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J Intensive Care Soc. 2018 Feb;19(1):26-34. doi: 10.1177/1751143717728631. Epub 2017 Sep 6.

'It's learned on the job and it depends who you're with.' An observational qualitative study of how internal jugular cannulation is taught and learned.

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1Lancaster Medical School, Lancaster University, UK.
2Department of Sociology and Centre for Science Studies, Lancaster University, UK.
Anaesthetic Department, Royal Lancaster Infirmary, UK.


Internal jugular cannulation may lead to serious complications. Ultrasound guidance is advocated; however, procedural complications remain a concern. Inconsistent education may be in part responsible for this. This study examined how internal jugular cannulation is taught and learned. An ethnographic approach was used in two acute hospitals. Methods comprised interviews, observations and focus groups. An inductive thematic analysis was undertaken. Three themes were identified: apprenticeship, trust and reciprocity. In apprenticeship, a new form of apprenticeship learning, necessitated by the structure of training is described. In trust the strategies by which trainers assess trainees' competence in order to allow them to gain experience is explored. In reciprocity the beneficial influence of trainees is illustrated. This study demonstrates how high-stakes procedures are learned. It provides insights into under-investigated topics such as the use of 'permitted mistakes' to stimulate reflection and the role played by trainees in promoting good practice.


Internal jugular cannulation; apprenticeship; medical education; patient safety; ultrasound

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