RESUMO
BACKGROUND: For both normal and difficult airway management, VL is thought to be more effective. However, VL seems far from being offered as a standard option in both healthcare delivery and educational activities in low-income countries, considering its high costs. Therefore, three-dimensional(3D)printed VLs may be considered an alternative to conventional VLs in low-income countries and other places with limited resources. Our objective was to compare the efficacy of AirAngel 3D-printed VL (3D-PVL) with those of commercially available Storz® VL (SVL) and conventional Macintosh® laryngoscope (MCL) in normal and difficult airway scenarios in the hands of inexperienced users. METHODS: This is a prospective randomized crossover manikin study that included 126 senior medical students with no experience in intubation. The effectiveness of all three laryngoscopy devices in the hands of inexperienced users was evaluated in terms of intubation time, glottic visualization, ease of use, endotracheal tube placement, and intubation success rate. Between 2020 and 2022, 126 last year medical students participated in the study. RESULTS: MCL resulted in significantly longer intubation times than 3D-PVL and SVL in the difficult airway scenario, with no significant difference between 3DPVL and SVL (Wilcoxon test, p < 0.016; Bonferroni correction MCL: 28.54 s; SVL: 26.68 s; 3DPVL: 26.64 s). Both SVL and 3D-PVL resulted in significantly better Cormack - Lehane grades in both normal and difficult airway scenarios, and thus provided better glottic viewing than MCL, with no significant difference between 3D-PVL and SVL (Wilcoxon test, p < 0.016; Bonferroni correction, MCL: 1.73; SVL: 1.29; 3DPVL: 1.25). The SVL was the easiest device to use for normal airway scenarios (1: very easy, 5: very difficult), while the MCL was the most difficult (MCL: 2.64; 3DPVL: 1.98; SVL: 1.49). Conversely, no significant difference was found between 3DPVL and other devices in terms of ease of use in difficult airway scenarios and in terms of accurate placement of the endotracheal tube and successful intubation attempts. CONCLUSION: 3D-PVL is a good educational and possible clinical alternative to conventional VL, particularly in places with limited resources, due to its low cost.
Assuntos
Estudos Cross-Over , Intubação Intratraqueal , Laringoscópios , Laringoscopia , Manequins , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Estudos Prospectivos , Laringoscopia/educação , Desenho de Equipamento , Competência Clínica , Masculino , Estudantes de Medicina , Impressão Tridimensional , FemininoRESUMO
Tracheal intubation poses a high risk of infection to medical staff due to Coronavirus disease 2019 (COVID-19) highly infectious nature. To mitigate this risk, various medical devices, including video laryngoscopy, have been developed to assist intubation. This study compared conventional laryngoscopy (Macintosh) and disposable video laryngoscopes (Medcaptain VS-10s and Honestmc Laryngoscope_LA10000) in terms of their use and operation processes. We designed a questionnaire to assess the operator perception of performing intubation with the devices, and statistical analysis was performed on 50 clinical staff members from 2 hospitals who had performed intubation or had learned intubation techniques. The primary outcomes were time to glottic visualization, intubation time, intubation success rate, distance between the operator and training model, and time from glottic visualization to tube insertion. The secondary outcomes were as follows: overall laryngoscope quality, operative feel, maneuverability, ease of use, and video quality. This study showed that video laryngoscopes were superior to conventional laryngoscopes in terms of quality, operative feel, and ease of use. When LA10000 was employed, the intubation success rate was higher, and the operator risk of infection was lower because of the greater distance from the training model. However, the use of video laryngoscopes requires appropriate education and training use of the devices. This study also demonstrated that when participants viewed a simple operation video prior to using video laryngoscopes, tube insertion time was shorter. Overall, video laryngoscopy can provide a safer and more convenient option for clinical medical personnel during pandemics.
