Achieving house staff competence in emergency airway management: results of a teaching program using a computerized patient simulator.
OBJECTIVE
Patient simulation is emerging as a training technique in the field of medicine. It has particular application in training responses to high-risk, low-frequency clinical events, of which a typical example is in-hospital cardiac arrest. A critical element of response by the cardiac arrest team is initial airway management. In teaching hospitals, medical interns are first responders to in-hospital cardiac arrests. Our objective was to design and test a program using a computer-controlled patient simulator to train medical interns and demonstrate their competence in initial airway management.


METHODS
Prospective, randomized, controlled, unblinded trial.


METHODS
Internal medicine residency training program in an urban teaching hospital.


METHODS
All 50 starting internal medicine interns in July 2002, all Advanced Cardiac Life Support certified in June 2002.


METHODS
All interns were tested in initial airway management skills and then were randomly assigned to receive either immediate or delayed individualized training using a computer-controlled patient simulator. The computer-simulated training process consisted of a scenario of respiratory arrest. The interns were challenged with the scenario twice following testing. The interns were debriefed extensively and given hands-on training by the attending using the simulator until they achieved perfect performance.


RESULTS
Initial airway management was divided into specific scorable steps. Individual step scores and total scores were recorded for each intern on initial and repeat testing. For 10 months following simulator training, intern airway management skills were scored in actual patient airway events. Despite recent Advanced Cardiac Life Support training and certification, all starting medical interns demonstrated poor airway management skills. The immediate training group showed significant improvement in initial airway management when tested before and 4 wks after training. In contrast, the delayed training group showed no significant improvement. Direct observation of interns in actual initial airway events revealed excellent clinical performance.


CONCLUSIONS
Individualized training of medical interns using a computer-controlled patient simulator is an effective means of achieving and measuring competence in initial airway management skills. The improvement appears to be transferable to the bedside of real patients.
Mayo
Paul H
PH
Beth Israel Medical Center, University Hospital and Manhattan Campus for the Albert Einstein College of Medicine, New York, NY, USA.
Hackney
Janel E
JE
Mueck
J Tristan
JT
Ribaudo
Vanessa
V
Schneider
Roslyn F
RF
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000628:therapy*; D002983:Clinical Competence; D003422:Critical Care; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D016544:Patient Simulation; D011336:Probability; D015397:Program Evaluation; D011446:Prospective Studies; D016037:Single-Blind Method; D013663:Teaching / Q000458:organization & administration*