Abstract:
This thesis aims to explore how anaesthesia is taught at the undergraduate level and to evaluate the impact of anaesthesia teaching on career intentions and future practice as junior doctors. The research was made up of several component studies; surveys of three academic/professional groups (all fourth-year medical students, two cohorts of preregistration house officers, and consultant anaesthetists in university teaching hospitals), focus group interviews with medical students, medical student logbook analysis, review of the current teaching programme for anaesthesia at the University of Auckland, and review of data held by the University of Auckland Tracking Project. Current teaching is relatively unstructured, particularly in intensive care medicine, at times adversely affecting the learning experience of medical students. There is overlap in teaching and assessment of perioperative medicine topics between different academic departments. Certain aspects of in-theatre teaching differ significantly between the teaching hospitals. Moderately senior consultants (2-10 years’ experience as a consultant) are significantly less enthusiastic about supervising medical students compared to their more senior counterparts (p < 0.001). Students in focus group interviews cite different examples of ideal and unfavourable teaching practices that were observed during the anaesthesia attachment. The number of tracheal intubations performed during medical school (mean 3.3 ± 2.4) is insufficient to achieve adequate competency. Preregistration house officers include knowledge of the following topics as being directly attributable to the anaesthesia attachment: anaesthesia drugs (28.2% of respondents), pain management (15.4%), and pre-anaesthetic assessment (10.9%), postoperative nausea and vomiting (4.5%), IV fluid management (4.5%), and recognition and management of acutely unwell patients (1.9%). Interest in anaesthesia as a career rises significantly immediately after the anaesthesia attachment (p < 0.001). Popularity of the specialty rises during medical school and again after graduation, during the preregistration house officer year. Students who participated in additional clinical attachments in anaesthesia during medical school were significantly more likely to rank anaesthesia as their first career choice (p = 0.021). Undergraduate medical education in anaesthesia should encompass perioperative medicine, pain management, resuscitation and airway management. When teaching airway management, emphasis should be placed on learning bag-mask ventilation and laryngeal mask insertion.