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Perception of training needs and opportunities in advanced airway skills: a survey of British and Irish trainees

Published online by Cambridge University Press:  01 June 2007

A. F. McNarry ,
T. Dovell ,
F. M. L. Dancey  and
M. E. Pead
A. F. McNarry*
Affiliation:
Barts and the London NHS Trust, St Bartholomew’s Hospital, Boyle Department of Anaesthesia, Horder Wing, West Smithfield, London
T. Dovell
Affiliation:
Barts and the London NHS Trust, St Bartholomew’s Hospital, Boyle Department of Anaesthesia, Horder Wing, West Smithfield, London
F. M. L. Dancey
Affiliation:
Barts and the London NHS Trust, St Bartholomew’s Hospital, Boyle Department of Anaesthesia, Horder Wing, West Smithfield, London
M. E. Pead
Affiliation:
Barts and the London NHS Trust, St Bartholomew’s Hospital, Boyle Department of Anaesthesia, Horder Wing, West Smithfield, London
*
Correspondence to: Dr Alistair McNarry, Department of Anaesthesia, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK. E-mail: [email protected]; Tel: +44 131 537 1652; Fax: +44 131 537 1025
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Summary

Background and objective

We surveyed delegates at the Group of Anaesthetists in Training (UK) meeting to investigate evidence of a training-gap (number of fibreoptic intubations believed to bestow competence vs. number actually performed).

Methods

Questionnaires were distributed to and collected from delegates in person. Questions covered six areas, including experience of fibreoptic intubation and cricothyrotomy, fibreoptic intubation as a specialist skill and ethical issues.

Results

We received 221 replies (76%). All trainees believed competence to be achievable with 10 intubations (interquartile range (IQR) 10–20); the median number performed was 2 (IQR 0–4). This was statistically significant for the groups senior house officers, 1st and 2nd year registrars and 3rd and 4th year registrars; P < 0.0001. Many final year trainees (12/20, 60%) also failed to achieve their competency target. Few trainees had seen or performed any cricothyrotomies (medians 0, IQRs 0–1 and 0–0). Most (195/208, 94%) believed that fibreoptic intubation was a core skill and 199/212 (94%) believed that all should be competent by completion of training. Ten percent (n = 208) felt it unethical to perform an awake training intubation with full consent and 10% believed it acceptable without explanation. Most (82.7%) would fibreoptically intubate an asleep patient (requiring intubation) without consent.

Conclusion

Trainees reported a gap between their perception of competence and achievement in awake fibreoptic intubation. Simple and complex simulations and structured training programmes may help. Anaesthetists must address the ethics of clinical training in advanced airway management.

Keywords

INTUBATIONINTRATRACHEALRESPIRATORY INSUFFICIENCY, airway obstructionSURGICAL PROCEDURESOPERATIVE, tracheotomyEDUCATION, methods, in-service trainingETHICS, standards
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 6 , June 2007 , pp. 498 - 504
Copyright
Copyright © European Society of Anaesthesiology 2006

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Footnotes

Presented in abstract form at the annual scientific meeting of the Difficult Airway Society, Lille, November 2005.