Assuntos
COVID-19 , Intubação Intratraqueal , Laringoscópios , Laringoscopia , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/instrumentação , COVID-19/prevenção & controle , Laringoscopia/métodos , Laringoscopia/instrumentação , Laringoscopia/educação , SARS-CoV-2 , Treinamento por Simulação/métodos , Masculino , Desenho de Equipamento , Feminino , Adulto , Técnicas e Procedimentos Assistidos por VídeoRESUMO
Endotracheal intubation is a life-saving procedure for many newborns. Historically, it has been achieved by obtaining an airway view through the mouth via direct laryngoscopy. It is a skill that takes time and practice to achieve proficiency. Increasing evidence for the benefit of videolaryngoscopy in adults and the new development of technology has allowed videolaryngoscopy to become a reality in neonatal care. Studies have examined its use as both a technique to improve intubation safety and success, and as a training tool for those learning the skill in this vulnerable population. We present the current evidence for videolaryngoscopy in neonates in different settings where intubation may be required, in addition to exploring the challenges and practicalities of implementing this technique into clinical practice.
Assuntos
Laringoscópios , Laringoscopia , Adulto , Recém-Nascido , Humanos , Laringoscopia/educação , Laringoscopia/métodos , Intubação Intratraqueal/métodosRESUMO
The aim of this paper is to gather and evaluate available literature about using videolaryngoscopy as a training tool for novice learners and compare it to direct laryngoscopy. Search of the available literature was performed using the MEDLINE database, through the PubMed searching tool. The inclusion criteria were that papers had to be original research and participants had to be novices in the field of airway management. The studies also had to pertain to the topic of using videolaryngoscopy as a training tool, therefore all papers that evaluated performance of videolaryngoscopy in clinical applications or did not pertain to using videolaryngoscopy as a training tool were excluded from this review. Five studies were identified that fitted the inclusion criteria, all of which showed a statistically significant difference in first attempt success at endotracheal intubation in favor of videolaryngoscopy when compared to direct laryngoscopy. One of the studies also demonstrated a faster skill acquisition rate when using videolaryngoscopy. The use of videolaryngoscopy in teaching airway management to trainees (emergency medicine residents included) is a viable option and should be encouraged and researched further.
Assuntos
Medicina de Emergência , Laringoscopia , Gravação em Vídeo , Laringoscopia/educação , Laringoscopia/métodos , Humanos , Medicina de Emergência/educação , Intubação Intratraqueal/métodos , Competência ClínicaRESUMO
OBJECTIVES/HYPOTHESIS: The role for endoscopic management in children with subglottic stenosis (SGS) has grown, but there are no data on resource utilization or the impact on surgical training in pediatric otolaryngology. This study hypothesizes that this shift has increased resource utilization and has impacted surgical training by shifting the focus toward more endoscopic techniques. STUDY DESIGN: Retrospective database review. METHODS: The Kids' Inpatient Database for 2003, 2006, 2009, and 2012 was queried for admissions with the diagnosis of SGS. Surgical caseload was studied using the Accreditation Council for Graduate Medical Education Accreditation data system for 2010 to 2017. RESULTS: Admissions with SGS remained constant between 2003 and 2012. Hospital charges per admission did not change between 2003 and 2009 but increased in 2012. Tracheostomy decreased from 10.5% of admissions in 2003 to 6.8% in 2012. The percentage requiring repair of the larynx did not change; other operations on the larynx increased from 4.5% in 2003 to 11.6% in 2012. The median number of laryngoplasties performed per trainee decreased from 14 to nine between 2010 and 2017, whereas the number of laryngoscopy with intervention procedures increased from 34 to 56. CONCLUSIONS: The evolution of SGS management appears to have led to a decrease in tracheostomy and an increase in certain procedures that may include endoscopic procedures. Recently, there has been a shift in airway surgical training, with trainees logging less open laryngotracheoplasty and more interventional laryngoscopy. Although these trends cannot be directly linked, the changes in trainee surgical experience may be justified by the decrease in larger open procedures and associated resource utilization. LEVEL OF EVIDENCE: 2c Laryngoscope, 132:S1-S9, 2022.
