(399) Development and Evaluation of a Simulation Activity for the Physiologically Difficult Airway

Introduction: Management of the physiologically difficult airway can be complex and involve many decisions to optimize success. Simulation training for the physiologically difficult airway is typically not routinely taught as part of formal critical care medicine training. The investigators developed a quality improvement project to aid in developing critical care fellows’ medical knowledge and skillset in managing the physiologically difficult airway.

Methods: A tabletop exercise was developed, and a clinical case was presented to each fellow individually via a slide set. Critical care fellows were then assessed using a scoring rubric. The scoring rubric (1: novice – 5: expert) was created based on critical actions necessary to successfully complete the case. The critical actions were then linked to Accreditation Council for Graduate Medical Education milestones for adult critical care medicine. A pre- and post-activity survey was also conducted evaluating the fellows’ confidence before and after the activity.

Results: The fellows were assessed for 11 critical actions during the simulation activity (see Figures 1, 2). A paired t-test was completed to determine differences between the July and subsequent May performances. Cohort 1 had a mean difference in these critical actions of 0.97, t value of 5.57, with a standard error difference of 0.175. Cohort 2 had a mean difference in these critical actions of 1.10, t value of 5.29, with a standard error difference of 0.207. These results were statistically significant. Subjective questionnaires pre- and post- simulation also showed that fellows felt more comfortable towards the end of the academic year in May as opposed to the beginning in July.

Conclusions: Assessing and managing the physiologically difficult airway is essential for intensivists. The investigators used simulation to enhance the management skills of critical care fellows using selected critical actions as a rubric; significant improvement was observed in fellows' performance from start to end of the year. Questionnaire results showed that simulated exposure to complex scenarios increased fellows' confidence in clinical settings. Simulation of the physiologically difficult airway should be considered for fellowship training to provide a safe, effective environment for managing such complex cases.