PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 12834424

Passing on tacit knowledge in anaesthesia: a qualitative study.

Catherine Pope·Andrew Smith·Dawn Goodwin·Maggie Mort
View original source ↗Export metadata ↓

Abstract

OBJECTIVE: To explore the acquisition of knowledge in anaesthetic practice using qualitative methods. METHODS: An ethnographic study examining the nature of expertise in anaesthesia in one English hospital. The study used qualitative research methods, including observation of anaesthetic practice and interviews with members of the anaesthetic team. An integral part of the study was a process of feedback to the anaesthetic team including presenting observational data and conducting debriefing interviews with individual team members. RESULTS: The study highlights the continued importance of the clinical apprenticeship in passing on knowledge, but also emphasizes the central role of practising independently in the acquisition of skills. Anaesthetists who participated in debriefing interviews or read observational transcripts found the experience valuable for thinking about their own practice. DISCUSSION: One suggestion arising from the use of qualitative methods in this setting is that the type of detailed, systematic observation and data recording used in this study could be beneficial in the training and, possibly, appraisal of anaesthetists. This novel and innovative application of qualitative methods in anaesthesia is described and discussed with a view to broadening the debate about specialist training.

Explore related subjects

AnesthesiaClinical CompetenceEducation, MedicalEnglandHealth Services ResearchHospitals, DistrictHumansQualitative ResearchResearch DesignJournal ArticleResearch Support, Non-U.S. Gov't

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Catherine Pope, Andrew Smith, Dawn Goodwin, Maggie Mort. 2003. Passing on tacit knowledge in anaesthesia: a qualitative study.. https://doi.org/10.1046/j.1365-2923.2003.01581.x

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Increase in exhaled nitric oxide and protective role of the nitric oxide system in experimental pulmonary embolism.

BACKGROUND AND PURPOSE: Pulmonary embolism (PE) represents a real diagnostic challenge. PE is associated with pulmonary hypertension due to pulmonary vascular obstruction and vasoconstriction. We recently reported that pulmonary gas embolism transiently increases exhaled nitric oxide (FENO), but it is not known whether solid emboli may alter FENO, and whether an intact endogenous NO synthesis has a beneficial effect in experimental solid pulmonary embolism. EXPERIMENTAL APPROACH: We used anaesthetised and ventilated rabbits in these experiments. To mimic PE, a single intravenous infusion of homogenized autologous skeletal muscle tissue (MPE) was given to rabbits with intact NO production (MPE of 60, 15, or 7.5 mg kg(-1); group 1) and to another group (group 2) with inhibited NO synthesis (L-NAME 30 mg kg(-1); MPE of 7.5, 15 or 30 mg kg(-1)). KEY RESULTS: In group 1, after MPE, FENO increased rapidly and dose-dependently and FENO was still significantly elevated after 60 min with the two highest emboli doses. All these animals survived more than 60 min after embolization. In group 2, MPE of 7.5, 15 and 30 mg kg(-1), in combination with NO synthesis inhibition, resulted in 67%, 50% and 25% survival at 60 min respectively, representing a statistically significant decrease in survival. Cardiovascular and blood-gas changes after MPE were intensified by pre-treatment with NO synthesis inhibitor. CONCLUSIONS AND IMPLICATIONS: We conclude that solid PE causes a sustained, dose-dependent increase in FENO, giving FENO a diagnostic potential in PE. Furthermore, intact NO production appears critical for tolerance to acute PE.

Anesthesia↗
PubMed2007

Evaluation of a laryngoscope and a rigid endoscope for the examination of the oral cavity of small mammals.

The oral cavities of 65 rabbits, 35 chinchillas, 38 guinea pigs, 19 degus and 13 prairie dogs suffering from a lack of appetite, hypersalivation, moist dermatitis, swelling of the lower jaw or mild exophthalmos were examined with a paediatric laryngoscope and rigid endoscope. The laryngoscope was safe and satisfactory for a preliminary examination, but changes in the less accessible caudal parts of the cavity could not be identified precisely. A rigid endoscope with 30 degrees optics made it possible to examine all parts of the oral cavity and oropharynx, and make detailed observations of surface lesions on the premolar and molar teeth and the mucosal surface of the gingiva, tongue and hard palate; endoscopy with 70 degrees optics provided an excellent view of the occlusal tooth surfaces, tooth crowns, and buccal mucosa. The collection of biopsy samples, the removal of foreign objects and the correction of malocclusions were greatly simplified by the use of the endoscope owing to the clear visualisation of the procedures, and the risk of injury was minimised. The examinations with a laryngoscope were made effectively on animals that were manually restrained, but a thorough examination with a rigid endoscope required the animals to be anaesthetised.

Anesthesia↗
PubMed2007

Perioperative management of familial dysautonomia: a systematic review.

BACKGROUND AND OBJECTIVE: Familial dysautonomia (FD), a rare genetic disorder, is characterized by autonomic instability, pulmonary infections, oesophageal dysmotility, spinal abnormalities and episodic "dysautonomic crisis" characterized by rash, vomiting, sweating and hypertension. Frequent anaesthetic complications have been reported. METHODS: We performed a comprehensive literature search of perioperative management of FD using an OVID-based search strategy. Identified reports were reviewed to identify perioperative complications as well as anaesthetic techniques and perioperative management strategies developed to minimize or prevent these complications. RESULTS: Eighteen case reports or series of perioperative management of FD were identified in the literature for a total of 179 patients undergoing 290 anaesthetics. Intraoperative cardiovascular lability, including cardiac arrests and postoperative pulmonary complications were commonly reported. Preoperative hydration, minimizing the use of volatile anaesthetic agents, postoperative ventilation, use of regional anaesthesia and minimally invasive surgical techniques reduced the incidence of these complications. CONCLUSIONS: While patients with FD are reported to have a relatively high rate of various perioperative complications, a full understanding of its pathophysiology can be used to develop a perioperative management strategy to anticipate and prevent many of these complications.

Anesthesia↗