Effect of a Patient Education Strategy on Resident Self-Efficacy and Maternal Outcomes (EDUCATE Study)

Abstract

Background – Patient education improves treatment plan compliance and outcomes. For anesthesiology residents, patient communication is highlighted on the obstetric subspecialty rotation. However, the clinical effectiveness of patient education on patient-controlled epidural analgesia (PCEA) dose requirements is unknown. We hypothesized that patients receiving care by residents who are formally instructed on patient education for PCEA, will have lower total local anesthetic consumption and higher satisfaction. Methods – A prospective, interrupted time series design was chosen. Residents participated in one of two sessions at the beginning of their two-month obstetric anesthesia rotation: 1) Education (E): residents taught how to educate patients on PCEA, followed by instructor-resident practice implementing a “teach-back” method for patient comprehension; 2) Control (C): no formal instruction on PCEA. Confidence in patient education was assessed at baseline and at the rotation end. The first 15–30 patients cared for by each resident after initiating epidural labor analgesia and PCEA were followed. Patient-level data included: total local anesthetic dose during labor, comprehension of PCEA goals, and satisfaction with childbirth experience using a validated questionnaire. The primary outcome was total local anesthetic medication consumed during labor. Results – A total of 285 patients (118 cared for by residents in Group E, 167 cared for by residents in Group C) were included. Local anesthetic dose consumption was similar between groups (Group E: mean bupivacaine dose (mg), 96.4 ± 58.2 vs. Group C: 105.4 ± 64.1, P = 0.23). Patient comprehension for PCEA goals and patient satisfaction with their childbirth experience were similar between groups. Residents in group E felt more comfortable teaching PCEA to patients by the end of their rotation (Group E self-efficacy scores: pre-rotation, 45.7 ± 7.5 v. post-rotation, 88.0 ± 9.2, P = 0.002). Conclusions – A resident teaching intervention to improve skills in patient education for PCEA did not reduce drug consumption or improve patient satisfaction, but educated residents felt more comfortable teaching patients by the end of their rotation. Teaching methods for patient education that improve not only clinician self-efficacy, but also clinical outcomes at the patient level, should be identified.