Evaluation of traditional lecture versus medical simulation training in airway management

Abstract

Study objectives: Traditional forms of medical education in airway management have included topical lectures and practice using mannequins and handling of equipment in an attempt to familiarize the trainees with the skills necessary to manage an airway appropriately. However, retention of airway skills has been unsatisfactory unless frequently reinforced and practiced. Quantification of the percentage of retention from traditional methodology has not been previously described. The purpose of this study is to try to quantify airway skills retention using a traditional lecture model and then testing of the trainees using a high-fidelity patient simulator. Methods: One hundred sixty-eight medical students were enrolled in the study and given a standard airway management lecture including handling of endotracheal tubes, laryngoscopes, Ambu ® bags, and oral and nasal airways. Intubation practice was performed on standard and larger-than-life mannequins to facilitate the ability to intubate. Approximately 1 week later, the students were tested on a clinical encounter that involved airway compromise and the need for appropriate airway management. These sessions were digitally recorded with the consent of the participants, and analysis of airway management was obtained. The analysis was limited to practical handling of the airway equipment. Students were given credit for correct airway management if they knew and demonstrated appropriate use of an AMBU bag, correct use of oral and nasal airways, and correct use of laryngoscopes and endotracheal tubes. They were not given credit if they were unable to assemble the laryngoscope or did not know how to hold or place an AMBU bag or how or where to place the endotracheal tube. Students were given feedback after all sessions. Results: Sixty-four (38%) of 168 students failed to appropriately manage the airway equipment during the patient simulation. This failure occurred despite prompting by the nursing staff and educator during the simulation encounter. Appropriate use of equipment, indications for use of specific equipment, and correct applications were demonstrated to the student during debriefing. Conclusion: High-fidelity patient simulation provides a detailed and practical tool to assess and monitor effectiveness of training methods. The relatively high failure rate so soon after a detailed lecture and practical session demonstrates the need for improvement in traditional educational methodology. The high levels of stress associated with high-fidelity patient simulation reproduce real-life patient encounters and reflect the difficulty in performance under stress. Future study is needed to evaluate subsequent performance after a longer period of time.