Maintaining competence in airway management.
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
20
12
2019
revised:
31
01
2020
accepted:
03
02
2020
pubmed:
9
2
2020
medline:
11
8
2021
entrez:
9
2
2020
Statut:
ppublish
Résumé
Airway management is a defining skill for anaesthesiologists. Anaesthesiologists must maintain and update these crucial skills throughout their career, but how this is best achieved remains unclear. This study aimed to clarify anaesthesiologists' procedural volume, confidence in airway management and their current and preferred future educational strategies. A questionnaire was developed consisting of 28 items exploring essential skills in airway management. All anaesthesiologists in the Capital Region of Denmark were invited to participate. The response rate was 84% (240/285). Most anaesthesiologists felt competent to a high or very high degree in basic airway management. Anaesthesiologists from anaesthesia felt confident to a significantly higher degree than those working in the intensive care unit (ICU) regarding the practical aspects of airway management in both the anticipated difficult airway (93% vs 73%, P < .001) and the unanticipated difficult airway (81% vs 61%, P = .002). Both groups performed most of the key advanced techniques ≤4 times yearly, whereas anaesthesiologists from the ICU had a lower and less diverse procedural volume than those working in anaesthesia. The anaesthesiologists preferred training through their daily clinical work, hands-on workshops, and scenario-based simulation training. However, a large discrepancy was identified between the current and the desired level of training. The anaesthesiologists felt competent to a high or very high degree in basic airway management but the current procedural volume in advanced airway management causes concern for skill maintenance. Furthermore, we found a gap between the current and the desired level of supplemental training.
Sections du résumé
BACKGROUND
Airway management is a defining skill for anaesthesiologists. Anaesthesiologists must maintain and update these crucial skills throughout their career, but how this is best achieved remains unclear. This study aimed to clarify anaesthesiologists' procedural volume, confidence in airway management and their current and preferred future educational strategies.
METHODS
A questionnaire was developed consisting of 28 items exploring essential skills in airway management. All anaesthesiologists in the Capital Region of Denmark were invited to participate.
RESULTS
The response rate was 84% (240/285). Most anaesthesiologists felt competent to a high or very high degree in basic airway management. Anaesthesiologists from anaesthesia felt confident to a significantly higher degree than those working in the intensive care unit (ICU) regarding the practical aspects of airway management in both the anticipated difficult airway (93% vs 73%, P < .001) and the unanticipated difficult airway (81% vs 61%, P = .002). Both groups performed most of the key advanced techniques ≤4 times yearly, whereas anaesthesiologists from the ICU had a lower and less diverse procedural volume than those working in anaesthesia. The anaesthesiologists preferred training through their daily clinical work, hands-on workshops, and scenario-based simulation training. However, a large discrepancy was identified between the current and the desired level of training.
CONCLUSION
The anaesthesiologists felt competent to a high or very high degree in basic airway management but the current procedural volume in advanced airway management causes concern for skill maintenance. Furthermore, we found a gap between the current and the desired level of supplemental training.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
751-758Investigateurs
Alexandros Kotinis
(A)
Anja Ulrike Mitchell
(AU)
Anne Birgitte Friis Munksgaard
(ABF)
Birgitte Marie Bonne Schousboe
(BMB)
Charlotte Vallentin Rosenstock
(CV)
Jonas Nielsen
(J)
Hans-Jørgen Frederiksen
(HJ)
Karin Graeser
(K)
Per Bo Larsen
(PB)
Peter Pfeiffer
(P)
Torsten Lauritsen
(T)
Informations de copyright
© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Références
Law JA, Duggan LV. The airway assessment has come of age-or has it? Anaesthesia. 2019;74:834-838.
Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106:617-631.
Cook TM, Woodall N, Harper J, Benger J. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011;106:632-642.
Cook TM. Strategies for the prevention of airway complications - a narrative review. Anaesthesia. 2018;73:93-111.
McNarry AF, Patel A. The evolution of airway management - new concepts and conflicts with traditional practice. Br J Anaesth. 2017;119:i154-i166.
Cook T, Woodall N, Frerk CE. Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society.Major complications of airway management in the United Kingdom. Report and findings.London, UK: Royal College of Anaethestists;2011.
Pusic MV, Santen SA, Dekhtyar M, et al. Learning to balance efficiency and innovation for optimal adaptive expertise. Med Teach. 2018;40:820-827.
Baker PA. Preparedness and education in airway management. Anesthesiol Clin. 2015;33:381-395.
