A Training Program for Novice Paramedics Provides Initial Laryngeal Mask Airway Insertion Skill and Improves Skill Retention at 6 Months

Abstract

Major resuscitation councils endorse the use of the laryngeal mask airway (LMA) by paramedics for lifesaving airway interventions. Learning and maintaining adequate skill level is important for patient safety. The aim of this project was to develop a training program that provides student paramedics with initial knowledge and experience in LMA insertion skills but equally important to provide ongoing skill retention. After ethics approval and informed consent, 55 first year Paramedic degree students watched a manufacturer's LMA instruction video and practiced insertion in three different part task trainers. Six months later, subjects were randomized to an intervention (reviewing the video and 10 minutes unsupervised practice) or control group before participating in a high-fidelity simulated clinical scenario. For equity of training, the control group received the intervention after the scenario. Main outcomes measured were time to insertion; success rate; and LMA skill retention (sum of LMA orientation; cuff inflation; bite block; securing; patient positioning; and overall subject performance). Fifty subjects completed the study. Those in the intervention group displayed significantly shorter insertion times (P = 0.029), fewer attempts to achieve success (P = 0.033), and had significantly higher LMA skill performance levels (P = 0.019) at 6 months. We devised a short intervention based on our training program using a video and practice in part task trainers. In an assessment using high-fidelity simulation, we demonstrated significant improvements in maintenance of LMA insertion skills in student paramedics at 6 months. Our model of just-in-time assessment and reinforcement of training prevents skill decay and has implications for healthcare skills training in general.