References

1.Goldman, K, Ferson, DZ. Education and training in airway management. Best Pract Res Clin Anaesthesiol 2005; 19: 717–732.CrossRefGoogle Scholar
2.Caplan, RA, Benumof, JL, Berry, FA et al. . (American Society of Anesthesiologists Task Force on Management of the Difficult Airway). Practice guidelines for the management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anaesthesiology 2003; 98: 1269–1277.Google Scholar
3.Popat, M. The airway [State of the Art]. Anaesthesia 2003; 58: 1166–1171.CrossRefGoogle ScholarPubMed
4.Vaughan, RS. Training in fibreoptic laryngoscopy. Br J Anaesth 1991; 66: 538–540.CrossRefGoogle ScholarPubMed
5.Ovassapian, A, Yelich, SJ. Learning fiberoptic intubation. Anesthesiol Clin NA 1991; 9: 175–185.CrossRefGoogle Scholar
6.Johnson, C, Roberts, JT. Clinical competence in the performance of fiberoptic laryngoscopy and endotracheal intubation: a study of resident instruction. J Clin Anesth 1989; 1: 344–349.CrossRefGoogle ScholarPubMed
7.Smith, JE, Jackson, APF, Hurdley, J, Clifton, PJM. Learning curves for fibreoptic nasotracheal intubation when using the endoscopic video camera. Anaesthesia 1997; 52: 101–106.CrossRefGoogle ScholarPubMed
8.Ovassapian, A, Dykes, MHM, Golmon, ME. A training programme for fibreoptic nasotracheal intubation. Use of model and live patients. Anaesthesia 1983; 38: 795–798.CrossRefGoogle ScholarPubMed
9.Dawson, AJ, Marsland, C, Baker, P, Anderson, BJ. Fibreoptic intubation skills among anaesthetists in New Zealand. Anaesth Intens Care 2005; 33: 777–783.CrossRefGoogle ScholarPubMed
10.Henderson, JJ, Popat, MT, Latto, IP, Pearce, AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59: 675–694.CrossRefGoogle Scholar
11.Chambers, WA. Difficult airways – difficult decisions: Guidelines for publication? Anaesthesia 2004; 59: 631–632.CrossRefGoogle ScholarPubMed
12.Hung, O. Airway management: the good the bad and the ugly. Can J Anaesth 2002; 49: 767–771.CrossRefGoogle ScholarPubMed
13.Wong, DT, Prabhu, AJ, Coloma, M, Imasogie, N, Chung, FF. What is the minimum training required for successful cricothyroidotmy? Anesthesiology 2003; 98: 349–353.CrossRefGoogle Scholar
14.Varaday, SS, Yentris, SM, Clarke, S. A homemade model for training in cricothyrotomy. Anaesthesia 2004; 59: 1012–1015.CrossRefGoogle ScholarPubMed
15.Caplan, RA, Posner, KL, Ward, RJ, Cheney, FW. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 1990; 72: 828–833.CrossRefGoogle ScholarPubMed
16.Buck, N, Devlin, HB. The Report of a Confidential Enquiry into Perioperative Deaths. London, UK: NCEPOD, 1987.Google Scholar
17.Ahmed, FB, Mitchell, V, Patel, A. Advanced Airway Techniques – the North Thames Central experience. Anaesthesia 2004; 59: 1042.Google Scholar
18.Martin, KM, Larsen, PD, Segal, R, Marsland, CP. Effective nonanatomical endoscopy training produces clinical airway endoscopy proficiency. Anesth Analg 2004; 99: 938–944.CrossRefGoogle ScholarPubMed
19.Smith, JE, Fenner, SG, King, MJ. Teaching fibreoptic nasotracheal intubation with and without closed circuit television. Br J Anaesth 1993; 71: 206–211.CrossRefGoogle ScholarPubMed
20.Cole, AFD, Mallon, JS, Rolbin, SH, Ananthanarayan, C. Fiberoptic intubation using anesthetized, paralyzed, apnoeic patients: Results of a resident training program. Anesthesiology 1996; 84: 1101–1106.CrossRefGoogle ScholarPubMed
21.Bray, JK, Yentis, SM. Attitudes of patients and anaesthetists to informed consent for specialist airway techniques. Anaesthesia 2002; 57: 1012–1015.CrossRefGoogle ScholarPubMed
22.Erb, T, Hampl, KF, Schurch, M, Kern, CG, Marsch, SC. Teaching the use of fiberoptic intubation in anesthetized, spontaneously breathing patients. Anesth Analg 1999; 89: 1292–1295.Google ScholarPubMed
23.Allan, AGL. Reluctance of anaesthetists to perform awake intubation. Anaesthesia 2004; 59: 413.CrossRefGoogle ScholarPubMed
24.Bokhari, A, Benham, SW, Popat, MT. Management of unanticipated difficult intubation: a survey of current practice in the Oxford region. Eur J Anaesthesiol 2004; 21: 123–127.CrossRefGoogle ScholarPubMed
25.Ezri, T, Szmuk, P, Warters, RD, Katz, J, Hagberg, CA. Difficult airway management practice patterns among anaesthesiologists practicing in the United States: have we made any progress? J Clin Anesth 2003; 15: 418–422.CrossRefGoogle ScholarPubMed
26.Goldman, K, Braun, U. Airway management practices at German university and university-affiliated teaching hospitals – equipment, techniques and training: results of a nationwide survey. Acta Anaesthesiol Scand 2006; 50: 298–305.CrossRefGoogle Scholar
27.Heidegger, T, Gerig, HJ, Ulrich, B, Kreienbuhl, G. Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies – an analysis of 13,248 intubations. Anesth Analg 2001; 92: 517–522.Google Scholar
28.Gerig, HJ, Schinder, T, Heidegger, T. Prophylactyic percutaneous transtracheal catheterisation in the management of patients with anticipated difficult airways: a case series. Anaesthesia 2005; 60: 801–805.CrossRefGoogle ScholarPubMed
29.Stringer, KR, Bajenov, S, Yentis, SM. Training in airway management. Anaesthesia 2002; 57: 967–983.CrossRefGoogle ScholarPubMed
30.McFetrich, J. A structured literature review on the use high fidelity patient simulators for teaching in emergency medicine. Emerg Med J 2006; 23: 509–511.CrossRefGoogle ScholarPubMed
31.Naik, VN, Matsumoto, ED, Houston, PL et al. . Fiberoptic orotracheal intubation on anesthetized patients: do manipulation skills learned on a simple model transfer into the operating room? Anesthesiology 2001; 95: 343–348.CrossRefGoogle ScholarPubMed
32.Ovassapian, A, Yelich, SJ, Dykes, MHM, Goldman, ME. Learning fibreoptic intubation: use of simulators V. traditional teaching. Br J Anaesth 1988; 61: 217–220.CrossRefGoogle ScholarPubMed
33.Basi, SK, Cooper, M, Ahmed, FB, Clarke, SG, Mitchell, V. Reluctance of anaesthetists to perform awake intubation. Anaesthesia 2004; 59: 918.CrossRefGoogle ScholarPubMed
34.Patil, V, Barker, GL, Harwood, RJ, Woodall, NM. Training course in local anaesthesia of the airway and Fibreoptic intubation using course delegates as subjects. Br J Anaesth 2002; 89: 586–593.CrossRefGoogle ScholarPubMed