Assuntos
Laringoscopia/educação , Laringoscopia/tendências , Laringoestenose/cirurgia , Otolaringologia/educação , Pediatria/educação , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Educação de Pós-Graduação em Medicina , Humanos , Lactente , Recém-Nascido , Laringoplastia , Estudos Retrospectivos , Adulto JovemRESUMO
En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,760,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica
In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice
Assuntos
Humanos , Lactente , Pediatria/educação , Laringoscópios/economia , Treinamento por Simulação/métodos , COVID-19/prevenção & controle , Intubação Intratraqueal/instrumentação , Laringoscopia/economia , Pediatria/economia , Fatores de Tempo , Gravação em Vídeo , Custos de Cuidados de Saúde , Competência Clínica/estatística & dados numéricos , Educação Médica Continuada/métodos , Curva de Aprendizado , COVID-19/transmissão , Internato e Residência/métodos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Laringoscopia/educação , Laringoscopia/instrumentação , Laringoscopia/métodos , ManequinsRESUMO
In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope. Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8- 148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001). A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice.
En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo. Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,760,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica.
Assuntos
COVID-19/prevenção & controle , Intubação Intratraqueal/instrumentação , Laringoscópios/economia , Laringoscopia/educação , Pediatria/educação , Treinamento por Simulação/métodos , Argentina , COVID-19/transmissão , Competência Clínica/estatística & dados numéricos , Educação Médica Continuada/métodos , Custos de Cuidados de Saúde , Humanos , Lactente , Internato e Residência/métodos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Laringoscopia/economia , Laringoscopia/instrumentação , Laringoscopia/métodos , Curva de Aprendizado , Manequins , Pediatria/economia , Fatores de Tempo , Gravação em VídeoAssuntos
Manuseio das Vias Aéreas , Anestesiologistas/educação , COVID-19/prevenção & controle , Laringoscopia/educação , Cirurgia Vídeoassistida/educação , Manuseio das Vias Aéreas/tendências , Anestesiologistas/tendências , COVID-19/epidemiologia , Humanos , Laringoscopia/tendências , Cirurgia Vídeoassistida/tendênciasRESUMO
ABSTRACT: Tracheal intubation is an essential technique for many healthcare professionals and one of the mega code simulations in advanced cardiac life support. In recent years, video laryngoscopy (VL) has provided a rescue for difficult airways during intubation and has proven to have higher success rates. Moreover, VL facilitates a more rapid learning curve for inexperienced doctors.In this article, we report 16 cases intubated with VL by a novice doctor of postgraduate year 1, who shared the learning experience and the difficulties encountered in this case series. We also conducted a statistical analysis to evaluate the learning outcomes of the trainee after 1 month.Our results showed that the overall first-shot success rate was 81.3% for the 16 objectives. Over time, improvements in intubation performance measures, including shortened duration and lower Intubation Difficulty Scale score, have been observed. In this learning project, we found that limitation of mouth opening (<2.5 fingers wide) is an important risk factor for predicting the initial difficulty of tracheal intubation on the novice trainee.For inexperienced doctors, VL produces high first-shot success rates for tracheal intubation and may be useful for training their performance in a short period of time. In addition, mouth opening <3 fingers wide may result in difficult intubation by novice doctors.
