PURPOSE: Emergency endotracheal intubation (EEI) is a key skill of the critical care physician. The ACGME requires that all critical care (CCM) and pulmonary/critical medicine (PCCM) fellows be proficient in EEI. Based upon informal discussion with program directors (PD) and PCCM/CCM fellows, we speculated that there were barriers to training fellows in the essential skill of EEI.
METHODS: Using Survey Monkey©, we sent surveys to all CCM and PCCM PD in USA. A similar survey was sent to third year CCM/PCCM fellows. Both surveys included questions regarding daily practices of EEI, equipment, and personnel available for training fellows as well as identification of barriers to training.
RESULTS: 37.5% of PD completed the questionnaire. As per PD, the mean number of EEI for proficient airway management was 32.5 with a median of 25. 62.5% of PD felt they have enough faculty proficient to train in EEI, 55.4% felt they had a set protocol for teaching EEI, and 64.8% for doing EEI. Fellows indicated that they did not use a set protocol for EEI (68.4%) nor for teaching EEI (65.8%). 78.6% of PD vs. 60% of fellows anticipated that, upon graduation, they would have proficiency in EEI. For PD, the two main barriers to training in EEI were lack of trained faculty (18.9%) and anesthesiology procedural dominance (13.2%); for fellows, they were anesthesiology procedural dominance (58%) and fear of unsuccessful intubations (44%).
CONCLUSIONS: A significant number of PD and fellows indicate they have insufficient training in airway management despite that the ACGME mandates competence in EEI. We found a difference between PD and fellows perceptions about protocols for doing and teaching EEI. The two main barriers to intubation in both groups were lack of trained faculty and anesthesiology procedural dominance
CLINICAL IMPLICATIONS: This suggests that PD’s need to implement standardized methods of training and performing EEI for their fellows.
DISCLOSURE: The following authors have nothing to disclose: Astha Chichra, Parikh Naval, Christopher Dibello, Adey Tsegaye, Paul Mayo, Seth Koenig, Mangala Narasimhan
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