Teaching Lifesaving Procedures: The Impact of Model Fidelity on Acquisition and Transfer of Cricothyrotomy Skills to Performance on Cadavers

Abstract

In Response: We are grateful for the insights offered by Drs. Soulsby and Kessel.1 The tested Melker kit is widely available in North America and currently is the one most residents will encounter. Its obvious advantage is that anesthesiologists are familiar with the Seldinger technique and therefore may be more comfortable with this procedure that they will rarely perform. Although we agree that residents should be taught surgical cricothyrotomy, studies have shown anesthesiologists would prefer a Seldinger technique to an open surgical technique.2 Residents should be familiarized with both options. We agree that our study is limited by the absence of a control group as discussed in our original article.3 However, the potential confounding factors of equipment familiarity and preparation for a posttest would be unlikely to be eliminated by a control group. To prevent an improvement in performance from residents preparing for the posttest, we did not warn them in advance. As for the instructional video, hands-on teaching was shown to be far superior to didactic teaching for procedural skill acquisition.4 The larynx of the Laerdal SimMan is anatomically correct in contrast to the low-fidelity model used and is commonly referred to in the literature as a high-fidelity model. We agree that the issues of cost, availability, and portability are central to the interpretation of our findings as highlighted in our article. Cadavers, although obviously an anatomically perfect model have their own drawbacks, including the stiffness of the tissues and the technical difficulty of aspirating air from the formalin-filled trachea. The main problem with cadavers is of course their scarcity, which was one of the most important reasons we undertook this study. Zeev Friedman, MD Kong E. You-Ten, MD, PhD, FRCPC Matthew D. Bould, MBChB, MRCP, FRCA Viren Naik, MD, MEd, FRCPC Department of Anesthesia Mount Sinai Hospital Toronto, Ontario, Canada Department of Anesthesia St Michael’s Hospital Toronto, Ontario, Canada [email protected]