Abstract
BackgroundLung isolation skills, such as correct insertion of double lumen endobronchial tube and bronchial blocker, are essential in anesthesia training; however, how to teach novices these skills is underexplored. Our aims were to determine (1) if novices can be trained to a basic proficiency level of lung isolation skills, (2) whether video-didactic and simulation-based trainings are comparable in teaching lung isolation basic skills, and (3) whether novice learners’ lung isolation skills decay over time without practice.MethodsFirst, five board certified anesthesiologist with experience of more than 100 successful lung isolations were tested on Human Airway Anatomy Simulator (HAAS) to establish Expert proficiency skill level. Thirty senior medical students, who were naive to bronchoscopy and lung isolation techniques (Novice) were randomized to video-didactic and simulation-based trainings to learn lung isolation skills. Before and after training, Novices’ performances were scored for correct placement using pass/fail scoring and a 5-point Global Rating Scale (GRS); and time of insertion was recorded. Fourteen novices were retested 2 months later to assess skill decay.ResultsExperts’ and novices’ double lumen endobronchial tube and bronchial blocker passing rates showed similar success rates after training (P >0.99). There were no differences between the video-didactic and simulation-based methods. Novices’ time of insertion decayed within 2 months without practice.ConclusionNovices could be trained to basic skill proficiency level of lung isolation. Video-didactic and simulation-based methods we utilized were found equally successful in training novices for lung isolation skills. Acquired skills partially decayed without practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0169-7) contains supplementary material, which is available to authorized users.
Highlights
Lung isolation skills, such as correct insertion of double lumen endobronchial tube and bronchial blocker, are essential in anesthesia training; how to teach novices these skills is underexplored
Data analysis Group differences between the Expert, Experienced, Simulation-based and Video-didactic for the final sum correct placement Global Rating Scale (GRS) scores were compared by the Kruskal Wallis and MannWhitney U test; the change in novices scores across time were assessed by Wilcoxon Signed Rank test
The unfamiliarity with the use of fiberoptic scope and anatomy of the tracheobronchial tree can increase placement time with decrease success rate in patients [3, 4]. In conclusion, in this comparative effectiveness educational study, we concluded that novice learners can be trained to basic skill level of lung isolation proficiency in the simulator setting
Summary
Lung isolation skills, such as correct insertion of double lumen endobronchial tube and bronchial blocker, are essential in anesthesia training; how to teach novices these skills is underexplored. Our aims were to determine (1) if novices can be trained to a basic proficiency level of lung isolation skills, (2) whether video-didactic and simulation-based trainings are comparable in teaching lung isolation basic skills, and (3) whether novice learners’ lung isolation skills decay over time without practice. [10,11,12,13,14] and video-based trainings [15,16,17,18] have become established as powerful teaching tools, we have a stronger standing in doing comparative effectiveness studies on instruction techniques [19]. The deficiency or decay of lung isolation skill among anesthesiologists is costly as it can result in delayed or cancelled surgeries [22], prolonged operating room time [23], and airway complications [5,6,7]
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