Turner Joseph S, Stewart Lauren K, Hybarger Andrew C, Ellender Timothy J, Stepsis Tyler M, Bartkus Edward A, Garverick Paul, Cooper Dylan D
Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA.
Western Michigan University, Homer Stryker M.D. School of Medicine Kalamazoo Michigan USA.
AEM Educ Train. 2023 Nov 22;7(6):e10917. doi: 10.1002/aet2.10917. eCollection 2023 Dec.
Cricothyrotomy is a high-stakes emergency procedure. Because the procedure is rare, simulation is often used to train residents. The Accreditation Council for Graduate Medical Education (ACGME) requires performance of three cricothyrotomies during residency, but the optimal number of training repetitions is unknown. Additional repetitions beyond three could increase proficiency, though it is unknown whether there is a threshold beyond which there is no benefit to additional repetition. The objective of this study was to establish a minimum number of simulated cricothyrotomy attempts beyond which additional attempts did not increase proficiency.
This was a prospective, observational study conducted over 3 years at the simulation center of an academic emergency medicine residency program. Participants were residents participating in a cricothyrotomy training as part of a longitudinal airway curriculum course. The primary outcome was time to successful completion of the procedure as first-year residents. Secondary outcomes included time to completion as second- and third-year residents. Procedure times were plotted as a function of attempt number. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and correlation analysis. Preprocedure surveys collected further data regarding procedure experience, confidence, and comfort.
Sixty-nine first-year residents participated in the study. Steady improvement in time to completion was seen through the first six attempts (from a mean of 75 to 41 sec), after which no further significant improvement was found. Second- and third-year residents initially demonstrated slower performance than first-year residents but rapidly improved to surpass their first-year performance. Resident mean times at five attempts were faster with each year of residency (first-year 48 sec, second-year 30 sec, third-year 24 sec). There was no statistically significant correlation between confidence and time to complete the procedure.
Additional repetition beyond the ACGME-endorsed three cricothyrotomy attempts may help increase proficiency. Periodic retraining may be important to maintain skills.
环甲膜切开术是一种高风险的急诊手术。由于该手术很少进行，模拟操作常被用于培训住院医师。毕业后医学教育认证委员会（ACGME）要求住院医师在培训期间进行三次环甲膜切开术，但最佳的训练重复次数尚不清楚。超过三次的额外重复训练可能会提高熟练程度，不过尚不清楚是否存在一个阈值，超过该阈值后额外重复训练就不再有益。本研究的目的是确定模拟环甲膜切开术的最低尝试次数，超过该次数后额外尝试不会提高熟练程度。
这是一项在一所学术性急诊医学住院医师培训项目的模拟中心进行的为期3年的前瞻性观察研究。参与者是参加环甲膜切开术培训的住院医师，该培训是纵向气道课程的一部分。主要结局是作为一年级住院医师成功完成手术的时间。次要结局包括作为二年级和三年级住院医师完成手术的时间。将手术时间绘制成尝试次数的函数。使用描述性统计、重复测量方差分析和相关性分析对数据进行分析。术前调查收集了有关手术经验、信心和舒适度的进一步数据。
69名一年级住院医师参与了该研究。在前六次尝试中，完成手术的时间稳步改善（从平均75秒降至41秒），此后未发现进一步的显著改善。二年级和三年级住院医师最初的表现比一年级住院医师慢，但迅速提高并超过了他们一年级时的表现。随着住院年份的增加，住院医师在五次尝试时的平均时间更快（一年级48秒，二年级30秒，三年级24秒）。信心与完成手术的时间之间没有统计学上的显著相关性。
超过ACGME认可的三次环甲膜切开术尝试进行额外的重复训练可能有助于提高熟练程度。定期再培训对于保持技能可能很重要。
