Intraoperative monitoring is a critical component of patient safety and successful surgical outcomes. It involves the continuous assessment of a patient's physiological parameters during surgery, providing real-time data that guide anesthetic management, surgical decisions, and the early detection of potential complications. Comprehensive intraoperative monitoring includes the evaluation of vital signs, electrocardiogram (ECG), oxygen saturation (SpO2), end-tidal carbon dioxide (EtCO2), temperature, and advanced hemodynamic parameters. The effectiveness of intraoperative monitoring hinges on the proficiency of healthcare providers in interpreting these data accurately and promptly, ensuring optimal patient care.^1-6

Interns, as emerging healthcare professionals, occupy a pivotal role within the medical team. Often the first point of contact in clinical settings, their responsibilities extend to assisting in surgeries and ensuring the continuous monitoring of patients under anesthesia. The competence of interns in intraoperative monitoring is crucial as it directly impacts patient safety and surgical outcomes. Despite the recognized importance of intraoperative monitoring, there exists variability in the awareness and proficiency among medical interns, influenced by the quality and frequency of training, hands-on experience, and accessibility to updated clinical guidelines and protocols.^7-12

Pt Jawahar Lal Nehru Government Medical College in District Chamba, Himachal Pradesh, serves as a vital healthcare institution, catering to the diverse medical needs of the region. The unique geographic and demographic characteristics of Chamba, marked by its remote and mountainous terrain, often pose challenges in accessing immediate advanced medical care. In such settings, the role of interns becomes even more critical. Their ability to effectively monitor patients intraoperatively can bridge the gap between basic medical care and advanced surgical interventions, thereby enhancing patient outcomes and safety.

Previous studies have consistently highlighted gaps in knowledge and skills related to intraoperative monitoring among healthcare providers, including interns.^13-15 These deficiencies are frequently attributed to inadequate training programs, irregular updates on monitoring protocols, and limited practical exposure. Addressing these gaps is imperative to ensure that interns are well-prepared to manage intraoperative monitoring efficiently and effectively. Enhancing their training and knowledge in this area can lead to improved patient outcomes, reduced perioperative complications, and better overall quality of surgical care.

This study aims to assess the awareness and knowledge of intraoperative monitoring among the interns of Pt Jawahar Lal Nehru Government Medical College. By identifying the current knowledge levels and potential areas for improvement, this research seeks to contribute to the enhancement of training programs related to intraoperative monitoring. The ultimate goal is to elevate the overall quality of surgical care provided by interns in District Chamba. The findings of this study will be instrumental in guiding targeted educational interventions and policy formulations, thereby strengthening the intraoperative monitoring capabilities of medical interns in this region and beyond.

Objectives of the Study:

The primary objective of this study is to assess the level of awareness and knowledge regarding intraopertive monitoring among the Interns Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh.

• Research Approach -Descriptive

• Research Design-  Cross-sectional survey design

• Study area: at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh.

• Study duration- between January 2024 to May 2024

• Study population: The study's target population encompassed Interns who had been  working in Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh.

• Sample size- A robust sample size of 100 was determined using a 95% confidence level, an estimated knowledge level of 50% regarding intraopertive monitoring, a precise 10% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding intraopertive monitoring was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding intraopertive monitoring. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the  Interns at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 100 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained. 

The study assessed 100 interns from Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh, focusing on their socio-demographic characteristics and knowledge of intraoperative monitoring.

Table 1 presents the socio-demographic variables of the interns. The vast majority of the participants (92%) were under the age of 25, indicating a predominantly young cohort, which is typical for medical interns who start their internships soon after completing their MBBS degrees. Only a small fraction (8%) were aged 25 years and above. Gender distribution showed a slight male predominance, with 58 male interns compared to 42 females, reflecting a common trend seen in medical institutions. The distribution of months of experience among the interns showed slight variation, with 32 interns having 1-2 months of experience, 38 with 3-4 months, and 30 with 5-6 months, reflecting the ongoing nature of internship programs and the uniform start date.

