Gaps in Training: Misunderstandings of Airway Management in Medical Students and Internal Medicine Residents

Abstract

Objectives (1) Evaluate baseline airway knowledge of medical students (MSs) and internal medicine (IM) residents. (2) Improve MS and IM resident understanding of airway anatomy, general tracheostomy and laryngectomy care, and management of airway emergencies. Methods A before-and-after survey study was carried out over a single academic year. MS and IM resident knowledge was evaluated before and after an educational, grand rounds–style lecture reviewing airway anatomy, tracheostomy tube components, tracheostomy and laryngectomy care, and clinical vignettes. The primary outcome measure was change in pre- and postlecture survey scores. Results Prelecture surveys were completed by 90 participants, and 83 completed a postlecture assessment. Postlecture scores were statistically improved for all questions on the assessment ( P < .001). Level of training did not confer an improved pre- or postlecture survey score. Discussion While the majority of participants in our study had previously cared for patients with a tracheostomy or laryngectomy, less than half were able to correctly address basic airway emergencies. Senior IM residents were no more proficient than MSs in addressing airway emergencies. The lack of formal airway training places patients at risk with routine care and in emergencies, demonstrating the need for formal airway education for early medical trainees. Implications for Practice Our data demonstrate a serious gap in MS and IM resident knowledge with respect to emergent airway care in patients with tracheostomies and laryngectomies. An interdepartmental collaborative curriculum offers a realistic and potentially life-saving solution for medical trainees.

Oral Intubation Attempts in Patients With a Laryngectomy: A Significant Safety Threat

“…Tokarz and colleagues' assessment of medical students and residents found that 25% would choose to orally intubate a hypothetical patient with a laryngectomy or occlude the stoma and supplement with oral/nasal oxygen. 13 The proportion choosing these potentially fatal options, which might be appropriate for a patient with a tracheostomy, did not improve with an increased level of clinical training, whereas a targeted educational intervention proved effective. Despite significant structural differences between the United States and United Kingdom, 14 we identified significant parallels across geographies in the challenges faced around management of laryngectomy cases.…”

“…As the number of total laryngectomies decreases due to organ preservation surgery and chemoradiation, 11 , 12 physicians, nurses, and allied health professionals encounter these advanced surgical airways less frequently, and associated knowledge and familiarity decline. Tokarz and colleagues’ assessment of medical students and residents found that 25% would choose to orally intubate a hypothetical patient with a laryngectomy or occlude the stoma and supplement with oral/nasal oxygen 13 . The proportion choosing these potentially fatal options, which might be appropriate for a patient with a tracheostomy, did not improve with an increased level of clinical training, whereas a targeted educational intervention proved effective.…”

Video‐Based Tracheostomy Care Education for Medical Students

“…Tokarz et al demonstrated that, among internal medicine and emergency medicine residents who have cared for patients with tracheostomy or laryngectomy, less than half were able to correctly address basic airway emergencies. 17 When primed with formal tracheostomy education, residents performed better following clinical rotations than their peers who attended rotations without a tracheostomy training course. 16 Therefore, formal education on airways and tracheostomy is a necessity in early medical education.…”

“…Despite this, previous studies have shown low confidence and knowledge levels with tracheostomy care in nonotolaryngologic providers. 2 , 14 - 17 …”

“…Formal training curriculums are an important primer to interactions with patients with tracheostomies, because exposure to patients in clinical settings alone is insufficient for gaining competency in managing airway emergencies. 17 Primary care physicians classified otolaryngology as one of the most highly relevant surgical disciplines and identified it as a surgical area in which they would benefit from additional exposure and training. 19 Some of the key deficits in primary care provider knowledge of otolaryngologic topics are indications for tracheostomy and airway obstruction, 19 emphasizing the importance of a standardized tracheostomy curriculum.…”