Education News

First responders need hands-on experience with pediatric airway management, but the impact of a learner program in the operating room (OR) is unknown. We developed, implemented, and evaluated a pediatric airway "rotator" (PAR) program for 8 multidisciplinary groups to obtain this experience. This quality improvement pilot was conducted in the pediatric ORs from November 2017 to January 2018. We surveyed learner group leaders and anesthesia teachers about their PAR airway management expectations and developed a universal set of prerequisites, objectives, and simulation experiences. Airway management skills were assessed in a group of PARs at baseline. During implementation, another group of PARs completed prerequisites and reviewed objectives before coming to the OR for simu-lation using an infant mannequin. Then they entered the OR for "live" airway management. A comparison of preintervention and postintervention skills suggested an improvement in performance for most airway management domains except laryngeal mask airway insertion, which stayed about the same, and intubation, which decreased in the postintervention group. In the postassessment surveys, the PARs indicated that the interventions were helpful to their learning, and the anesthesia teachers' responses indicated that the primary goals to improve PARs' preparedness, airway management, and communication skills were achieved.

A randomized controlled trial of nasolaryngoscopy training techniques

OBJECTIVES/HYPOTHESIS

Flexible nasolaryngoscopy is an essential skill for otolaryngology trainees to develop, but there is a lack of standardized training for this procedure. The aim of this study was to assess whether using training on a realistic human mannequin together with structured video feedback improved trainees' performance at flexible nasolaryngoscopy.

STUDY DESIGN

Three-armed, single-blinded, randomized controlled study.

METHODS

Thirty-six junior doctors and final-year medical students were randomly allocated to one of three groups. All received a lecture and video presentation on flexible nasolaryngoscopy. One group received additional tuition using a training mannequin. The last group received mannequin training and feedback on their performance using a video recording. The trainees then undertook flexible nasolaryngoscopy on volunteers with these endoscopies recorded. Blinded observers scored the trainees on a range of objective and subjective measures. The volunteers who were also blinded to the candidates' training scored the comfort of the procedure.

RESULTS

Adding mannequin training showed a trend toward improvement of performance but did not reach statistical significance. Mannequin training together with video feedback produced significant performance improvement in patient comfort (P = .0065), time to reach the vocal folds (P = .017), and global ability (P = .0006). Inter-rater reliability was excellent with P < .01 in all assessments.

CONCLUSIONS

Simulation-based training using an anatomically correct model of the upper airway together with formalized video-assisted feedback on that training is a simple and effective way to improve endoscopy skills prior to starting flexible nasolaryngoscopy on patients.