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Initial Airway Management Skills of Senior Residents^*

Simulation Training Compared With Traditional Training

^* From the Division of Pulmonary and Critical Care Medicine (Drs. Kory, Eisen, Ribaudo, and Mayo), Beth Israel Medical Center, New York, NY; Department of Medicine (Dr. Adachi), William W. Backus Hospital, Norwich, CT; and Department of Geographic Medicine and Infectious Diseases (Dr. Rosenthal), Tufts-New England Medical Center, Boston, MA.

Correspondence to: Pierre D. Kory, MPA, MD, Beth Israel Medical Center, Division of Pulmonary and Critical Care, First Ave and 16th St, New York, NY 10003; e-mail: pkory{at}chpnet.org

Abstract

Background: Scenario-based training (SBT) with a computerized patient simulator (CPS) is effective in teaching physicians to manage high-risk, low-frequency events that are typical of critical care medicine. This study compares the initial airway management skills of a group of senior internal medicine residents trained using SBT with CPS during their first year of postgraduate training (PGY) with a group of senior internal medicine residents trained using the traditional experiential method.

Methods: This was a prospective, controlled trial that compared two groups of PGY3 internal medicine residents at an urban teaching hospital. One group (n = 32) received training in initial airway management skills using SBT with CPS in their PGY1 (ie, the simulation-trained [ST] group). The second group (n = 30) received traditional residency training (ie, the traditionally trained [TT] group). Each group was then tested during PGY3 in initial airway management skills using a standardized respiratory arrest scenario.

Results: The ST group performed significantly better than the TT group in 8 of the 11 steps of the respiratory arrest scenario. Notable differences were found in the ability to attach a bag-valve mask (BVM) to high-flow oxygen (ST group, 69%; TT group, 17%; p < 0.001), correct insertion of oral airway (ST group, 88%; TT group, 20%; p < 0.001), and achieving an effective BVM seal (ST group, 97%; TT group, 20%; p < 0.001).

Conclusions: Traditional training consisting of 2 years of clinical experience was not sufficient to achieve proficiency in initial airway management skills, mostly due to inadequate equipment usage. This suggests that SBT with CPS is more effective in training medical residents than the traditional experiential method.

Key Words: medical simulation • residency education • resuscitation skills • scenario-based training