C2B - 08: AN EFFECTIVE MULTI-MODALITY MODEL FOR SINGLE-SESSION CRICOTHYROIDOTOMY TRAINING FOR TRAINEES
Charity Glass, MD1, Charles Parsons, MD1, Nakul Raykar, MD1, Ammara Watkins, MD1, Sayuri Jinadasa1, Sarah Carlson, MD2, Denis Gilmore, MD3, Alok Gupta, MD1; 1Beth Israel Deaconess Medical Center, 2Dartmouth-Hitchcock Medical Center, 3Vanderbilt University Medical Center
Background: Learning to perform cricothyroidotomy during routine clinical training is not always feasible, due to the infrequent need for an emergent airway. The ideal teaching method for this short, single operator procedure is not well understood. We piloted a new curriculum combining a flipped classroom with two-stage narration, role-play, and task trainer simulation to teach this critical skill to students, residents and fellows in surgery and anesthesia.
Methods: Medical students, surgical and anesthesia residents and critical care fellows participated in a flipped classroom module for open and percutaneous cricothyroidotomy (OC and PC) from 2012 to 2017. Participants were first required to watch two 4-minute training videos for OC and PC. The simulation session consisted of a brief discussion of a humanities reading, followed by a 45-minute hands-on simulation of OC and PC in which participants rotated between the roles of operator, narrator, and critiquer. Trainees were scored on their performance by an evaluation tool developed by a modified Delphi method. Major criteria included basic steps critical to correct performance of cricothyroidotomy, such as correct anatomical incision. Minor criteria were defined as those steps that facilitated performance, like demonstrating organization and foresight during the procedure. Median scores were calculated.
Results: Seventy-seven trainees were evaluated. Medical students, anesthesia and surgical residents, and critical care fellows represented 63%, 30%, and 7% of the total study population, respectively. The median performance score was 14 out of maximum 14 (range: 9-14) across all trainees for OC, with a median score of 10 (range: 7-10) for the major criteria and 4 (range: 1-4) for the minor criteria. The median performance score was 13 out of maximum 13 (range: 3-13) across all trainees for PC, with a median score of 9 (range: 3-9) for the major criteria and 4 (range: 0-4) for the minor criteria.
Conclusion: A multi-modality approach including the flipped classroom, role-play, and task trainer simulation is an efficient and effective method for teaching trainees proficiency in a short, single operator procedures such as open and percutaneous cricothyroidotomy that are rarely encountered in clinical practice.