Richard B Silverman1, Sean M Quinn1. 1. Physician, Tracheostomy Service, Division of Critical Care Medicine, Dept. of Anesthesiology and Perioperative Medicine, Miller School of Medicine, University of Miami & Jackson Memorial Hospital, Miami, Florida.
Abstract
BACKGROUND: Airway management is a core competency in anesthesiology training and practice. Residents are taught how to evaluate patients and identify those who may difficulty in securing their airway. The ASA has devised an algorithm on management of those difficult airways. The conservative methods are taught and practiced throughout training. However, the default last resort is obtaining an invasive airway. It is this potentially life-saving, procedure that residents may graduate and have never performed clinically. In our institution, the Anesthesiology Critical Care Division routinely performs percutaneous tracheostomies throughout the hospital. As residents began to inquire, they too were folded into this service to provide real hands on experience. After 3 years we sought to determine if residents perceived this hands-on training to be a benefit. METHODS: We devised a multi-question survey and distributed to our 131 residents. The purpose of the survey was to determine of those who participated in the tracheostomy service if they felt this was of benefit, which specialists they could look to should an invasive airway be needed and if they felt this exposure gave them greater confidence to perform an emergency invasive airway. RESULTS: In unanimity, the residents all felt that this training was both beneficial and essential in their training. However, none of the residents felt this training had adequately prepared them to actually perform this procedure in an emergency. CONCLUSIONS: The residents felt this was an essential aspect of their anesthesiology training. However they did not feel they obtained invasive airway competence. We postulate the residents relatively limited exposure may have been the cause. While we do not know the impact of this training in residency on management of a future difficult airway, the residents uniformly felt this was vital in their clinical curriculum and should be universal.
BACKGROUND: Airway management is a core competency in anesthesiology training and practice. Residents are taught how to evaluate patients and identify those who may difficulty in securing their airway. The ASA has devised an algorithm on management of those difficult airways. The conservative methods are taught and practiced throughout training. However, the default last resort is obtaining an invasive airway. It is this potentially life-saving, procedure that residents may graduate and have never performed clinically. In our institution, the Anesthesiology Critical Care Division routinely performs percutaneous tracheostomies throughout the hospital. As residents began to inquire, they too were folded into this service to provide real hands on experience. After 3 years we sought to determine if residents perceived this hands-on training to be a benefit. METHODS: We devised a multi-question survey and distributed to our 131 residents. The purpose of the survey was to determine of those who participated in the tracheostomy service if they felt this was of benefit, which specialists they could look to should an invasive airway be needed and if they felt this exposure gave them greater confidence to perform an emergency invasive airway. RESULTS: In unanimity, the residents all felt that this training was both beneficial and essential in their training. However, none of the residents felt this training had adequately prepared them to actually perform this procedure in an emergency. CONCLUSIONS: The residents felt this was an essential aspect of their anesthesiology training. However they did not feel they obtained invasive airway competence. We postulate the residents relatively limited exposure may have been the cause. While we do not know the impact of this training in residency on management of a future difficult airway, the residents uniformly felt this was vital in their clinical curriculum and should be universal.