Femtosecond dynamics of metal-centered and ligand-to-metal charge-transfer (t2g-based) electronic excited states in various solvents: A comprehensive study of IrBr6 2.

The photophysical properties of intraconfigurational metal-centered (MC) and ligand-to-metal charge transfer (LMCT) states were studied in a prototype low spin heavy d5 transition metal complex, IrBr6 2-. The femtosecond-to-picosecond dynamics of this complex was investigated in solutions of drastically different polarity (acetonitrile, chloroform, and water) by means of ultrafast broadband transient absorption spectroscopy. We observed that the system, when excited into the third excited [second LMCT, 2Uu'(T1u)] state, undergoes distortion from the Franck-Condon geometry along the t2g vibrational mode as a result of the Jahn-Teller effect, followed by rapid internal conversion to populate (90 fs) the second excited [first LMCT, 2Ug'(T1g)] state. Vibrational decoherence and vibrational relaxation (∼400 fs) in 2Ug'(T1g) precede the decay of this state via internal conversion (time constants, 2.8 and 3 ps in CH3CN and CHCl3 and 0.76 ps in water), which can also be viewed as back electron transfer and which leads into the intraconfigurational MC 2Ug'(T2g) state. This is the lowest-excited state, from which the system returns to the ground state. This MC state is metastable in both CH3CN and CHCl3 (lifetime, ∼360 ps), but is quenched via OH-mediated energy transfer in aqueous environments, with the lifetime shortening up to 21 ps in aqueous solutions. The cascade relaxation mechanism is the same upon excitation into the second excited state. Excitation of IrBr6 2- in chloroform into higher 2Uu'(T2u), 2Eu″(T2u), and 2Eg'(T1g) states is observed to populate the third excited 2Uu'(T1u) state within 100 fs. These experiments allow us to resolve the ultrafast relaxation coordinate and emphasize that the excited-state Jahn-Teller effect is a driving force in the ultrafast dynamics, even for heavy transition metal complexes with very significant spin-orbit interactions.

Perfecting practice: a protocol for assessing simulation-based mastery learning and deliberate practice versus self-guided practice for bougie-assisted cricothyroidotomy performance.

BACKGROUND: Simulation-based medical education (SBME) is a cornerstone for procedural skill training in residency education. Multiple studies have concluded that SBME is highly effective, superior to traditional clinical education, and translates to improved patient outcomes. Additionally it is widely accepted that mastery learning, which comprises deliberate practice, is essential for expert level performance for routine skills; however, given that highly structured practice is more time and resource-intensive, it is important to assess its value for the acquisition of rarely performed technical skills. The bougie-assisted cricothyroidotomy (BAC), a rarely performed, lifesaving procedure, is an ideal skill for evaluating the utility of highly structured practice as it is relevant across many acute care specialties and rare - making it unlikely for learners to have had significant previous training or clinical experience. The purpose of this study is to compare a modified mastery learning approach with deliberate practice versus self-guided practice on technical skill performance using a bougie-assisted cricothyroidotomy model. METHODS: A multi-centre, randomized study will be conducted at four Canadian and one American residency programs with 160 residents assigned to either mastery learning and deliberate practice (ML + DP), or self-guided practice for BAC. Skill performance, using a global rating scale, will be assessed before, immediately after practice, and 6 months later. The two groups will be compared to assess whether the type of practice impacts performance and skill retention. DISCUSSION: Mastery learning coupled with deliberate practice provides systematic and focused feedback during skill acquisition. However, it is resource-intensive and its efficacy is not fully defined. This multi-centre study will provide generalizable data about the utility of highly structured practice for technical skill acquisition of a rare, lifesaving procedure within postgraduate medical education. Study findings will guide educators in the selection of an optimal training strategy, addressing both short and long term performance.

Force of Habit: Developing Situation Awareness in Critical Care Transport.

