Tracheostomy Management Skills Competency in Physical Medicine and Rehabilitation Residents

Abstract

This educational unit was developed to instruct physical medicine and rehabilitation residents on tracheostomy management in non-ventilator-dependent patients and to implement an objective assessment format to measure the attainment of these skills. Thirty-one subjects participated in a 2-day didactic and hands-on workshop supervised by an attending physiatrist, certified speech pathologists, and registered nurses. Assessment tools developed for this program address the basic competencies outlined by the Accreditation Council for Graduate Medical Education. To test the success of the standardized educational module, data have been collected on an ongoing basis for a period of 6 yrs. A before-and-after multiple-choice written examination, as well as simulated patient encounters consisting of eight segments divided into four stations, was used to assess knowledge acquisition and skill achievement. Before instruction, none of the 31 participants were able to perform appropriate tracheostomy care. After the workshop, 31 of 31 (100%) successfully demonstrated clinical proficiency in every segment of the evaluation element of the educational module. Furthermore, a significant increase in knowledge was observed in the multiple-choice examination from pretest to posttest (pretest, 52.7%; posttest, 84.5%). Participation in this module resulted in substantial acquisition of knowledge and skills regarding tracheostomy management for physical medicine and rehabilitation residents.

Improving knowledge, technical skills, and confidence among pediatric health care providers in the management of chronic tracheostomy using a simulation model

“…Similar results from other studies 15,18,22,23 indicate that health care providers are generally not comfortable caring for patients with a tracheostomy and lack an understanding of critical tracheostomy concepts. Smith-Miller 27 evaluated the comfort level of ICU graduate nurses before and after a tracheostomy educational session and found that baseline knowledge and comfort level were low (5.95 on scale 1-10; where 1 ¼ very comfortable and 10 ¼ very uncomfortable).…”

“…Current ACGME program requirements for pediatrics do not include routine or emergency tracheostomy management as a competency . Recently, Khademi et al demonstrated that educational and hands‐on skills sessions enhanced knowledge and improved skills in managing tracheostomies among physical medicine and rehabilitation residents. Several studies report that pediatric residents are not proficient in airway management skills .…”

Emergency airway and ventilator procedures for community based home care staff validation of an educational program

“…This hypothesis was supported by the significant improvement in comfort and skills test scores. Our participant pre‐test scores were comparable to others demonstrating that health care providers have opportunities to improve their emergency response skills. Participants demonstrated lower scores on the self‐assessment of comfort scores which suggests that HCS are aware of the need for ongoing skill development, and seek to improve their confidence and knowledge.…”

“…Our program is the first to describe this short, risk focused, simulation program focusing on tracheostomy, and ventilator care specifically designed for HCS. Others have described the use of didactic and simulation methods to teach primary care physicians, residents, and advanced practice nurses tracheostomy care and management skills, however, none of these have included ventilator management. While tracheostomy skills are important, mastery of tracheostomy management skills alone would not achieve the goal of improved patient safety.…”

“…A variety of evidence suggests that training for home health care providers is inadequate . Families report that nurses are unskilled and surveys of home care nursing staff have identified knowledge deficiencies in many critical areas of care .…”