Abdominal field block: a new approach via the lumbar triangle

Abstract

We conducted a postal survey of audit and continuous educational and professional development (CEPD) arrangements amongst the departments of anaesthesia represented by consultants attending the Twelfth South West Thames Anaesthesia Update Conference , held in Belle Plagne this year. One consultant in each NHS Trust represented was sent a single questionnaire. Eighty questionnaires were distributed and 58 (73%) were completed and returned to us. In addition to identifying the time allocated for CEPD and audit, by type, size and location of hospital (Table 1), we quantified attendance at CEPD and audit meetings and qualified reasons for non-attendance. Of the respondents, 36 represented district general hospitals and 22 worked at teaching or specialist hospitals. Two departments had seven or fewer consultants , 23 had 8±15, 20 had 16±24 and 13 had in excess of 24 consultants. Regular CEPD meetings were held by 41/58 departments (71%). An average of 53.9 h per year were allocated for departmental CEPD (approximately 1 h per week). Such meetings commonly took place during lunch breaks (35/41). The amount of time allocated to CEPD did not depend on the region, the type or the size of hospital. Of the 17 departments that did not have regular departmental CEPD sessions, the most common excuse cited was that clinical work took priority (9/17). Departmental audit meetings were arranged by 45/58 (78%) of departments , commonly rostering a rolling rota of one half-day session per month (25/45). An average of 32 h per year were allocated for audit meetings (approximately 2.5 h per month). Audit invariably took place in morning or afternoon sessions (42/45 departments). Similar to arrangements for CEPD, the time allocated to audit did not vary between the region, the type of hospital or size of the department. Clinical workload was once again cited as the commonest obstruction to the organisation of regular departmental audit meetings (9/13). Generalised audit sessions were organised in 9/45 hospitals, such that all departments held audit sessions simultaneously; attendance at audit in these hospitals always exceeded 50%. All departments participated in either audit or CEPD meetings. Attendance at meetings was less than 30% in 5/58, 30±50% in 20/58 and more than 50% in 33/58 of departments. The General Medical Council has stated [1] that the doctor must both `keep (his/her) knowledge up to date throughout their working life. In particular (s/he) should take part regularly in educational activities which develop (his/her) competence and performance' and`takeand`take part in regular and systematic medical and clinical audit'. The Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland (AAGBI) have issued guidelines concerning regular audit practice and CEPD [2] within anaesthetic departments. The Audit Commission identified that a `value-for-money anaesthetic directorate' links the personal development needs of consultant and juniors to those of the department and the trust and involves trainees and non-consultant career grades in audit [3]. Audit became a contractual obligation for doctors in the early 1990s. It is apparent from our audit that current guidelines are not being universally followed. We acknowledge that we did not enquire after CEPD activity undertaken externally to the anaesthetic department and that in some replies, CEPD was considered synonymous with audit. Nevertheless, approximately 30% of departments did not have formal CEPD meetings, and general attendance was less than 50% in those that did. Absence due to clinical workload was prevalent, despite advice from the Royal College of Anaesthetists and AAGBI [2] that`thethat`the cancellation of operating lists may be required' and`requestsand`requests for exceptions to attendance must be resisted', in order to expedite CEPD. We suspect that CEPD is still viewed as the monotonous pursuit of quantities of CME credits (in order to satisfy putative q 2001