Situation awareness (SA) is a vital cognitive skill for high-stakes, high-hazard occupations, including military, aviation, and health care. The ability to maintain SA can deteriorate in stressful situations, exposing patients to dangerous errors. The literature regarding how to best teach SA techniques is sparse. This article explores specific techniques to promote and maintain SA in dynamic clinical environments using principles derived from cognitive psychology, neuroscience, and human behavioral and organizational research. The authors propose strategies to help individuals and teams to develop ingrained, subconscious behaviors that can help to maintain effective SA in high-stress environments. Situation awareness (SA) is critical in high-stakes circumstances, such as the resuscitation of critically ill or injured patients. Exploratory research in psychology, neuroscience, human factors engineering, and to a lesser extent health care has led to a deeper understanding of what SA is and how it can be measured. Unfortunately, little is known about how we can adapt training in order to more consistently create behaviors that heighten SA during dynamic, high-stakes clinical events. In this article, the prevailing theory of SA is reviewed, and the evidence for evaluating it in medicine is presented. In addition, the authors draw from the fields of neuroscience and cognitive psychology to suggest some strategies that can develop effective behaviors that promote SA in resuscitation.

Trauma Non-Technical Training (TNT-2): the development, piloting and multilevel assessment of a simulation-based, interprofessional curriculum for team-based trauma resuscitation.

Medical error is common during trauma resuscitations. Most errors are nontechnical, stemming from ineffective team leadership, nonstandardized communication among team members, lack of global situational awareness, poor use of resources and inappropriate triage and prioritization. We developed an interprofessional, simulation-based trauma team training curriculum for Canadian surgical trainees. Here we discuss its piloting and evaluation.

Dream one, do one, teach one: a mental practice script for bougie assisted cricothyrotomy.

Mental practice is an effective method for skill acquisition in medicine. We describe the integration of interview-derived sensory cues with a list of procedural steps into a cohesive script to facilitate mental practice for a High Acuity, Low-Occurrence procedure, the bougie-assisted cricothyrotomy. Data collection occurred through interviews with emergency physicians. Interview transcripts were analyzed on a coding framework based on a previously published list of procedural steps. These cues were integrated with procedural steps to create a narrative script. Eight interview transcripts were analyzed. A total of 328 cues were identified. On average, each participant identified 13.7 cues per procedure. This represents the first attempt to combine cues identified by practitioners along with procedural steps with the aim of supporting rich mental representations of a procedure. We expect that this script will be useful to physicians seeking to improve their skills in this rare procedure.

RéSUMé: La pratique mentale est une méthode efficace d'acquisition de compétences en médecine. Nous décrivons l'intégration d'indices sensoriels dérivés de l'entrevue avec une liste d'étapes procédurales dans un scénario cohésif pour faciliter la pratique mentale pour une procédure de haute acuité, de faible occurrence, la cricothyrotomie assistée par bougie. La collecte de données s'est faite au moyen d'entrevues avec des médecins urgentistes. Les transcriptions des entrevues ont été analysées selon un cadre de codage fondé sur une liste d'étapes procédurales déjà publiée. Ces indices ont été intégrés aux étapes procédurales pour créer un scénario narratif. Huit transcriptions d'entrevues ont été analysées. Au total, 328 indices ont été identifiés. En moyenne, chaque participant a identifié 13,7 indices par procédure. Il s'agit de la première tentative de combiner des indices identifiés par les praticiens avec des étapes procédurales dans le but de soutenir des représentations mentales riches d'une procédure. Nous nous attendons à ce que ce texte soit utile aux médecins qui cherchent à améliorer leurs compétences dans cette procédure rare.

Beyond crisis resource management: new frontiers in human factors training for acute care medicine.

PURPOSE OF REVIEW: Error is ubiquitous in medicine, particularly during critical events and resuscitation. A significant proportion of adverse events can be attributed to inadequate team-based skills such as communication, leadership, situation awareness and resource utilization. Aviation-based crisis resource management (CRM) training using high-fidelity simulation has been proposed as a strategy to improve team behaviours. This review will address key considerations in CRM training and outline recommendations for the future of human factors education in healthcare. RECENT FINDINGS: A critical examination of the current literature yields several important considerations to guide the development and implementation of effective simulation-based CRM training. These include defining a priori domain-specific objectives, creating an immersive environment that encourages deliberate practice and transfer-appropriate processing, and the importance of effective team debriefing. Building on research from high-risk industry, we suggest that traditional CRM training may be augmented with new training techniques that promote the development of shared mental models for team and task processes, address the effect of acute stress on team performance, and integrate strategies to improve clinical reasoning and the detection of cognitive errors. SUMMARY: The evolution of CRM training involves a 'Triple Threat' approach that integrates mental model theory for team and task processes, training for stressful situations and metacognition and error theory towards a more comprehensive training paradigm, with roots in high-risk industry and cognitive psychology. Further research is required to evaluate the impact of this approach on patient-oriented outcomes.

Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice.

OBJECTIVES: Simulation-based technical skills training is now ubiquitous in medicine, particularly for high acuity, low occurrence (HALO) procedures. Mastery learning and deliberate practice (ML + DP) are potentially valuable educational methods, however, they are resource intensive. We sought to compare the effect of deliberate practice and mastery learning versus self-guided practice on skill performance of the rare, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC). METHODS: We conducted a multi-center, randomized study at five North American emergency medicine (EM) residency programs. We randomly assigned 176 EM residents to either the ML + DP or self-guided practice groups. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test), after (post-test) and 6-12 months (retention) after the training session. The primary outcome was post-test skill performance using a global rating score (GRS). Secondary outcomes included performance time and skill performance at the retention test. RESULTS: Immediately following training, GRS scores were significantly higher as mean performance improved from pre-test, (22, 95% CI = 21-23) to post-test (27, 95% CI = 26-28), (p < 0.001) for all participants. However, there was no difference between the groups on GRS scores (p = 0.2) at the post-test or at the retention test (p = 0.2). At the retention test, participants in the ML + DP group had faster performance times (66 s, 95% CI = 57-74) compared to the self-guided group (77 s, 95% CI = 67-86), (p < 0.01). CONCLUSIONS: There was no significant difference in skill performance between groups. Residents who received deliberate practice and mastery learning demonstrated an improvement in skill performance time.

ABSTRAIT: OBJECTIFS: La formation aux compétences techniques fondée sur la simulation est maintenant omniprésente en médecine, en particulier pour les procédures de grande acuité et de faible occurrence (HALO). L'apprentissage de la maîtrise et la pratique délibérée (ML+DP) sont des méthodes éducatives potentiellement précieuses, mais elles exigent beaucoup de ressources. Nous avons cherché à comparer l'effet de la pratique délibérée et de l'apprentissage de la maîtrise par rapport à la pratique autoguidée sur le rendement des compétences de la rare intervention de sauvetage, une cricothyroïdotomie à la bougie. MéTHODES: Nous avons mené une étude multicentrique randomisée dans le cadre de cinq programmes nord-américains de résidence en médecine d'urgence. Nous avons affecté au hasard 176 résidents en SE aux groupes de ML+DP ou de pratique autoguidée. Trois experts des voies respiratoires aveuglés ont évalué de façon indépendante la performance des compétences en BAC par examen vidéo avant (pré-test), après (post-test) et 6 à 12 mois (rétention) après la séance de formation. Le principal résultat a été le rendement des compétences après le test au moyen d'une cote globale (SRC). Les résultats secondaires comprenaient le temps consacré au rendement et le rendement des compétences au test de rétention. RéSULTATS: Immédiatement après la formation, les résultats des SRC étaient beaucoup plus élevés, car le rendement moyen s'est amélioré entre le prétest (22, IC à 95 % = 21 à 23) et le post-test (27, IC à 95 % = 26 à 28), (p < 0,001) pour tous les participants. Cependant, il n'y avait aucune différence entre les groupes sur les scores GRS (p = 0,2) au post-test ou au test de rétention (p = 0,2). Au test de rétention, les participants du groupe ML+DP avaient des temps de performance plus rapides (66 secondes, IC à 95 % = 57 à 74) que ceux du groupe autoguidé (77 secondes, IC à 95 % = 67 à 86) (p < 0,01). CONCLUSIONS: Il n'y avait pas de différence significative dans le rendement des compétences entre les groupes. Les résidents qui ont bénéficié d'une pratique délibérée et d'un apprentissage de la maîtrise ont démontré une amélioration du temps consacré aux compétences.

Defining adverse events during trauma resuscitation: a modified RAND Delphi study.

