Obstetrics is a high risk specialty with high negligence claims payments in the NHS. The introduction of the European Working Time Directive (EWTD) and the breakdown of the traditional ?firm? structure has meant that contact time between consultants and their trainees is falling, and young doctors run the risk of losing valuable experience gained from being mentored by senior staff.
New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology proposes the use of statistical process control (SPC) charts to monitor and audit doctors? performance, as part of the revalidation process.
SPC detects changes in performance patterns based on the frequency of training in a specific procedure set against an expected failure rate, and warning and action limits. Immediate action can be taken once a failure pattern is observed thereby preventing further damage being caused.
The competencies of sixteen doctors in amniocentesis and ventouse delivery at the Liverpool Women?s Hospital Fetal Centre were retrospectively analysed in the study over a period of a year.
Researchers found that once expected failure rates were established, and performance was charted, doctors operating below acceptable success rates could be easily discerned.
Once under-performing doctors were identified, extra training and supervision should be provided to help doctors improve their skills and confidence levels.
Researcher Dr Andrew Weeks, Senior Lecturer in Obstetrics at University of Liverpool, said ?In Liverpool Women?s Hospital, we have been giving doctors individualised feedback on their complication rates for ventouse and forceps for the last 3 years. The doctors have found it useful to get this information, and over that time, we have seen a significant decrease in the number of failed deliveries. ?
?As a junior doctor, you used to be able to rely on the head of your ?firm? to give you detailed feedback. With the increasing fragmentation of care and shift work, it can be difficult to get good quality feedback on your performance. Using SPS charts allows trainees to accurately identify areas of strength and weakness within their clinical workload.?
Professor Philip Steer, BJOG editor-in-chief, said ?The monitoring of doctors? performance via SPC acts as an early warning system that spots if mistakes are being repeated over a number of procedures carried out.?
?Indeed, SPC could be used as a valuable tool in the continuous professional development of doctors. The strength of such a monitoring system is three-fold: we are able to pick out doctors who are poorly-performing, provide them with the support they need to improve their skills and prevent accidents from occurring in the future.?