Panchal Ashish R, Way David P, King Andrew M, Yudkowsky Rachel, Terndrup Thomas E
Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH.
Department of Medical Education University of Illinois at Chicago College of Medicine Chicago IL.
AEM Educ Train. 2018 Oct 12;3(1):39-49. doi: 10.1002/aet2.10127. eCollection 2019 Jan.
The Emergency Medicine (EM) Milestone Project provides guidance for assessment of resident trainee airway management proficiency (PC10). Although milestones provide a general structure for assessment, they do not define performance standards. The objective of this project was to establish comprehensive airway management performance standards for EM trainees at both novice and mastery levels of proficiency.
Comprehensive airway management standards were derived using standard-setting procedures. A panel of residency education and airway management experts was convened to determine how trainees would be expected to perform on 51 individual tasks in a standardized airway management simulation encompassing preparation, endotracheal intubation, backup airway use, and ventilation. Experts participated in facilitated exercises in which they were asked to 1) define which items were critical for patient safety, 2) predict the performance of a "novice" learner, and 3) predict the performance of a "mastery" learner nearing independent practice. Experts were given a worksheet to complete and descriptive statistics were calculated using STATA 14.
Experts identified 39 of 51 (76%) airway management items as critical for patient safety. Experts also noted that novice trainees do not need to complete all the items deemed to be critical prior to starting practice since they will be supervised by a board-certified EM physician. In contrast, mastery-level trainees would be expected to successfully complete not only the critical tasks, but also nearly all the items in the assessment (49/51, 96%) since they are nearing independent practice.
In this study, we established EM resident performance standards for comprehensive airway management during a simulation scenario. Future work will focus on validating these performance standards in current resident trainees as they move from simulation to actual patient care.
急诊医学（EM）里程碑项目为评估住院医师培训学员的气道管理能力（PC10）提供指导。尽管里程碑为评估提供了总体框架，但它们并未定义绩效标准。本项目的目的是为处于新手和熟练掌握水平的急诊医学学员建立全面的气道管理绩效标准。
采用标准设定程序得出全面的气道管理标准。召集了一个住院医师教育和气道管理专家小组，以确定学员在标准化气道管理模拟中在51项单独任务上的预期表现，该模拟涵盖准备、气管插管、备用气道使用和通气。专家们参与了促进性练习，在练习中他们被要求：1）确定哪些项目对患者安全至关重要；2）预测“新手”学习者的表现；3）预测接近独立实践的“熟练掌握”学习者的表现。为专家们提供了一份工作表来填写，并使用STATA 14计算描述性统计数据。
专家们确定51项气道管理项目中的39项（76%）对患者安全至关重要。专家们还指出，新手学员在开始实践之前不需要完成所有被认为至关重要的项目，因为他们将由获得委员会认证的急诊医学医生进行监督。相比之下，熟练掌握水平的学员预计不仅要成功完成关键任务，还要完成评估中的几乎所有项目（49/51，96%），因为他们已接近独立实践。
在本研究中，我们建立了急诊医学住院医师在模拟场景中进行全面气道管理的绩效标准。未来的工作将集中于在当前住院医师培训学员从模拟过渡到实际患者护理时验证这些绩效标准。
