Design and Implementation of an Educational Program in Advanced Airway Management for Anesthesiology Residents

Hindawi Publishing Corporation Anesthesiology Research and Practice Volume 2012, Article ID 737151, 7 pages doi:10.1155/2012/737151 Review Article Design and Implementation of an Educational Program in Advanced Airway Management for Anesthesiology Residents Zana Borovcanin1 and Janine R. Shapiro2 1 Advanced Airway Management Educational Program, Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, P.O. Box 604, Rochester, NY 14642, USA 2 Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, P.O. Box 604, Rochester, NY 14642, USA Correspondence should be addressed to Zana Borovcanin, zana Received 2 February 2011; Accepted 29 October 2011 Academic Editor: Zahid Hussain Khan Copyright © 2012 Z. Borovcanin and J. R. Shapiro. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. 1. Introduction 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 [1]. 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. 2. Comprehensive Advanced Airway Management Educational Program 2.1. Educational Goals and Planning. The goals of the comprehensive advanced airway management educational program are to enable residents to obtain significant experience with a broad spectrum of advanced airway management 2 techniques and devices, learn to appropriately apply the ASA Difficult Airway Algorithm, and develop an understanding of the critical decision points in the course of the difficult or failed airway management. In order to successfully implement such a program, it is necessary to develop a specific curriculum, have excellent airway equipment always available, and have a core group of faculty with expertise in advanced airway management. The proposed curriculum detailed below was accepted by the program director and the resident education committee. Our department has a core group of faculty with expertise in advanced airway management. Standardized difficult airway carts, uniformly stocked and set up, are utilized during the education and training in advanced airway management techniques. 2.2. Advanced Airway Techniques (AAT) Rotation 2.2.1. Curriculum. The AAT rotation is an elective rotation offered to the CA-3 resident for a duration of a minimum of two weeks and a maximum of four-weeks. Resident responsibilities are to read the goals and objectives of the rotation, become familiar with the classic and current literature on advanced airway management, and complete the log sheets daily during the rotation. The patient’s medical record number, the success and timing of the technique, and the supervising faculty name are written on the log sheet. The educational material for the AAT rotation is posted on Blackboard, is accessible to all residents, and is discussed by the faculty with the residents during the rotation. The educational material includes the introductory article ASA Practice Guidelines for Management of Difficult Airway published in 2003 [1]. The additional material is grouped according to the advanced airway devices and techniques for the difficult airway management [5–39]. Every advanced airway management device or technique used during the rotation is discussed with resident with regards to description, instruction on insertion technique, and current clinical use. Adequate supervision of the resident by the faculty with expertise in advanced airway management is important to master the techniques. Selection of the patients is also important. ASA l or ll patients with a class l or ll airway undergoing elective surgery under general anesthesia are ideal. Patients with a known or suspected difficult airway, as well as patients who are candidates for awake flexible fiberoptic intubation, are assigned to the resident on the AAT rotation. Education and training in flexible fiberoptic laryngoscopy and intubation emphasizes the approach and skills needed for awake flexible fiberoptic intubation (FFI). Troubleshooting of FFI is taught. Residents become competent in the mechanical manipulation of the fiberoptic bronchoscope, learn to identify normal pharyngeal and laryngeal anatomy, and confirm the proper placement of the endotracheal tube in the trachea. FFI is mostly performed on asleep paralyzed patients. The average number of flexible fiberoptic intubations performed per resident is ten to twenty, an (...truncated)