title: Effect of simulation training on compliance with difficult airway management algorithms, technical ability, and skills retention for emergency cricothyrotomy.
abstract: BACKGROUND
  The effectiveness of simulation is rarely evaluated. The aim of this study was to assess the impact of a short training course on the ability of anesthesiology residents to comply with current difficult airway management guidelines.
  
  
  METHODS
  Twenty-seven third-year anesthesiology residents were assessed on a simulator in a "can't intubate, can't ventilate" scenario before the training (the pretest) and then randomly 3, 6, or 12 months after training (the posttest). The scenario was built so that the resident was prompted to perform a cricothyrotomy. Compliance with airway management guidelines and the cricothyrotomy's duration and technical quality were assessed as a checklist score [0 to 10] and a global rating scale [7 to 35].
  
  
  RESULTS
  After training, all 27 residents (100%) complied with the airway management guidelines, compared with 17 (63%) in the pretest (P < 0.005). In the pretest and the 3-, 6-, and 12-month posttests, the median [range] duration of cricothyrotomy was respectively 117 s [70 to 184], 69 s [43 to 97], 52 s [43 to 76], and 62 s [43 to 74] (P < 0.0001 vs. in the pretest), the median [range] checklist score was 3 [0 to 7], 10 [8 to 10], 9 [6 to 10], and 9 [4 to 10] (P < 0.0001 vs. in the pretest) and the median [range] global rating scale was 12 [7 to 22], 30 [20 to 35], 33 [23 to 35], and 31 [18 to 33] (P < 0.0001 vs. in the pretest). There were no significant differences between performance levels achieved in the 3-, 6-, and 12-month posttests.
  
  
  CONCLUSIONS
  The training session significantly improved the residents' compliance with guidelines and their performance of cricothyrotomy.
authors.affiliation: From the Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire (CHU), Amiens, France (V.H., A.D., R.D., Y.M., and H.D.); Active Teaching and Health Simulation Training Center (CPA-SimUSanté©), CHU and Université de Picardie Jules Verne, Amiens, France (V.H., A.D., Y.M., and H.D.); and INSERM UMR 1088, Université de Picardie Jules Verne, Amiens, France (Y.M., H.D.).
authors.forename: Vincent
authors.initials: V
authors.lastname: Hubert
authors.forename: Antoine
authors.initials: A
authors.lastname: Duwat
authors.forename: Romain
authors.initials: R
authors.lastname: Deransy
authors.forename: Yazine
authors.initials: Y
authors.lastname: Mahjoub
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
mesh_terms: D058109:Airway Management / Q000379:methods*; D000465:Algorithms; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003413:Cricoid Cartilage / Q000601:surgery; D004632:Emergency Medical Services / Q000379:methods*; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008348:Manikins; D017410:Practice Guidelines as Topic; D013965:Thyroidectomy / Q000379:methods