Assuntos
Internato e Residência , Intubação Intratraqueal , Laringoscopia/educação , Aprendizagem Baseada em Problemas , Adulto , Idoso , Competência Clínica , Feminino , Humanos , Laringoscópios , Masculino , Pessoa de Meia-Idade , Gravação em Vídeo , Adulto JovemRESUMO
OBJECTIVE: To assess the first attempt neonatal intubation success rates of pediatric trainees following the implementation of an evidence-based training package. STUDY DESIGN: Data collection was undertaken from February, 1 2017, to January 31, 2018, to ascertain baseline preimplementation intubation success rates. An intubation training package, which included the use of videolaryngoscopy, preprocedure pause, and standardized instruction during the procedure, was introduced. Data on all subsequent intubations were collected prospectively from May 1, 2018, to April 30, 2020. RESULTS: Preimplementation baseline data over a 1-year period demonstrated overall first attempt intubation success rate of junior trainees to be 37% (33/89). After implementation of the training package, 290 intubations were analyzed over a 2-year period. The overall success rate was 67% (194/290); 61% (117/192) for junior trainees and 79% (77/98) for senior clinicians. Three or more attempts were required for 13% of intubations (38/290). During the study period, the overall number of intubations being carried out decreased. Intubations with the videolaryngoscope had higher success rates for all tiers of clinician, most marked in the junior tiers. CONCLUSIONS: The introduction of a standardized intubation training package, along with videolaryngoscopy, improved trainee intubation success rates.
Assuntos
Competência Clínica , Cuidados Críticos , Intubação Intratraqueal , Laringoscopia/educação , Pediatria/educação , Aprendizagem Baseada em Problemas/organização & administração , Humanos , Recém-Nascido , Internato e Residência , Gravação em VídeoRESUMO
OBJECTIVES: The main objective was to describe physicians' perception of their knowledge, skill, and safety before and after training to perform videolaryngoscopy while using the Intubox barrier system when managing the airway of a patient with the coronavirus 2019 disease (COVID-19). The secondary objective was to assess the safety afforded by the barrier by means of visually evaluating particle dispersion during intubation. MATERIAL AND METHODS: Single-arm clinical simulation trial. The participants were physicians who received training in both a lowfidelity and a high-fidelity simulation zone. The participants assessed their knowledge, skill, and safety when using the Intubox before and after training using a specially designed and validated questionnaire. Droplet contamination was estimated visually. RESULTS: Twenty-seven physicians with a mean (SD) age of 40 (10.8) years participated; 63% were women. They perceived their knowledge, skill, and safety to be significantly higher after training. Droplet contamination was seen to decrease when airway management maneuvers were done with the barrier in place. CONCLUSION: After simulation training the emergency physicians judged their knowledge, skill, and safety to be greater when they used the barrier during airway management in patients with COVID-19. The combined use of a laryngoscope and the Intubox barrier resulted in less particle dispersion during intubation.
OBJETIVO: El objetivo principal fue describir el grado de percepción sobre el conocimiento, las habilidades y la seguridad antes y después de un programa de entrenamiento con videolaringoscopia y mecanismo de protección Intubox® en el manejo de la vía aérea de pacientes con COVID-19. El objetivo secundario fue evaluar la seguridad de los dispositivos de barrera en la intubación a través de un análisis visual de dispersión de partículas. METODO: Ensayo clínico de un solo brazo basado en simulación. Los participantes fueron médicos que realizaron un programa de formación mediante simulación clínica de baja y alta fidelidad. Se usó un instrumento diseñado y validado específico para evaluar la percepción sobre el conocimiento, las habilidades y la seguridad antes y después del programa. Se realizó un análisis visual de la contaminación por gotas. RESULTADOS: La muestra final estuvo compuesta por 27 médicos, con una edad media de 40 (DE 10,8) años y el 63% mujeres. Se obtuvo un incremento estadísticamente significativo en las dimensiones conocimiento, habilidad y seguridad tras el entrenamiento. Se observó una menor contaminación cuando se realizaron las técnicas de manejo de vía aérea con urna protectora. CONCLUSIONES: Los urgenciólogos incrementaron su percepción sobre los conocimientos, habilidades y seguridad en el manejo de la vía aérea en pacientes con COVID-19 tras un programa de formación con simulación. El uso combinado de laringoscopia y dispositivo de barrera Intubox® causó menor dispersión de partículas durante la intubación.
