Efforts to move from time-based to outcome-based training have led to development of novel training methodologies including Proficiency-Based Progression (PBP). Recently, our group has demonstrated that PBP training based on pre-defined metrics improves, not just physician performance, but meaningful patient outcome (53% decrease in failure incidence of epidurals placed by anaesthetic trainees).ObjectivesThe principal objective of this study is to examine for association i. quality of performance (in a simulated setting) of epidural insertion by novices following PBP training and ii. subsequent success in achieving epidural analgesia for labouring parturients. MethodsWith institutional ethical approval, all trainees in anaesthesiology (approximately 12) scheduled to train in obstetric anaesthesia at Cork University Maternity Hospital during 2019-2020 will be invited to participate.Following baseline testing (knowledge, visuospatial ability and handedness), trainees will undertake PBP training with one-to-one supervision of a consultant anaesthetist trained in PBP. Detailed descriptions of pre-defined metrics/errors will be provided. Each will then practice each metric in a simulated setting with metrics-based feedback in real time. Trainees will proceed to the clinical phase when they have attained the pre-defined proficiency benchmark. All subsequent attempts at labour epidural catheter placement performed by participating trainees will be documented, including success, defined as satisfactory analgesia achieved within 60 minutes of placement. Overall incidence of success and other performance parameters will be calculated and compared with historical reports (including at CUMH).ResultsThis study is still recruiting, we successfully trained five novices who performed seventy-four labour epidural catheter placement. Trainee characteristics were comparable. The proportion of epidural failure was 14.9% (11/74), the proportion of senior takeover was 8% (6/74), the incidence of complications was 6% (5/74), difficulty to insert epidural due to patient factors was 18% (14/74), patient satisfaction with the epidural performance and overall hospital experience satisfaction on a scale (0-10) are 8.8u00b11.6 and 9.5u00b10.8 respectively.