Short reportFluid and electrolyte balance: The impact of goal directed teaching
Introduction
Despite having been given little instruction on the subject at medical school1, 2 and after commencing work,1, 2, 3 inexperienced junior surgical doctors are responsible for over 80% of perioperative fluid prescriptions.1, 2, 3, 4, 5 A survey published by us in 2001, revealed that although most junior trainees were reasonably confident in their ability to prescribe fluids, their level of knowledge did not seem to justify this confidence.1 Furthermore, there was no difference in knowledge between trainees in the early or later part of their training, indicating a failure to learn from experience and/or a lack of in-service training in this subject.1
The dangers and consequences of inappropriate fluid and electrolyte management have been highlighted previously.4, 5, 6, 7, 8, 9, 10, 11 A multifaceted approach to tackle current deficiencies in knowledge on fluid and electrolyte therapy should include the provision of validated educational opportunities. Therefore, the aims of this study were to determine if a structured workshop on fluid and electrolyte balance for junior surgical trainees led to an improvement in knowledge on the subject and to evaluate the perceived helpfulness of such a workshop.
Section snippets
Setting
This study took place in a University Teaching Hospital in the United Kingdom.
Participants
Junior surgical trainees working in general surgery, orthopaedics, ENT, urology and spinal surgery participated in a teaching workshop organised as part of the Surgical Training Programme of the East-Midlands Deanery.
Interventions
Participants attended an interactive lecture-based workshop on fluid and electrolyte balance and related aspects of critical care. Participants had online access to the presentation prior to the training
Results
Thirty-seven trainees participated in the workshop. Participants comprised speciality trainees years 1 and 2 (ST1 and 2) which are the equivalent of training grades 3 and 4 years after graduating from medical school, respectively. There were 17 (46%) ST1 trainees and 20 (54%) ST2 trainees. Twenty-six (70%) trainees worked at university teaching hospitals and the remainder worked in district general hospitals located within the region.
There was a statistically significant improvement in test
Discussion
The 1999 UK National Confidential Enquiry into Perioperative Deaths (NCEPOD) report recorded that 20% of the patients sampled had either poor documentation of fluid balance or had unrecognised/untreated fluid imbalance and that this could contribute to serious postoperative morbidity and mortality.7 A more recent prospective audit of perioperative fluid management found that 55.6% of patients who had intravenous hydration following laparotomy developed at least one-fluid related complication.4
Conflict of interest statement
None declared.
Acknowledgements
The authors thank Mona Awad for marking the MCQ papers.
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The pathophysiology of fluid and electrolyte balance in the older adult surgical patient
2014, Clinical NutritionCitation Excerpt :If perioperative optimisation of fluid and electrolyte balance is to be achieved, doctors need to be well informed and, therefore, empowered to make accurate decisions on fluid prescription. This was shown to be achievable through the provision of a dedicated fluid and electrolyte physiology interactive workshop and maybe useful in tackling current gaps in knowledge and training.119 The ageing population has increased in recent years due to advances in medical care.
Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a fast track program
2012, Journal of Surgical ResearchCitation Excerpt :Measures to minimize a preoperative hypovolemic state by reducing preoperative fasting to a minimum for example, or avoiding perioperative hypovolemia seem necessary in FT programs [3, 5, 10, 23]. Alternatively to a stringent fluid regime, some groups propagate a goal directed plasma volume expanding fluid administration controlled by esophagus Doppler or pulse contour analyzed cardiac index [6, 7, 34, 35]. However, its clinical applicability is demanding and the benefit of these work-intensive algorithms and invasive tools compared with simple dogmatic restrictive crystalloid based fluid regimes in colonic surgery has not been shown yet.
Peri-operative fluid and electrolyte management: Undergraduate preparation and awareness
2011, e-SPENCitation Excerpt :In particular, recent years have seen a recognition of this evidence base in a Zeitgeist advocating balanced crystalloids,2,6 a message which does not seem to have reached the student community. Inadequate undergraduate preparation for this role has been suggested as a causative factor,4,8 our findings have quantified this and identified an opportunity for intervention. Thus far such interventions have focussed on those newly qualified doctors.
Knowledge and attitudes of surgical trainees towards nutritional support: Food for thought
2010, Clinical NutritionCitation Excerpt :The need for validated educational programs8,10 is even more pressing given that there was little difference in knowledge between trainees in the early and later part of their training, possibly reflecting a failure to learn from experience and/or a lack of in-service training in this subject. Workshops dedicated to teaching the principles of nutritional support and management may be a useful method to address these deficiencies10,14 and there is evidence that the provision of nutritional educational programs and guidelines leads to improved nutritional practice.7,8,15,16 Although the number of trainees sampled was small, they did represent a broad spectrum of trainees at differing stages of their training and the sample may be viewed as representative of a regional surgical training programme.