Early Experiences with Training Programs

 

 

In 1983, Ovassapian and co-workers (11) published their experiences with a structured training program for flexible bronchoscopy-assisted (FBA) nasotracheal intubation. This program, primarily developed and instituted for anesthesia residents, first provided lectures on the function and handling of flexible fiberoptic bronchoscopes (FFBs) and practice on a bronchoscopy teaching model, then exposure of laryngeal structures by nasopharyngeal laryngoscopy in consenting patients recovering from general anesthesia at the postanesthesia care unit, and finally performance of awake FBA nasotracheal intubation in consenting patients (in whom this route of access was indicated) under topical anesthesia and conscious sedation.

Throughout the program, the residents were closely supervised by an experienced instructor who also evaluated and documented their performance. The 12 participating residents successfully completed 74 out of 75 awake FBA nasotracheal intubations attempted. The weakness of this program was primarily the need to obtain informed consent, limiting the number of patients available.

Ovassapian and co-workers (12) evaluated this structured training program for awake FBA nasotracheal intubation in comparison with traditional training of anesthesia residents (with 16 randomly selected participants in each group). Traditonal training (the see-one-do-one method) provided one demonstration of the procedure by the instructor in anesthetic practice and then performance by the resident on patients. Residents undergoing the structured training program were initially (in their first series on 6 selected patients) significantly more successful in performing awake FBA nasotracheal intubation (in 86 out of 96 attempts) than those who had traditional training (in 64 out of 96 attempts); the instructor had to identify the laryngeal structures on one and fourteen occasion(s), respectively, before successful tracheal intubation was performed by the resident.

Ovassapian also offered training of FBA tracheal intubation for practising anesthetists from other departments. The results of a questionnare survey among participants of these early hands-on workshops revealed that 35 percent of them could introduce these techniques into their clinical practice or improve their success rate (2). These results supported the value and effectiveness of workshops for dissemination of endoscopic skills by lectures, instruction, and practice on models.
 

 

Training Program for Anesthesia Residents