Rapid implementation of COVID-19 tracheostomy simulation training to increase surgeon safety and confidence

Am J Otolaryngol. 2020 Sep-Oct;41(5):102574. doi: 10.1016/j.amjoto.2020.102574. Epub 2020 Jun 1.


Objective: To determine if rapid implementation of simulation training for anticipated COVID-19 tracheostomy procedures can increase physician confidence regarding procedure competency and use of enhanced personal protective equipment (PPE).

Methods: A brief simulation training exercise was designed in conjunction with the development of a COVID-19 Tracheostomy Protocol. The simulation training focused primarily on provider safety, pre and post-surgical steps and the proper use of enhanced PPE. Simulation training was performed in the simulation lab at the institution over 2 days. Pre and post self-evaluations were measured using standardized clinical competency questionnaires on a 5-point Likert Scale ranging from "No knowledge, unable to perform" up to "Highly knowledgeable and confident, independent."

Results: Physicians self-reported a significant increase in knowledge and competency immediately after completing the training exercise. Resident physicians increased from a mean score of 3.00 to 4.67, p-value 0.0041, mean increase 1.67 (CI 95% 0.81 to 2.52). Attending physicians increased from a mean score of 2.89 to 4.67, p-value 0.0002, mean increase 1.78 (CI 95% 1.14 to 2.42). Overall, all participants increased from a mean score of 3.06 to 4.71, p-value 0.0001, mean increase 1.65 (CI 95% 1.24 to 2.05).

Discussion: Implementation of this simulation training at our institution resulted in a significant increase in physician confidence regarding the safe performance of tracheostomy surgery in COVID-19 patients.

Implications for practice: Adoption of standardized COVID-19 tracheostomy simulation training at centers treating COVID-19 patients may result in improved physician safety and enhanced confidence in anticipation of performing these procedures in real-life scenarios.

Keywords: Airway; COVID-19; PPE; PSQI; Safety; Simulation; Tracheostomy.

MeSH terms

  • Betacoronavirus*
  • COVID-19
  • Clinical Competence*
  • Clinical Protocols
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / therapy*
  • Coronavirus Infections / transmission
  • Humans
  • Pandemics
  • Patient Selection
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / therapy*
  • Pneumonia, Viral / transmission
  • SARS-CoV-2
  • Simulation Training*
  • Tracheostomy / education*