Airway management is critical to resuscitation. Medical housestaff are initial responders to cardiorespiratory arrest and their competence in airway management is essential. We have previously shown that use of a Computerized Patient Simulator (CPS) is effective at training medical interns in initial airway management skills. These skills could also be acquired during medical residency without formal training through observation and practice in clinical situations. We examine whether this is the case.
Subjects: 49 new internal medicine interns compared to 30 senior residents in Jul-Aug, 2003. Intervention: Interns were tested and trained using the CPS (SimMan) in initial airway skills. One month later, they were retested to determine training effect. Senior residents who had not received prior CPS training were tested in identical fashion. They had extensive clinical experience including 12 weeks of critical care rotation. Testing with the CPS was done with standard clinical scenario. Initial airway management was divided into specific scorable steps. Performance was scored under video control by two observers. Following testing all senior residents were trained using the CPS.
Interns had poor airway management skills before training; these improve following training. Senior residents also had low skill level. Interns who trained using the CPS scored significantly better than senior residents. (See tableStepsIntern pre trainingIntern post trainingSenior ResidentN= 49N= 49N= 30Identifies apnea42 (86%)48 (98%)26 (87%)Calls code team18 (37%)47(96%)15 (50%)Position at head of bed3 (6%)46 (94%)8 (27%)02 to BVM and on full0 (0%)40 (82%)5 (17%)Inserts oral airway correctly3 (6%)44 (90%)6 (20%)2 person BVM ventilation12 (24%)45 (92%)12 (40%)Effective BVM seal1 (2%)45 (92%)6 (20%)Attaches pulse oximeter34 (69%)44 (90%)23 (77%)Places towel under head0 (0%)33 (67%)2 (7%)Attaches suction1 (2%)23 (47%)2 (7%)Positions intubation tray13 (27%)38 (78%)4 (13%)).
Two years of clinical experience was insufficient trainig to achieve proficiency in initial airway management. CPS training is a more effective means of training housestaff in initial airway management than standard clinical residency training.
The CPS may be utilized effectively to train internal medicine residents in high-risk, low-frequency events like initial airway management.
M. Adachi, None.