Developing Modules to Train Anesthesiology Residents & Medical Students in a Lung Isolation Technique.

ABSTRACT

BACKGROUND: One-lung ventilation (OLV) can be accomplished by using ether a double-lumen endotracheal tube (DLT) or a bronchial blocker. Patient factors, surgical requirements and the anesthesiologist's expertise influence technique choice. Bronchial blockers are in general less traumatic, safer to place, and suitable in a wider variety of scenarios than DLTs, but require greater technical skill. We designed a study to determine whether trainees can achieve OLV using a bronchial blocker on completion of a 4-week multimodal training module. METHODS: Anesthesia residents and medical students took part in didactic (lecture and video) and clinical simulation training. During simulation training, participants practiced placing a bronchial blocker under supervision until they performed the technique satisfactorily. Trainees could then practice independently as often as they wished. A skills check was performed during the supervised and after the independent practice; feedback was provided. For more advanced learners, practical clinical training was continued in the operating room. Assessments data (test scores and skills checks) were analyzed using the t-test. RESULTS: Difference between pre-test and post-test scores (didactics) was statistically significant (p=0.02) as was the number of skills checks items satisfactorily demonstrated by the 14 participants on the first supervised attempt and the last independent practice (simulation; p<0.01). All eight who performed one-lung isolation in the operating room were technically proficient in achieving adequate OLV to the satisfaction of the supervising attending anesthesiologist. CONCLUSIONS: This multimodal standardized teaching module which incorporates didactics, simulation training, and, for more advanced trainees, practical clinical experience, improves trainees' knowledge and skills in bronchial blocker placement and OLV.