An investigation into emergency medicine resident cricothyrotomy competency: Is three the magic number?

Autor: Turner JS; Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA., Stewart LK; Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA., Hybarger AC; Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA., Ellender TJ; Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA., Stepsis TM; Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA., Bartkus EA; Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA., Garverick P 2nd; Western Michigan University, Homer Stryker M.D. School of Medicine Kalamazoo Michigan USA., Cooper DD; Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA.
Jazyk: angličtina
Zdroj: AEM education and training [AEM Educ Train] 2023 Nov 22; Vol. 7 (6), pp. e10917. Date of Electronic Publication: 2023 Nov 22 (Print Publication: 2023).
DOI: 10.1002/aet2.10917
Abstrakt: Objectives: Cricothyrotomy is a high-stakes emergency procedure. Because the procedure is rare, simulation is often used to train residents. The Accreditation Council for Graduate Medical Education (ACGME) requires performance of three cricothyrotomies during residency, but the optimal number of training repetitions is unknown. Additional repetitions beyond three could increase proficiency, though it is unknown whether there is a threshold beyond which there is no benefit to additional repetition. The objective of this study was to establish a minimum number of simulated cricothyrotomy attempts beyond which additional attempts did not increase proficiency.
Methods: This was a prospective, observational study conducted over 3 years at the simulation center of an academic emergency medicine residency program. Participants were residents participating in a cricothyrotomy training as part of a longitudinal airway curriculum course. The primary outcome was time to successful completion of the procedure as first-year residents. Secondary outcomes included time to completion as second- and third-year residents. Procedure times were plotted as a function of attempt number. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and correlation analysis. Preprocedure surveys collected further data regarding procedure experience, confidence, and comfort.
Results: Sixty-nine first-year residents participated in the study. Steady improvement in time to completion was seen through the first six attempts (from a mean of 75 to 41 sec), after which no further significant improvement was found. Second- and third-year residents initially demonstrated slower performance than first-year residents but rapidly improved to surpass their first-year performance. Resident mean times at five attempts were faster with each year of residency (first-year 48 sec, second-year 30 sec, third-year 24 sec). There was no statistically significant correlation between confidence and time to complete the procedure.
Conclusions: Additional repetition beyond the ACGME-endorsed three cricothyrotomy attempts may help increase proficiency. Periodic retraining may be important to maintain skills.
Competing Interests: The authors declare no conflicts of interest.
(© 2023 The Authors. AEM Education and Training published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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