Design and implementation of an educational program in advanced airway management for anesthesiology residents

The evolution of a national, advanced airway management simulation-based course for anaesthesia trainees

BACKGROUND

Needs analyses involving patient complaints and anaesthesiologists' confidence levels in difficult airway management procedures in Denmark have shown a need for training in both technical and non-technical skills.

OBJECTIVE

To provide an example of how to design, implement and evaluate a national simulation-based course in advanced airway management for trainees within a compulsory, national specialist training programme.

DESIGN AND RESULTS

A national working group, established by the Danish Society for Anaesthesiology and Intensive Care Medicine, designed a standardised simulation course in advanced airway management for anaesthesiology trainees based on the six-step approach. Learning objectives are grounded in the curriculum and analyses-of-needs (in terms of knowledge, skills and attitudes, including non-technical skills, which encompass the cognitive skills and social skills, necessary for safe and effective performance). A total of 28 courses for 800 trainees have been conducted. Evaluation has been positive and pre and posttests have indicated a positive effect on learning.

CONCLUSION

The course was successfully designed and implemented within the national training programme for trainees. Important factors for success were involvement of all stakeholders, thorough planning, selection of the most important learning objectives, the use of interactive educational methods and training of the facilitators.

Assessing anesthesiology residents' out-of-the-operating-room (OOOR) emergent airway management

BACKGROUND

At many academic institutions, anesthesiology residents are responsible for managing emergent intubations outside of the operating room (OOOR), with complications estimated to be as high as 39%. In order to create an OOOR training curriculum, we evaluated residents' familiarity with the content and correct adherence to the American Society of Anesthesiologists' Difficult Airway Algorithm (ASA DAA).

METHODS

Residents completed a pre-simulation multiple-choice survey measuring their understanding and use of the DAA. Residents then managed an emergent, difficult OOOR intubation in the simulation center, where two trained reviewers assessed performance using checklists. Post-simulation, the residents completed a survey rating their behaviors during the simulation. The primary outcome was comprehension and adherence to the DAA as assessed by survey responses and behavior in the simulation.

RESULTS

Sixty-three residents completed both surveys and the simulation. Post-survey responses indicated a shift toward decreased self-perceived familiarity with the DAA content compared to pre-survey responses. During the simulation, 22 (35%) residents were unsuccessful with intubation. Of these, 46% placed an LMA and 46% prepared for cricothyroidotomy. Nineteen residents did not attempt intubation. Of these, only 31% considered LMA placement, and 26% initiated cricothyroidotomy.

CONCLUSIONS

Many anesthesiology residency training programs permit resident autonomy in managing emergent intubations OOOR. Residents self-reported familiarity with the content of and adherence to the DAA was higher than that observed during the simulation. Curriculum focused on comprehension of the DAA, as well as improving communication with higher-level physicians and specialists, may improve outcomes during OOORs.

A prospective, randomised, clinical study to compare the use of McGrath(®), Truview(®) and Macintosh laryngoscopes for endotracheal intubation by novice and experienced Anaesthesiologists

Background and Aims:

Video laryngoscopy has been recommended as an alternative during difficult conventional direct laryngoscopy using the Macintosh blade (MAC). However, successful visualisation of the larynx and tracheal intubation using some of the indirect laryngoscopes or video laryngoscopes (VL) requires hand-eye coordination. We conducted this study to determine whether non-channel VLs are easy to use for novices and whether there is any association between expertise with MAC and ease of tracheal intubation with VLs.

Methods:

Anaesthesiologists participating in the study were divided into three groups: Group novice to intubation (NTI), Group novice to videoscope (NVL)- experienced with MAC, novice to VLs and Group expert (EXP) experienced in all. Group NTI, NVL received prior mannequin training. VLs- Truview^® and McGrath series 5 (MGR) were compared with MAC. One hundred and twenty six adult patients with normal airway were randomised to both, the intubating anaesthesiologist and laryngoscope. The time taken to intubate (TTI) and participants’ rating of the ease of use was recorded on a scale of 1–10 (10-most difficult).

Results:

In Group NTI, there was no difference in mean TTI with the three scopes (P = 0.938). In Group NVL, TTI was longer with the VLs than MAC (P < 0.001). In Group EXP, TTI with VL took 20 s more (P < 0.001). There was significant difference in participants’ rating of ease of use of laryngoscope in Group NVL (P = 0.001) but not in the NTI (P = 0.205), EXP (P = 0.529) groups. A high failure was seen with MGR in Group NTI and NVL.

Conclusion:

In Group NTI, TTI and the ease of use were similar for all scopes. Expertise with standard direct laryngoscopy does not translate to expertise with VLs. Separate training and experience with VLs is required.

An Innovative Use of an Online Procedure Logbook to Improve Airway Training among Anesthesiology Residents

INTRODUCTION

We performed a single-institution pilot study to determine the potential value of an electronic logbook of airway procedures performed during a one month airway rotation for anesthesiology residents. For two years, CA-3 residents taking an advanced airway management rotation entered all airway procedures in this electronic logbook. We expected this logbook to produce results of potential use to program directors by determining the numbers of specific procedures performed by each resident.

METHODS

All residents taking this rotation were required to enter specific data from each airway procedure into our on-line electronic logbook. Entered information was available in tabular form to the program director and each resident. Numbers of procedures with each technique were compared among residents and to a previously determined target number of procedures for several techniques.

RESULTS

Sixty seven residents entered data for nine specific airway procedures over a 24 month pilot study duration. When compared to target numbers of procedures for specific techniques, we discovered most residents performed less than 2 standard deviations from the target number with flexible fiberoptic intubation (usually exceeding the target number) but greater than 3 standard deviations with surgical and percutaneous procedures (usually falling short of the target number). Analysis also determined that resident experience exhibited considerable variability as shown by the ranges of several techniques. Though there was a wide range of numbers for most techniques, most were within two standard deviations of the mean values of the technique.

CONCLUSIONS

The authors conclude that this electronic logbook was easily administered at minimal cost and administrative effort. Future studies may confirm the logbook as a feasible intervention permitting anesthesiology training programs to in crease the breadth of data related to their resident airway education.