Table 1: Socio-Demographic Variables of Interns (N = 100)

Table 2 summarizes the interns' responses to 20 structured questions assessing their awareness and knowledge of intraoperative monitoring. The results demonstrate a generally high level of knowledge among the interns on several key aspects. For instance, 85 interns correctly identified what ECG stands for, and 72 knew the normal range for SpO2. Knowledge about the recommended rate for chest compressions in CPR was correctly identified by 65 interns, while 62 knew the appropriate depth for chest compressions. A significant number of interns (77) were aware of the normal end-tidal CO2 range, and 79 knew the first step if a patient's SpO2 drops below 90%. The importance of monitoring temperature during surgery was correctly understood by 70 interns. The function of an Automated External Defibrillator (AED) was known by 75 interns, and 68 knew how to check for a pulse in an unresponsive patient. However, some areas showed room for improvement, such as the frequency of intraoperative monitoring training refreshers, with only 48 interns answering correctly.

Table 2: Awareness and Knowledge Questions on Intraoperative Monitoring (N = 100)

Table 3 categorizes the overall knowledge scores into four groups: Very Good (16-20 correct answers), Good (12-15 correct answers), Fair (8-11 correct answers), and Poor (<8 correct answers). The data revealed that 41 interns fell into the Very Good category, demonstrating a strong understanding of intraoperative monitoring. Another 36 interns were classified as Good, indicating a satisfactory level of knowledge. Fair scores were observed in 15 interns, while 8 scored Poorly, highlighting areas where substantial improvement is needed. This distribution suggests that while a majority of interns have a solid foundation in intraoperative monitoring, targeted efforts are required to address the knowledge gaps among the lower-performing individuals.

Table 3: Overall Intraoperative Monitoring Knowledge Scores (N = 100)

Table 4 provides a univariate analysis of factors associated with intraoperative monitoring knowledge, revealing significant relationships between various socio-demographic variables and knowledge levels. There was a notable difference in knowledge levels related to age (chi-square = 10.57, p = 0.029). Among interns aged less than 25 years, 39 scored Very Good, 34 scored Good, 13 scored Fair, and 6 scored Poor. For those aged 25 years and above, 2 interns scored Very Good, 2 scored Good, 2 scored Fair, and 2 scored Poor, indicating that younger interns tend to have a better grasp of intraoperative monitoring concepts.

Gender also showed a significant association with knowledge levels (chi-square = 8.94, p = 0.041). Among male interns, 25 scored Very Good, 21 scored Good, 8 scored Fair, and 4 scored Poor. Among female interns, 16 scored Very Good, 15 scored Good, 7 scored Fair, and 4 scored Poor, suggesting some differences in knowledge levels between male and female interns, with males generally performing slightly better.

The months of experience showed a significant association with knowledge (chi-square = 10.92, p = 0.026). Interns with 1-2 months of experience had 14 scoring Very Good, 9 scoring Good, 6 scoring Fair, and 3 scoring Poor. Those with 3-4 months had 15 scoring Very Good, 15 scoring Good, 5 scoring Fair, and 3 scoring Poor. Finally, interns with 5-6 months had 12 scoring Very Good, 12 scoring Good, 4 scoring Fair, and 2 scoring Poor. This data suggests that knowledge levels tend to vary with the duration of experience, with a general trend indicating that more months of experience correlate with higher knowledge scores.

In summary, these findings highlight the socio-demographic factors that influence the knowledge levels of interns in intraoperative monitoring. This emphasizes the need for tailored educational interventions to address these disparities and improve overall proficiency.

Table 4: Univariate Analysis of Factors Associated with Intraoperative Monitoring Knowledge

The present study aimed to assess the awareness and knowledge of intraoperative monitoring among interns at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh. The findings provide valuable insights into the current state of intraoperative monitoring knowledge among interns and highlight areas requiring targeted educational interventions.

The socio-demographic profile of the study participants reveals a predominantly young cohort, with 92% of the interns being less than 25 years of age. This age distribution is typical for medical interns who usually start their internships shortly after completing their MBBS degrees. The gender distribution showed a slight male predominance, with 58% males and 42% females, which aligns with gender distributions in medical education in various regions.The distribution of months of experience among the interns varied slightly, reflecting the ongoing nature of internship programs.

