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Perception of training needs and opportunities in advanced airway skills: a survey of British and Irish trainees

Published online by Cambridge University Press:  01 June 2007

A. F. McNarry ,
T. Dovell ,
F. M. L. Dancey  and
M. E. Pead
A. F. McNarry*
Affiliation:
Barts and the London NHS Trust, St Bartholomew’s Hospital, Boyle Department of Anaesthesia, Horder Wing, West Smithfield, London
T. Dovell
Affiliation:
Barts and the London NHS Trust, St Bartholomew’s Hospital, Boyle Department of Anaesthesia, Horder Wing, West Smithfield, London
F. M. L. Dancey
Affiliation:
Barts and the London NHS Trust, St Bartholomew’s Hospital, Boyle Department of Anaesthesia, Horder Wing, West Smithfield, London
M. E. Pead
Affiliation:
Barts and the London NHS Trust, St Bartholomew’s Hospital, Boyle Department of Anaesthesia, Horder Wing, West Smithfield, London
*
Correspondence to: Dr Alistair McNarry, Department of Anaesthesia, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK. E-mail: althegasman@btinternet.com; Tel: +44 131 537 1652; Fax: +44 131 537 1025
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Summary

Background and objective

We surveyed delegates at the Group of Anaesthetists in Training (UK) meeting to investigate evidence of a training-gap (number of fibreoptic intubations believed to bestow competence vs. number actually performed).

Methods

Questionnaires were distributed to and collected from delegates in person. Questions covered six areas, including experience of fibreoptic intubation and cricothyrotomy, fibreoptic intubation as a specialist skill and ethical issues.

Results

We received 221 replies (76%). All trainees believed competence to be achievable with 10 intubations (interquartile range (IQR) 10–20); the median number performed was 2 (IQR 0–4). This was statistically significant for the groups senior house officers, 1st and 2nd year registrars and 3rd and 4th year registrars; P < 0.0001. Many final year trainees (12/20, 60%) also failed to achieve their competency target. Few trainees had seen or performed any cricothyrotomies (medians 0, IQRs 0–1 and 0–0). Most (195/208, 94%) believed that fibreoptic intubation was a core skill and 199/212 (94%) believed that all should be competent by completion of training. Ten percent (n = 208) felt it unethical to perform an awake training intubation with full consent and 10% believed it acceptable without explanation. Most (82.7%) would fibreoptically intubate an asleep patient (requiring intubation) without consent.

Conclusion

Trainees reported a gap between their perception of competence and achievement in awake fibreoptic intubation. Simple and complex simulations and structured training programmes may help. Anaesthetists must address the ethics of clinical training in advanced airway management.

Keywords

INTUBATIONINTRATRACHEALRESPIRATORY INSUFFICIENCY, airway obstructionSURGICAL PROCEDURESOPERATIVE, tracheotomyEDUCATION, methods, in-service trainingETHICS, standards
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 6 , June 2007 , pp. 498 - 504
Copyright
Copyright © European Society of Anaesthesiology 2006

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Footnotes

Presented in abstract form at the annual scientific meeting of the Difficult Airway Society, Lille, November 2005.

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