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

Abstract

A decline in emergency surgical airway procedures in recent years has resulted in a decreased exposure to cricothyrotomy. Consequently, residents have very little experience or confidence in performing this intervention. In this study, we compared cricothyrotomy skills acquired on a simple inexpensive model to those learned on a high fidelity simulator using valid evaluation instruments and testing on cadavers. First and second year anesthesiology residents were recruited. All subjects performed a videotaped pretest cricothyrotomy on cadavers. Subjects were randomized into two groups: The high fidelity group (n = 11) performed two cricothyrotomies on a full-scale simulator with an anatomically accurate larynx. The low fidelity group (n = 11) performed two cricothyrotomies on a low fidelity model constructed from corrugated tubing. Within 2 wk all subjects performed a posttest. Two blinded examiners graded and timed the performances using a checklist and a global rating scale. There was no significant difference in the change from pretest to posttest performance between the model groups as evaluated by all three measures (all: P = NS). Training on both models significantly improved performance on all measures (all: P < 0.001). Inter-rater reliability was strong (checklist: r = 0.90; global rating scale: r = 0.89). Our study shows that a simple inexpensive model achieved the same effect on objectively rated skill acquisition as did an expensive simulator. The skills acquired on both models transferred effectively to cadavers. Training for this life-saving skill does not need to be limited by simulator accessibility or cost.