HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Adachi, M. Articles by Mayo, P. Search for Related Content PubMed Articles by Adachi, M. Articles by Mayo, P.

Achieving Housestaff Competence in Emergency Airway Management: Standard Training Versus Training Using a Computerized Patient Simulator

Beth Israel Medical Center, New York, NY

PURPOSE: 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.

METHODS: 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.

RESULTS: 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 table

Steps Intern pre training Intern post training Senior Resident N= 49 N= 49 N= 30 Identifies apnea 42 (86%) 48 (98%) 26 (87%) Calls code team 18 (37%) 47(96%) 15 (50%) Position at head of bed 3 (6%) 46 (94%) 8 (27%) 02 to BVM and on full 0 (0%) 40 (82%) 5 (17%) Inserts oral airway correctly 3 (6%) 44 (90%) 6 (20%) 2 person BVM ventilation 12 (24%) 45 (92%) 12 (40%) Effective BVM seal 1 (2%) 45 (92%) 6 (20%) Attaches pulse oximeter 34 (69%) 44 (90%) 23 (77%) Places towel under head 0 (0%) 33 (67%) 2 (7%) Attaches suction 1 (2%) 23 (47%) 2 (7%) Positions intubation tray 13 (27%) 38 (78%) 4 (13%)

).

CONCLUSION: 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.

CLINICAL IMPLICATIONS: The CPS may be utilized effectively to train internal medicine residents in high-risk, low-frequency events like initial airway management.

DISCLOSURE: M. Adachi, None.