BACKGROUND: The majority of preventable adverse event (AEs) in trauma care occur during the initial phase of resuscitation, often within the trauma bay. However, there is significant heterogeneity in reporting these AEs that limits performance comparisons between hospitals and trauma systems. The objective of this study was to create a taxonomy of AEs that occur during trauma resuscitation and a corresponding classification system to assign a degree of harm. METHODS: This study used a modified RAND Delphi methodology to establish a taxonomy of AEs in trauma and a degree of harm classification system. A systematic review informed the preliminary list of AEs. An interdisciplinary panel of 22 trauma experts rated these AEs through two rounds of online surveys and a final consensus meeting. Consensus was defined as 80% for each AE and the final checklist. RESULTS: The Delphi panel consisted of 22 multidisciplinary trauma experts. A list of 57 evidence-informed AEs was revised and expanded during the modified Delphi process into a finalized list of 67 AEs. Each AE was classified based on degree of harm on a scale from I (no harm) to V (death). DISCUSSION: This study developed a taxonomy of 67 AEs that occur during the initial phases of a trauma resuscitation with a corresponding degree of harm classification. This taxonomy serves to support a standardized evaluation of trauma care between centers and regions. LEVEL OF EVIDENCE: Level 5.

Trauma Resuscitation Using in situ Simulation Team Training (TRUST) study: latent safety threat evaluation using framework analysis and video review.

INTRODUCTION: Trauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs). In situ simulation (ISS) provides a novel prospective approach to recreate clinical situations that may manifest LSTs. Using ISS coupled with a human factors-based video review and modified framework analysis, we sought to identify and quantify LSTs within trauma resuscitation scenarios. METHODS: At a level 1 trauma centre, we video recorded 12 monthly unannounced ISS to prospectively identify trauma-related LSTs. The on-call multidisciplinary trauma team participated in the study. Using a modified framework analysis, human factors experts transcribed and coded the videos. We identified LST events, categorised them into themes and subthemes and used a hazard matrix to prioritise subthemes requiring intervention. RESULTS: We identified 843 LST events during 12 simulations, categorised into seven themes and 38 subthemes, of which 23 are considered critical. The seven themes relate to physical workspace, mental model formation, equipment, unclear accountability, demands exceeding individuals' capacity, infection control and task-specific issues. The physical workspace theme accounted for the largest number of critical LST events (n=152). We observed differences in LST events across the four scenarios; complex scenarios had more LST events. CONCLUSIONS: We identified a diverse set of critical LSTs during trauma resuscitations using ISS coupled with video-based framework analysis. The hazard matrix scoring, in combination with detailed LST subthemes, supported identification of critical LSTs requiring intervention and enhanced efforts intended to improve patient safety. This approach may be useful to others who seek to understand the contributing factors to common LSTs and design interventions to mitigate them.

An Active Shooter in Your Hospital: A Novel Method to Develop a Response Policy Using In Situ Simulation and Video Framework Analysis.

Hospital shootings (Code Silver) are events that pose extreme risk to staff, patients, and visitors. Hospitals are faced with unique challenges to train staff and develop protocols to manage these high-risk events. In situ simulation is an innovative technique that can evaluate institutional responses to emergent situations. This study highlights the design of an active shooter in situ simulation conducted at a Canadian level-1 trauma center to test a Code Silver active shooter protocol response. We further apply a modified framework analysis to extract latent safety threats (LSTs) from the simulation using ethnographic observation of the response by law enforcement, hospital security, logistics, and medical personnel.The video-based framework analysis identified 110 LSTs, which were assigned hazard scores, highlighting 3 high-risk LSTs that did not have effective control measures or were not easily discoverable. These included lack of security during patient transport, inadequate situational awareness outside the clinical area, and poor coordination of critical tasks among interprofessional team members. In situ simulation is a novel approach to support the design and implementation of similar events at other institutions. Findings from ethnographic observations and a video-based analysis form a structured framework to address safety, logistical, and medical response considerations.

The Mindset of the Resuscitationist.

Excellent resuscitation requires technical skills and knowledge, but also the right mindset. Expert practitioners must master their internal affective state, and create the environment that leads to optimal team performance. Leaders in resuscitation should use structured approaches to prepare for resuscitation, and psychological skills to enhance their performance including mental rehearsal, positive self-talk, explicit communication strategies, and situational awareness skills. Postevent recovery is equally important. Providers should have explicit plans for recovery after traumatic cases, including developing resilience and self-compassion. Experts in resuscitation can improve their performance (and that of their team) by consciously incorporating psychological skills into their armamentarium.

