Discussion

 

 

For many years, airway models have been used in teaching and training, particularly for emergency medicine residents and paramedics. Anesthesia residents should also first acquire hands-on experience in airway management (AM) techniques on models (14) and optional, in a further step, on full-scale simulation systems (15) before practising on actual patients.

 

More than two decades before, Ovassapian initiated a structured training program for teaching flexible bronchoscopy-assisted (FBA) tracheal intubation and airway evaluation, primarily intended for anesthesia residents. This program provided lectures for covering the theoretical background, formal hands-on training on airway models (for acquisition of sufficient manipulation skills), and instructor supervision (optional using video systems for concurrent constructive feedback) during the first series of practice on patients until obtaining acceptable clinical performance and competence. Comparable programs should be standard for all AM techniques (4). Unfortunately, hands-on training on airway models (and simulation systems) is still underused during anesthesia residency training (5, 7).

 

Anesthesia residency training programs usually are provided for subspeciality rotations (for example, rotations through obstetric and pediatric anesthesia) guided by instructors with appropriate expertise; however, as evaluated by recently published survey questionnaires (3, 5, 8, 13), only few institutions have a structured training program (block rotations) for advanced AM supervised by experienced instructors. Therefore it is not surprising, that many anesthesia residents still lack special knowledge and practical skills in handling the difficult airway (DA). Structured teaching and training of advanced AM techniques and practising strategies for DA management should be an integral part of any anesthesia residency training program as advocated by the Canadian Airway Focus Group (1); unfortunately, other published guidelines and recommendations for the management of the (un)anticipated DA have not incorporated these advocations. After formal hands-on training on models (and simulation systems), anesthesia residents should become familiar with advanced AM techniques first on elective patients to be prepared and trained mastering these techniques in difficult situations. Provision of regular practice throughout the remainder of their residency training is a prerequisite to obtain these objectives.

 

Anesthetists who have not been instructed and trained to perform FBA tracheal intubation and airway evaluation during their residency training face a special challenge in introducing these techniques into their clinical practice. Enhanced continued medical education activities and efficient instruction programs emerged; attendence to hands-on workshops may favourably change the practice patterns of anesthetists without or with less experiences in these techniques (2).
 

Staff anesthesists in general are not trained as teachers; they usually have no formal training in educational psychiology and methology, and frequently they do not use the educational resources available. With his outstanding textbooks (9, 10), Ovassapian gave us many advices and expert guidance serving as teachers in advanced AM techniques, particularly in FBA tracheal intubation and airway evaluation. The author of this special article wishes to express gratitude and admiration towards Ovassapian on behalf of his pioneer work for teaching of AM techniques.

 

 

References