The assessment of intraoperative monitoring knowledge among the interns revealed a generally high level of understanding of key components. For instance, 85% of interns correctly identified what ECG stands for, and 72% knew the normal range for SpO2. These results are consistent with findings from similar studies. Previous studies reported that a high percentage of medical interns could correctly identify basic monitoring parameters such as ECG and SpO2 ranges.^13-16 However, specific areas showed room for improvement, particularly the frequency of intraoperative monitoring training refreshers, with only 48% answering correctly. This finding aligns with the  previous studies, which emphasized the importance of regular training and updates in maintaining high levels of competency in monitoring skills.^17-19

The categorization of overall knowledge scores into Very Good, Good, Fair, and Poor provided a clear indication of the competency levels among the interns. With 41% of the interns falling into the Very Good category and 36% in the Good category, it is evident that a majority possess a solid understanding of intraoperative monitoring. These findings are encouraging and reflect positively on the existing training programs at the institution. However, the 15% of interns categorized as Fair and the 8% as Poor highlight the need for continued education and training efforts. Similar trends have been observed in studies conducted by Perkins et al. (2015), where continuous training and periodic assessments were recommended to address identified gaps in knowledge and skills.

The univariate analysis of factors associated with intraoperative monitoring knowledge revealed significant associations with several socio-demographic variables.

The study found a significant difference in knowledge levels related to age (chi-square = 10.57, p = 0.029). Interns under 25 years showed higher proficiency in intraoperative monitoring compared to those aged 25 and above. This trend suggests that younger interns, who are more recently graduated, may be more familiar with the latest guidelines and protocols. This aligns with findings of earlier studies which noted that recent graduates tend to retain more up-to-date knowledge due to their recent educational experiences.^13-16

Gender also showed a significant association with knowledge levels (chi-square = 8.94, p = 0.041). Males generally performed better than females, with 25 males scoring Very Good compared to 16 females. This disparity might be reflective of differences in training opportunities or engagement levels, as suggested by studies that highlight gender differences in clinical skills acquisition. Addressing these disparities through tailored educational programs could help bridge this gap.

The association between months of experience and intraoperative monitoring knowledge was significant (chi-square = 10.92, p = 0.026). Interns with more months of experience tended to have higher knowledge levels, indicating that practical exposure and hands-on experience play crucial roles in reinforcing theoretical knowledge. This supports the findings of previous studies, who highlighted the importance of clinical experience in enhancing life support skills.^14,15,20

The findings of this study have important implications for practice and policy at Pt Jawahar Lal Nehru Government Medical College and similar healthcare institutions. The high level of intraoperative monitoring knowledge among the majority of interns is encouraging and should be maintained through regular refresher courses and updates on the latest resuscitation guidelines. For those with Fair or Poor scores, targeted training programs should be developed to address specific gaps in knowledge and skills.

The significant associations between socio-demographic variables and intraoperative monitoring knowledge suggest that training programs should be customized to address the unique needs of different groups. For instance, younger interns and those with less experience may benefit from more frequent hands-on training sessions and simulations. Additionally, gender-specific training approaches might be considered to ensure that both male and female interns receive the most effective instruction.

Limitations

This study has several limitations that should be acknowledged. Firstly, the use of a cross-sectional survey design limits the ability to infer causality between the identified factors and intraoperative monitoring knowledge levels. Longitudinal studies would be more effective in establishing causal relationships. Secondly, the reliance on self-reported data through a Google form questionnaire may introduce response bias, as participants might overestimate their knowledge or provide socially desirable answers. Thirdly, the study was conducted at a single institution, which may limit the generalizability of the findings to other settings with different demographic and educational profiles. Additionally, the sample size, although robust, might not capture the full diversity of the interns' experiences and backgrounds. Lastly, the questionnaire, while pre-tested, might not encompass all aspects of intraoperative monitoring knowledge and skills, potentially overlooking critical areas that require attention

In conclusion, this study provides valuable insights into the current state of intraoperative monitoring knowledge among interns at Pt Jawahar Lal Nehru Government Medical College in District Chamba, Himachal Pradesh. The findings highlight a generally high level of awareness and understanding of intraoperative monitoring, with a significant portion of the interns demonstrating very good and good knowledge levels. However, gaps in specific areas, such as the frequency of intraoperative monitoring training refreshers, underscore the need for ongoing education and targeted training interventions. The significant associations between socio-demographic factors and intraoperative monitoring knowledge suggest that customized training programs, addressing the unique needs of different demographic groups, could enhance the effectiveness of these interventions. Ensuring regular updates on monitoring protocols and providing hands-on training sessions are essential steps towards maintaining and improving intraoperative monitoring proficiency. By addressing these gaps and tailoring training to meet the diverse needs of interns, healthcare institutions can enhance their surgical care capabilities, ultimately improving patient outcomes in intraoperative settings. The findings of this study will inform future educational strategies and policy formulations aimed at strengthening the intraoperative monitoring skills of medical interns in similar settings.

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