Just the Facts: What are the roles of oxygen escalation and noninvasive ventilation in COVID-19?

A 37-year-old female presents with cough, fever, dyspnea, and myalgias for five days after recent contact with a family member with confirmed 2019 coronavirus disease (COVID-19). Her vital signs include T 38.3° C, HR 108, BP 118/70 mm Hg, RR 26 breaths per minute, and oxygen saturation 67% on room air. She is not in respiratory distress currently and is protecting her airway. Her chest X-ray reveals bilateral airspace opacities. You plan to immediately intervene and address her hypoxia.

Pushing boundaries of video review in trauma: using comprehensive data to improve the safety of trauma care.

Adverse events and lapses in safety are identified after the fact and often discussed through postevent review. These rounds rely on personal recollection, information from patient charts and incident reports that are limited by retrospective data collection. This results in recall bias and inaccurate or insufficient detail related to timeline, incidence and nature adverse events. To better understand the interplay of the complex team and task-based challenges in the trauma bay, we have developed a synchronized data capture and analysis platform called the Trauma Black Box (Surgical Safety Technologies, Toronto). This system continuously acquires audiovisual, patient physiological and environmental data from a sophisticated array of wall-mounted cameras, microphones and sensors. Expert analysts and software-based algorithms then populate a data timeline of case events from start to finish, retaining a handful of anonymized video clippings to supplement the review. These data also provide a consistent and reliable method to track specific quality metrics, such as time to trauma team assembly or time to blood product arrival. Furthermore, data can also be linked to patients' electronic medical records to explore relationships between initial trauma resuscitation and downstream patient-oriented outcomes. A video capture and data analysis system for the trauma bay overcomes the inherent deficiencies in the current standard for evaluating patient care in the trauma bay and offers exciting potential to enhance patient safety through a comprehensive data collection system.

Just the facts: What drugs are safe and effective for COVID-19?

A 53-year-old male presents with cough, fever, and myalgias for 7 days. Vitals include temperature, 38.0°C; heart rate, 110; blood pressure, 118/70 mm Hg; respiration rate, 28; and oxygen saturation 83% on room air. His only past medical history is hypertension. Your community is in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The patient is hypoxic but responds to oxygen supplementation with nasal cannula and a face mask. His chest x-ray demonstrates multifocal infiltrates. Are there any therapeutic agents currently available for COVID-19?

Just the Facts: Protected code blue - Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic.

Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?

Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest - A systematic review and meta-analysis.

AIM: To summarize the prognostic associations of pre- and intra-arrest factors with return of spontaneous circulation (ROSC) and survival (in-hospital or 30 days) after traumatic out-of-hospital cardiac arrest. METHODS: We conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched Medline, Pubmed, Embase, Scopus, Web of Science and the Cochrane Database of Systematic Reviews from inception through December 1st, 2019. We included English language studies evaluating pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA. Risk of bias was assessed using the QUIPS tool. We pooled unadjusted odds ratios using random-effects models and presented adjusted odds ratios with 95% confidence intervals. We used the GRADE method to describe certainty. RESULTS: We included 53 studies involving 37,528 patients. The most important predictors of survival were presence of cardiac motion on ultrasound (odds ratio 33.91, 1.87-613.42, low certainty) or a shockable initial cardiac rhythm (odds ratio 7.29, 5.09-10.44, moderate certainty), based on pooled unadjusted analyses. Importantly, mechanism of injury was not associated with either ROSC (odds ratio 0.97, 0.51-1.85, very low certainty) or survival (odds ratio 1.40, 0.79-2.48, very low certainty). CONCLUSION: This review provides very low to moderate certainty evidence that pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA predict ROSC and survival. This evidence is primarily based on unadjusted data. Further well-designed studies with larger cohorts are warranted to test the adjusted prognostic ability of pre- and intra-arrest factors and guide therapeutic decision-making.

Design Thinking-Informed Simulation: An Innovative Framework to Test, Evaluate, and Modify New Clinical Infrastructure.

