Rethinking Airway Management Training in Emergency Medicine Residency Programs: Improving Resident Airway Skills with a Comprehensive Airway Boot Camp Course

摘要

Background: For most residents in emergency medicinetraining programs, airway management skills are acquiredand refined one case at a time while caring for patients in theemergency department and augmented with the obligatoryoff-service anesthesia rotation. Intubation experiences maydiffer between residents due to the variability of airway casesthat present on any given day. Therefore, residents should beexposed to a standardized airway curriculum that covers coreairway principals and management of difficult airway scenarios.Educational Objectives: Improve all residents’ airwaymanagement skills by providing them with an 8-hour airwaycourse during intern orientation.Curricular Design: The resident airway boot campimplements multiple learning modalities to engage theparticipants and more effectively reinforce basic and advancedairway concepts. Several interactive lectures incorporatingan audience response system are augmented with handsonbreakout sessions. The hands-on training focuses on thefamiliarization of adult and pediatric intubation equipment andtechniques, as well as airway adjuncts (i.e. bougie, extraglotticdevices, video laryngoscopes and fiberoptic intubatingbronchoscopes). Pig tracheas are used to realistically teachboth surgical and percutaneous cricothyrotomy techniques.Finally, the residents test their newly acquired knowledgeand technical skills by participating in 8 separate airway codesimulations in a high fidelity simulation center.Impact/Effectiveness: The participants (n=16) completeda survey before and after the airway boot camp, wherethey ranked their perceived skill level for different airwaytasks. A comparison of pre and post survey results showed astatistically significant improvement in participants’ perceivedskill in 6 airway categories after completing the course:bag valve mask ventilation, adult endotracheal intubation,pediatric endotracheal intubation, use of a bougie, use of anextraglottic device, and cricothyrotomy (Table 1). Emergencymedicine residents appear to benefit from a highly integrated,comprehensive airway training session, as a supplement tointubation experiences in the emergency department. Theimplementation of this curriculum ensures standardization ofairway training for all residents.