Date Published: February 28, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Zana Borovcanin, Janine R. Shapiro.
Education and training in advanced airway management as part of an anesthesiology residency program is necessary to help residents attain the status of expert in difficult airway management. The Accreditation Council for Graduate Medical Education (ACGME) emphasizes that residents in anesthesiology must obtain significant experience with a broad spectrum of airway management techniques. However, there is no specific number required as a minimum clinical experience that should be obtained in order to ensure competency. We have developed a curriculum for a new Advanced Airway Techniques rotation. This rotation is supplemented with a hands-on Difficult Airway Workshop. We describe here this comprehensive advanced airway management educational program at our institution. Future studies will focus on determining if education in advanced airway management results in a decrease in airway related morbidity and mortality and overall better patients’ outcome during difficult airway management.
Anesthesiologists are recognized as experts in difficult or failed airway management. However, anesthesiology residents are not exposed frequently enough to a difficult or failed airway during the course of their three years of clinical training in order to attain “expert” status in difficult or failed airway management. The American Society of Anesthesiologist (ASA) Practice Guidelines for Management of Difficult Airway suggests that when conventional intubation techniques fail after three attempts, advanced airway management devices or techniques should be utilized and immediately available . A comprehensive advanced airway management educational program as a part of an anesthesiology residency program is necessary to help anesthesiology residents earn the status of expert in difficult airway management [2–4] and be able to use successfully advanced airway management devices or techniques when faced with a difficult airway. Three years ago we implemented an Advanced Airway Techniques (AAT) rotation as a new two- to four-week rotation for residents in anesthesiology during their third year of clinical anesthesia training (CA-3 year). This educational activity is supplemented with a Difficult Airway Workshop, a semiannual educational activity. Before initiation of this rotation, education in advanced airway management was sporadic at our institution consisting of occasional individual teaching as difficult airways arose. With implementation of this rotation, a formal advanced airway management program was instituted. We describe below details of this educational program.
Although the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Graduate Medical Education in Anesthesiology emphasizes that resident must obtain significant experience with a broad spectrum of airway management techniques (e.g., performance of fiberoptic intubation, double lumen endotracheal tube, endobronchial blockers) , there is no specific information on what constitutes the minimum clinical experience that should be obtained in order to ensure competency with the specific airway management technique. A rotation in advanced airway management should be part of the required curricula in anesthesiology residency programs. Standardization of resident training in advanced airway management can be achieved by a clinical certification process and established competencies for the training in advanced airway management techniques and devices. A survey concerning formal training in advanced airway management techniques was performed twice [3, 44]. In 1995, only 27% of the anesthesiology programs reported to have a formal advanced airway rotation in their curriculum . The majority of these airway rotations (60%) were less than two weeks in duration. The other survey conducted in 2002 demonstrated that only 33% of the anesthesiology programs had a dedicated airway rotation . Of these, more than 61% of the rotations were only one week in duration . A well-designed survey would be valuable in assessing current practices within US anesthesiology residency programs.