A simulation-based study evaluating the preparedness of interns’ post-anaesthesia rotation in managing a failed obstetric intubation scenario: Is our training good enough?

Abstract

Background. Difficult or failed intubation of obstetric patients may be up to 8 times higher than in general surgical patients. A decline in obstetric intubation opportunities may be a contributing factor, resulting in reduced training opportunities for junior doctors, who therefore do not acquire airway management skills. Objectives. To assess post-anaesthesia rotation interns' preparedness to manage a difficult/failed obstetric airway scenario. Methods. We recruited 49 interns, obtained informed consent and individually assessed them on a simulation-based scenario using a highfidelity manikin. Two independent assessors scored participants using a checklist assessment and a global rating scale. After the simulationbased scenario, participants completed a questionnaire on their internship training, rated the simulation experience and received debriefing. The borderline regression method was used to determine the checklist pass mark. Results. Analysis showed that 40% of interns passed. Correlation between assessors was strong for checklist scores and global ratings. The main reasons for failing were repeated attempts at intubation and failure to optimise the intubating position or conditions. There was concern regarding the infrequent use of a supraglottic airway device as a rescue. Twenty-eight interns had performed <5 general obstetric anaesthetic procedures. Conclusions. There are concerns regarding adequate anaesthetic preparation for interns to manage a difficult/failed intubation scenario in a full-term pregnancy. Despite the Essential Steps in Managing Obstetric Emergencies (ESMOE) airway module training, which all interns should receive, a high rate of success was not achieved in this study. Simulation-based training and assessment may be a valuable tool to improve intern training and preparedness.

South African medical interns’ perspectives on the use of point of care ultrasound

“…A concern regarding interns' readiness for community service was, however, observed in a recent study looking at simulation-based assessments of interns' management of failed obstetric intubation, where only 40% passed the assessment. 13 Additional research is needed to clarify this observation. Of interest is the response to the question of when ultrasound training should be introduced; 96% of the participants recommended that POCUS training be included at both undergraduate level and in the internship years.…”

Safe caesarean sections in South Africa: Is internship training sufficient?

“…Similar figures were found in another study, showing that only 53% of interns surveyed attended ESMOE. [13] These figures are concerning, given that ESMOE participation is compulsory for interns. Other simple surgical measures that can be taught to doctors performing CS include uterine artery ligation, the B-Lynch suture and the Foley's catheter uterine tourniquet.…”

“…With the increasing use of neuraxial techniques as the preferred form of anaesthetic for obstetric patients, interns have limited exposure to GA. A recently published study by Kiwalabye et al [13] questions if anaesthetic training of interns is satisfactory. The authors assessed interns after completion of their rotation using a high-fidelity difficult obstetric airway simulation -only 40% of interns passed.…”

Updates on Simulation in Obstetrical Anesthesiology Through the COVID-19 Pandemic

“…Simulation-based skills assessment has continued in line with advances in training. Kiwalabye and colleagues 27 assessed preparedness of anesthesia interns in managing a failed obstetric intubation following their anesthesiology rotation. They observed a pass rate of only 40% despite prior exposure to an Essential Steps in Managing Obstetric Emergencies training module, leading them to propose that this gap in skill acquisition discovered by simulated scenarios can be remedied through the use of simulation-based education during their training.…”