Baker PA, Feinleib J, O’Sullivan EP. Is it time for airway management education to be mandatory? Br J Anaesth. 2016;117:i13-i16.
Grange K, Mushambi MC, Jaladi S, Athanassoglou V. Techniques and complications of awake fibre-optic intubation - a Survey of Difficult Airway Society Members. Trends Anaesth Crit Care. 2019;28:21-26.
Brewster DJ, Nickson CP, Gatward JJ, Staples M, Hawker F. Should ongoing airway education be a mandatory component of continuing professional development for College of Intensive Care Medicine Fellows? Anaesth Intensive Care. 2018;46:190-196.
Kennedy CC, Cannon EK, Warner DO, Cook DA. Advanced airway management simulation training in medical education: a systematic review and meta-analysis. Crit Care Med. 2014;42:169-178.
Lindkaer Jensen NH, Cook TM, Kelly FE. A national survey of practical airway training in UK anaesthetic departments. Time for a national policy? Anaesthesia. 2016;71:1273-1279.
Law JA, Broemling N, Cooper RM, et al. The difficult airway with recommendations for management - part 2 - the anticipated difficult airway. Can J Anesth. 2013;60:1119-1138.
Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827-848.
Higgs A, Mcgrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120:207-209.
Chrimes N. The Vortex: a universal “high-acuity implementation tool” for emergency airway management. Br J Anaesth. 2016;117:i20-i27.
Thomsen JLD, Nørskov AK, Rosenstock CV. Supraglottic airway devices in difficult airway management: a retrospective cohort study of 658,104 general anaesthetics registered in the Danish Anaesthesia Database. Anaesthesia. 2019;74:151-157.
Ahmad I, El-Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia. 2019; Epub ahead of print.
Law JA. Deficiencies in locating the cricothyroid membrane by palpation: we can’t and the surgeons can’t, so what now for the emergency surgical airway? Can J Anesth. 2016;63:791-796.
Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005;80:S46-S54.
You-Ten KE, Siddiqui N, Teoh WH, Kristensen MS. Point-of-care ultrasound (POCUS) of the upper airway. Can J Anesth. 2018;65:473-484.
Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79:S70-S81.
Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med. 2015;90:1471-1486.
Brisard L, Péan D, Bourgain JL, et al. Training experts in difficult airway management: evaluation of a continuous professional development program. Anaesth Crit Care Pain Med. 2016;35:115-121.
Bessmann EL, Østergaard HT, Nielsen BU, et al. Consensus on technical procedures for simulation-based training in anaesthesiology: a Delphi-based general needs assessment. Acta Anaesthesiol Scand. 2019;63:720-729.
Sawyer T, White M, Zaveri P, et al. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine. Acad Med. 2015;90:1025-1033.
Kuduvalli PM, Jervis A, Tighe SQM, Robin NM. Unanticipated difficult airway management in anaesthetised patients: a prospective study of the effect of mannequin training on management strategies and skill retention. Anaesthesia. 2008;63:364-369.
Boet S, Borges BCR, Naik VN, et al. Complex procedural skills are retained for a minimum of 1 yr after a single high-fidelity simulation training session. Br J Anaesth. 2011;107:533-539.
Siu LW, Boet S, Borges BCR, et al. High-fidelity simulation demonstrates the influence of anesthesiologists’ age and years from residency on emergency cricothyroidotomy skills. Anesth Analg. 2010;111:955-960.
Nilsson PM, Russell L, Ringsted C, Hertz P, Konge L. Simulation-based training in flexible fibreoptic intubation. Eur J Anaesthesiol. 2015;32:609-614.
Melchiors J, Todsen T, Nilsson P, et al. Self-directed simulation-based training of emergency cricothyroidotomy: a route to lifesaving skills. Eur Arch Oto-Rhino-Laryngol. 2016;273:4623-4628.
Jones CPL, Fawker-Corbett J, Groom P, Morton B, Lister C, Mercer SJ. Human factors in preventing complications in anaesthesia: a systematic review. Anaesthesia. 2018;73:12-24.
Sorbello M, Afshari A, De Hert S. Device or target? A paradigm shift in airway management: implications for guidelines, clinical practice and teaching. Eur J Anaesthesiol. 2018;35:811-814.
Sørensen JL, Østergaard D, LeBlanc V, et al. Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation. BMC Med Educ. 2017;17:1-9.
Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: a meta-analysis. JAMA. 2008;300:1181-1196.