Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation based training

Silverio, SA ORCID: 0000-0001-7177-3471, Wallace, H, Gauntlett, W, Berwick, R, Mercer, S, Morton, B, Rogers, SN, Sandars, JE, Groom, P and Brown, JM (2021) Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation based training. PLoS ONE, 16 (3). ISSN 1932-6203

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Abstract

The time-critical 'can't intubate, can't oxygenate' [CICO] emergency post-induction of anaesthesia is rare, but one which, should it occur, requires Anaesthetists to perform rapid emergency front of neck access [FONA] to the trachea, restoring oxygenation, and preventing death or brain hypoxia. The UK Difficult Airway Society [DAS] has directed all Anaesthetists to be trained with surgical cricothyroidotomy [SCT] as the primary emergency FONA method, sometimes referred to as 'Cric' as a shorthand. We present a longitudinal analysis using a classical approach to Grounded Theory methodology of ten Specialist Trainee Anaesthetists' data during a 6-month training programme delivered jointly by Anaesthetists and Surgeons. We identified with a critical realist ontology and an objectivist epistemology meaning data interpretation was driven by participants' narratives and accepted as true accounts of their experience. Our theory comprises three themes: 'Identity as an Anaesthetist'; 'The Role of a Temporary Surgeon'; and 'Training to Reconcile Identities', whereby training facilitated the psychological transition from a 'bloodless Doctor' (Anaesthetist) to becoming a 'temporary Surgeon'. The training programme enabled Specialist Trainees to move between the role of control and responsibility (Identity as an Anaesthetist), through self-described 'failure' and into a role of uncertainty about one's own confidence and competence (The Role of a Temporary Surgeon), and then return to the Anaesthetist's role once the airway had been established. Understanding the complexity of an intervention and providing a better insight into the training needs of Anaesthetic trainees, via a Grounded Theory approach, allows us to evaluate training programmes against the recognised technical and non-technical needs of those being trained.

Item Type:	Article
Uncontrolled Keywords:	Humans; Longitudinal Studies; Intubation, Intratracheal; Anesthesiology; Adult; Emergency Service, Hospital; Female; Male; Grounded Theory; Simulation Training; Anesthesiologists; Adult; Anesthesiologists; Anesthesiology; Emergency Service, Hospital; Female; Grounded Theory; Humans; Intubation, Intratracheal; Longitudinal Studies; Male; Simulation Training; General Science & Technology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Psychology (from Sep 2019)
Publisher:	PLos ONE
Date of acceptance:	11 March 2021
Date of first compliant Open Access:	5 December 2022
Date Deposited:	05 Dec 2022 16:30
Last Modified:	05 Jul 2025 12:00
DOI or ID number:	10.1371/journal.pone.0249070
URI:	https://researchonline.ljmu.ac.uk/id/eprint/18290

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