INTRODUCTION: Designing new healthcare facilities is complex and transitions to new clinical environments carry high risks, as unanticipated problems may arise resulting in inefficient care and patient harm. Design thinking, a human-centered design method, represents a unique framework to support the planning, testing, and evaluation of new clinical spaces throughout all phases of construction. Healthcare simulation has been used to test new clinical spaces, yet most report using simulation only in the late design stages. Moreover, healthcare design models have potentially underused human factors approaches calling for human-centered design. We applied a multimodal simulation-based approach underpinned by the principles of design thinking throughout the planning and construction stages of a newly renovated academic emergency department. METHODS: A multidisciplinary team developed and integrated 3 simulation strategies (table-top, mock-up, and in situ simulation) into the 5-step process of design thinking. Through end-user engagement, we identified potential challenges, prototyped solutions through table-top and mock-up simulations, and iteratively tested these solutions through in situ simulation within the actual clinical space. RESULTS: The team used end-user engagement and feedback to brainstorm and implement effective solutions to problems encountered before opening the new emergency department. The iterative steps and targeted use of simulation resulted in redesigning departmental processes and actual clinical space while mitigating anticipated safety threats and departmental deficiencies. CONCLUSIONS: Design thinking coupled with multimodal simulation across all phases of construction enhanced the design and testing of new clinical infrastructure. Applying this approach early, thoroughly, and efficiently will help healthcare organizations plan changes to clinical spaces.

Understanding diagnosis through ACTion: evaluation of a point-of-care checklist for junior emergency medical residents.

Background Avoiding or correcting a diagnostic error first requires identification of an error and perhaps deciding to revise a diagnosis, but little is known about the factors that lead to revision. Three aspects of reflective practice, seeking Alternative explanations, exploring the Consequences of missing these alternative diagnoses, identifying Traits that may contradict the provisional diagnosis, were incorporated into a three-point diagnostic checklist (abbreviated to ACT). Methods Seventeen first and second year emergency medicine residents from the University of Toronto participated. Participants read up to eight case vignettes and completed the ACT diagnostic checklist. Provisional and final diagnoses and all responses for alternatives, consequences, and traits were individually scored as correct or incorrect. Additionally, each consequence was scored on a severity scale from 0 (not severe) to 3 (very severe). Average scores for alternatives, consequences, and traits and the severity rating for each consequence were entered into a binary logistic regression analysis with the outcome of revised or retained provisional diagnosis. Results Only 13% of diagnoses were revised. The binary logistic regression revealed that three scores derived from the ACT tool responses were associated with the decision to revise: severity rating of the consequence for missing the provisional diagnosis, the percent correct for identifying consequences, and the percent correct for identifying traits (χ2 = 23.5, df = 6, p < 0.001). The other three factors were not significant predictors. Conclusions Decisions to revise diagnoses may be cued by the detection of contradictory evidence. Education interventions may be more effective at reducing diagnostic error by targeting the ability to detect contradictory information within patient cases.

Bougie-assisted cricothyroidotomy: Delphi-derived essential steps for the novice learner.

OBJECTIVE: A cricothyroidotomy is a life-saving procedure, performed as a final option to emergency airway algorithms, and is essential for all clinicians who perform emergency airway management. The bougie-assisted cricothyroidotomy (BAC) is a novel technique that may be performed faster and with fewer complications than other traditional approaches. There is no established standard set of steps to guide the instruction of BAC performance. This study sought to systematically develop a BAC checklist for novice instruction using a modified Delphi methodology and international airway experts. METHODS: A literature review informed the creation of a preliminary BAC checklist. A three round, modified Delphi method was used to establish a BAC checklist intended for novice-level instruction. The consensus level for each step and the final checklist were predefined at 80%. Participants were international airway experts identified by study personnel and snowball sampling. RESULTS: Fourteen international airway experts across six acute care specialities participated in the study. The checklist was refined using a seven-point rating scale for each item and participant comments. A 17-item checklist was developed with expert consensus achieved after three rounds. Internal consistency, measured with Cronbach's α, was 0.855 (95% confidence interval 0.73-0.94). CONCLUSION: This modified Delphi-derived checklist is the first systematically developed list of essential steps for guiding BAC instruction for novice learners. This tool serves to standardize BAC skill instruction and provide learners with a structured and consistent set of steps for deliberate practice.