Elsevier

Clinical Nutrition

Volume 27, Issue 3, June 2008, Pages 473-478
Clinical Nutrition

Short report
Fluid and electrolyte balance: The impact of goal directed teaching

https://doi.org/10.1016/j.clnu.2008.03.009Get rights and content

Summary

Background & aims

We aimed 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.

Methods

Surgical trainees attended an interactive lecture-based workshop on fluid and electrolyte balance. Participants had online access to the presentation prior to the training event. They completed a multiple choice question (MCQ) test, derived from topics covered in the presentation, prior to the lecture. The MCQ test was repeated after the lecture to assess retention and application of knowledge. Participants were unaware that they would be tested and provided written feedback on their perceptions of the session.

Results

Thirty-seven trainees from speciality training years 1 and 2 participated in the workshop. There was a significant improvement in mean test scores after the lecture when compared with pre-lecture scores (24.6/30 vs. 19.7/30, p < 0.001). Trainees felt the topic and event were relevant to everyday practice (mean score 4.9/5) and that it would improve their clinical skills (4.5/5).

Conclusions

The provision of a dedicated fluid and electrolyte physiology interactive workshop to postgraduate trainees is a successful way of tackling current inadequacies in training.

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.

References (12)

There are more references available in the full text version of this article.

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