment model. Checklists type assessments force the developer to comprehensively
      characterize the procedure of interest and then validate the completed procedure
      characterization. This approach has been quantitatively shown to have higher assessment
      reliability levels compared to Likert-scale assessment.

      The objective of the project is to develop and validate a comprehensive procedure
      characterization for labor epidural catheter placement. Another objective is to compare this
      new assessment tool with existing checklist and global rating scale for labor epidural to
      establish concurrent validity.5 A well-developed objective, validated procedure
      characterization serves as a master tool which has multiple applications. It helps to build a
      training programme for the procedure, allows providing metrics based feedback to trainees
      using simulator, helps to assess the performance of trainees and in future might be used as
      benchmark to allow competency based progression in the training.
    

Detailed description: 
      Study part 1 After ethics committee approval a group of experts (n = 3 ) in conventional
      lumbar epidural catheter placement will be selected (an expert is defined as one who has
      performed more than 500 labor epidurals in preceding 5 year period). During a number of
      face-to-face meetings experts will identify, characterize and define the procedure. They will
      analyze task and identify units of behavior to be measured which constitute in a step-wise
      fashion how the procedure is optimally performed and deviations from optimal procedure
      performance as described previously. After informed consent from the patient and the
      anaesthetist performing the procedure, 2 video recordings of experts performing epidural and
      2 video recordings of novices (defined as one who has done less than 50 epidurals) performing
      epidural will be recorded for detailed review during metric development meetings.

      Study part 2 The developed metrics will be subjected to assessments of construct validity (a
      set of procedures for evaluating a testing instrument based on a degree to which the test
      terms identify the quality, ability or trait it was designed to measure) and concurrent
      validity (the evaluation in which the relationship between the test scores and the scores on
      the another instrument purporting to measure the same construct are related). We will also
      evaluated the inter-rater reliability of the metrics using i) proportion of agreement between
      raters, ii) correlation strength (using Pearson's Correlation Coefficient) and iii)
      Coefficient Alpha. After informed consent,10 experts (who are not a part of committee
      developing the metrics) each performing one or more lumbar epidural catheter placements for
      labor and 10 novices each performing one or more lumbar epidural catheter placements for
      labor will be video recorded. Two experts will review the video recording and score the
      performance based on checklist based system developed and compare with likert-scale
      checklists/global rating scale system.
    

Intervention name(s): Video validation
Intervention type(s): Other
Intervention description(s): Video taping of anaesthetist (experts and novices) perfoming labor epidural.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Expertes and novice anaesthetist perfoming labor epidural analgesia
      
Keywords: labor,epidural,analgesia