Assuntos
Manuseio das Vias Aéreas/métodos , COVID-19/terapia , Competência Clínica , Educação Médica Continuada/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laringoscopia/educação , Adulto , Manuseio das Vias Aéreas/instrumentação , COVID-19/prevenção & controle , COVID-19/transmissão , Feminino , Humanos , Laringoscopia/instrumentação , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Percepção , Autoeficácia , Gravação em VídeoRESUMO
BACKGROUND: Peritonsillar abscess, or quinsy, is one of the most common emergency presentations to ENT departments, and is the most common deep tissue infection of the head and neck. In the UK, junior members of the ENT team are regularly required to independently assess, diagnose and treat patients with peritonsillar aspiration or incision and drainage. ISSUE: Inexperienced practitioners can stumble at several obstacles: poor access due to trismus; poor lighting; difficulty in learning the therapeutic procedure; and difficulty in accurately documenting findings and treatment. SOLUTION: To counter these and other difficulties, the authors describe the routine use of video endoscopy as a training tool and therapeutic adjunct in the management of quinsy.
Assuntos
Drenagem/métodos , Laringoscópios , Laringoscopia/métodos , Abscesso Peritonsilar/cirurgia , Endoscopia/educação , Endoscopia/métodos , Humanos , Laringoscopia/educação , Orofaringe , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Procedimentos Cirúrgicos Otorrinolaringológicos/métodosRESUMO
OBJECTIVES: To present the value of office-based laryngological procedures as an effective alternative method to the treatment of benign and malignant laryngeal pathologies. METHODS: We have reviewed the technological advancements of fiber-guided laser systems, fiberoptic endoscopes, and high-definition imaging systems that have enabled office-based laryngological procedures. We describe the importance of case and patient selection, the available laser systems, and the technique applied. RESULTS: Several benign and malignant pathologies can be now treated in the office under local anesthesia with angiolytic or thermocoagulative lasers and with success rate comparable to that of general anesthesia. Safety guidelines and laser precautions must be implemented invariably to protect the patient and caregivers from the untoward effects of laser. Although there is considerable reduction of cost with office procedures, there are risks of undertreatment, increased repeatability, as well as tissue edema from the burning effect. CONCLUSIONS: The low learning curve, high patient satisfaction rate, and excellent results indicate that in-office laser procedures have become an effective weapon in our armamentarium.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Terapia a Laser/métodos , Otolaringologia/tendências , Procedimentos Cirúrgicos Ambulatórios/educação , Humanos , Laringoscopia/educação , Laringe/cirurgia , Curva de Aprendizado , Otolaringologia/educação , Satisfação do Paciente , Resultado do TratamentoRESUMO
INTRODUCTION: Neonatal intubation is a challenging skill to acquire. A randomised controlled trial (RCT) found junior trainees had higher intubation success rates if their supervisor shared their airway view on a videolaryngoscope screen compared with intubations where the supervisor could not see the videolaryngoscope screen. The intubations in the trial were supervised by a group of experienced neonatologists who developed an intubation teaching package that aimed to be informative, consistent and supportive. We surveyed the trainees to assess their experiences of the intubation attempts. METHODS: Trainees participating in the RCT completed questionnaires anonymously after each intubation attempt. Questionnaires used 5-point Likert scales and free comment sections. Quantitative analysis was performed using descriptive statistics. In a qualitative analysis, free comments were coded to identify central recurring themes. RESULTS: Two hundred and six questionnaires were completed by 36 trainees. The majority reported that the guidance received during intubation was helpful, the postprocedure feedback was educational and their confidence levels were increased. Trainees appreciated a controlled environment and calm, consistent guidance. They found intubations in the delivery room, those involving unstable infants, large audiences and parental presence more stressful. Responses were positive whether the videolaryngoscope screen was visible or covered, emphasising the importance of consistent guidance. Overall, 16% of intubations were reported as intimidating. CONCLUSION: The shared airway view offered by videolaryngoscopy was well received. In addition, taking measures to control the setting, with standardised guidance and feedback, improved confidence and created a more positive learning experience.
