High-fidelity medical simulation as an assessment tool for pediatric residents' airway management skills

Pediatr Emerg Care. 2007 Jan;23(1):11-5. doi: 10.1097/PEC.0b013e31802c61d5.

Abstract

Objectives: To evaluate high-fidelity medical simulation as an assessment tool for pediatric residents' ability to manage an acute airway.

Methods: We performed a prospective, observational study in which 16 pediatric residents were consented and then brought to the medical simulation center. They were placed in 2 different computer-driven scenarios and asked to manage the cases. The first scenario was a 3-month-old infant with bronchiolitis and severe respiratory distress and was programmed to develop respiratory failure. The second case was a 16-year-old adolescent with alcohol intoxication and respiratory depression and was programmed for emesis and aspiration. Both cases included a nurse, parent, and intern. We recorded performance of predetermined critical actions and any harmful actions.

Results: There were 47 attempts at intubation with 27 successes (56%). Appropriate preoxygenation was performed in 15 (47%) of 32 cases. Appropriate rapid sequence induction was administered in 21 (66%) of 32 cases. Cricoid pressure was applied in 20 (63%) of 32 cases. End-tidal carbon dioxide detector was used in 11 (34%) of 32 cases. A nasogastric tube was placed in 14 (44%) of 32 cases. Harmful actions included rapid sequence induction administered before intubation equipment setup, bag-valve mask not connected to oxygen, inappropriate endotracheal tube size, pulling cuffed endotracheal tube out while inflated, and placing the laryngoscope blade on backwards.

Conclusions: Our data identified many areas of concern with resident skills in managing an airway. This project suggests that high-fidelity medical simulation can assess a resident's ability to manage an airway as well as a program's effectiveness in teaching the skills necessary to manage an acute pediatric airway.

MeSH terms

  • Clinical Competence*
  • Computer Simulation
  • Humans
  • Internship and Residency*
  • Intubation, Intratracheal / standards*
  • Patient Simulation*
  • Pediatrics / education*
  • Prospective Studies
  • Respiratory Tract Diseases / therapy*