Nonsurgical airway management training for surgeons.

PURPOSE

Airway management occupies a crucial component of surgical education. As such, it can be difficult to provide adequate training within the hospital setting alone. To be facile in all aspects of nonsurgical airway management, the surgical resident must have thorough cognitive understanding of the process as well as technical mastery. The Department of Surgery at the Methodist Hospital in Houston has developed a curriculum for nonsurgical airway management that uses multiple modalities for education, reinforcement, and testing. Didactic lectures based on established national guidelines are provided as a foundation. This method is supplemented by hands-on group scenarios that use inanimate models. Throughout the course, faculty leaders provide guidance and skills assessment. Residents are tested for competency using core value checklists based on knowledge and technical proficiency. During its pilot year, the curriculum has proven its need and success in residency education. Future improvements include development of specific clinical scenarios as well as integration of more advanced educational equipment and models for use in nonsurgical airway management.

DEVELOPMENT OF THE ACTIVITY AND MATERIALS

Materials used for this program include an article by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway, the New England Journal of Medicine article entitled "Videos in clinical medicine. Orotracheal intubation" by Kabrhel et al,(2) "Management of the difficult and failed airway" by Hung and Murphy,(3) the American Heart Association Airway Management course 2007,(4) and the Manual of Emergency Airway Management by Walls et al.(5) EVALUATION COMPONENT: Before participating in the module, residents completed a written pretest and performed an initial simulation to establish a baseline. Residents then worked through a series of skills that provided experience in both the cognitive and the procedural aspects of airway management. To complete the module successfully, residents were required to attend three 3-hour sessions. After supervised practice, residents were tested on the procedural techniques via a procedural checklist and cognitive aspects with respect to emergency, crash, difficult, and failed airway algorithms.(1,5) The simulations are based on the 2003 American Society of Anesthesiologists Task Force on Management of the Difficult Airway Algorithms(1) and emergency, crash, difficult, and failed airway algorithms.(2,5) PROPOSED OUTCOME MEASURES: Proposed long-term outcome measures will include evaluations from faculty on a resident's noninvasive airway management skills and the resident's self-evaluation in actual noninvasive airway management situations. Resident performance will be evaluated by faculty using standardized checklists, review of simulation parameters, and review of audio-video recording of the simulation.

EXPERIENCE TO DATE

This article describes our first implementation in the evolution of this module. The module was introduced to residents at all postgraduate levels in September 2007. Scores on pretests and performance on initial simulations were similar in all postgraduate years, with minimally superior pretest and initial simulation performance from the senior residents. Correct procedural adoption occurred rapidly after prebriefing and initial hands-on demonstration and supervised practice in simulated patient scenarios on airway mannequins.

CONCLUSIONS AND NEXT STEPS

Our preliminary experience with a nonsurgical airway management training module for surgical residents has shown that a need for training exists in this critical area. Correct procedural adoption occurred rapidly after a didactic and procedural hands-on experience. Time intervals needed for review to maintain competence will also be studied. Improvements to the proficiency criteria and simulations are underway.