Assuntos
Intubação Intratraqueal/métodos , Laringoscopia/educação , Laringoscopia/métodos , Competência Clínica , Humanos , Recém-NascidoRESUMO
BACKGROUND: Videolaryngoscopy is increasingly advocated as the standard intubation technique, while fibreoptic intubation is broadly regarded as the 'gold standard' for difficult airways. Traditionally, the training of these techniques is on patients, though manikins, simulators and cadavers are also used, with their respective limitations. In this study, we investigated whether the novel 'Fix for Life' (F4L) cadaver model is a suitable and realistic model for the teaching of these two intubation techniques to novices in airway management. METHODS: Forty consultant anaesthetists and senior trainees were instructed to perform tracheal intubation with videolaryngoscopy and fibreoptic tracheoscopy in four F4L cadaver models. The primary outcome measure was the verbal rating scores (scale 1-10, higher scores indicate a better rating) for suitability and for realism of the F4L cadavers as training model for these techniques. Secondary outcomes included success rates of the procedures and the time to successful completion of the procedures. RESULTS: The mean verbal rating scores for suitability and realism for videolaryngoscopy was 8.3 (95% CI, 7.9-8.6) and 7.2 (95% CI, 6.7-7.6), respectively. For fibreoptic tracheoscopy, suitability was 8.2 (95% CI, 7.9-8.5) and realism 7.5 (95% CI, 7.1-7.8). In videolaryngoscopy, 100% of the procedures were successful. The mean (SD) time until successful tracheal intubation was 34.8 (30.9) s. For fibreoptic tracheoscopy, the success rate was 96.3%, with a mean time of 89.4 (80.1) s. CONCLUSIONS: We conclude that the F4L cadaver model is a suitable and realistic model to train and teach tracheal intubation with videolaryngoscopy and fibreoptic tracheoscopy to novices in airway management training.
Assuntos
Manuseio das Vias Aéreas , Anestesiologistas/educação , Tecnologia de Fibra Óptica/educação , Intubação Intratraqueal , Laringoscopia/educação , Cirurgia Vídeoassistida/educação , Adulto , Manuseio das Vias Aéreas/métodos , Cadáver , Desenho de Equipamento/métodos , Feminino , Tecnologia de Fibra Óptica/métodos , Humanos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Cirurgia Vídeoassistida/métodosRESUMO
PURPOSE: Fiberoptic laryngoscopy (FOL) is a critical tool for the diagnosis, staging, assessment of treatment response, and detection of recurrence for head and neck (H&N) malignancies. No standardized recommendations exist for procedural FOL education in radiation oncology. We therefore implemented a pilot simulation workshop to train radiation oncology residents in pertinent H&N anatomy and FOL technique. METHODS AND MATERIALS: A 2-phase workshop and simulation session was designed. Residents initially received a lecture on H&N anatomy and the logistics of the FOL examination. Subsequently, residents had a practical session in which they performed FOL in 2 simulated environments: a computerized FOL program and mannequin-based practice. Site-specific attending physicians were present to provide real-time guidance and education. Pre- and postworkshop surveys were administered to the participants to determine the impact of the workshop. Subsequently, postgraduate year (PGY)-2 residents were required to complete 6 supervised FOL examinations in clinic and were provided immediate feedback. RESULTS: Annual workshops were performed in 2017 to 2019. The survey completion rate was 14 of 18 (78%). Participants ranged from fourth-year medical students to PGY-2 to PGY-5 residents. All PGY-2 residents completed their 6 supervised FOL examinations. On a 5-point Likert scale, mean H&N anatomy knowledge increased from 2.4 to 3.7 (standard deviation = 0.6, P < .0001). Similarly, mean FOL procedural skill confidence increased from 2.2 to 3.3 (standard deviation = 0.7, P < .0001). These effects were limited to novice (fourth-year medical students to PGY-2) participants. All participants found the exercise clinically informative. CONCLUSIONS: A simulation-based workshop for teaching FOL procedural skills increased confidence and procedural expertise of new radiation oncology residents and translated directly to supervised clinical encounters. Adoption of this type of program may help to improve resident training in H&N cancer.