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From the Department of Anesthesia, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.
Address correspondence to: Dr. Viren Naik, Department of Anesthesia, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. Phone: 416-864-5071; Fax: 416-864-6014; E-mail: naikv{at}smh.toronto.on.ca
Purpose: Simulation centres, where trainees can practise technical procedures on models of varying fidelity, provide a training option that allows them to acquire skills in a controlled environment prior to clinical performance. It has been proposed that the time to complete a simulator task may translate to proficiency in the clinical setting. The objective of this study was to determine whether time to complete a simulator task translates to clinical fibreoptic manipulation (FOM) performance.
Methods: Thirty registered respiratory therapists at a teaching hospital were recruited as subjects for a single-blinded randomized trial. Subjects were randomized to training on either a low fidelity (n = 15) or high fidelity (n = 15) model. After training, each subject was tested for the time required to complete a specific task on his/her respective model. Subjects then performed a fibreoptic orotracheal intubation (FOI) on healthy, consenting, and anesthetised patients requiring intubation for elective surgery. Performance was measured independently by blinded examiners using a checklist and global rating scale (GRS); and time was measured from insertion of the fibreoptic scope to visualization of the carina. Data were analyzed using Spearman rank order correlation coefficients.
Results: There was no correlation between the time to complete a task on either the high or low fidelity simulators, and the clinical FOI performance as assessed by a checklist, GRS, and time to complete the FOM (all P = NS).
Conclusion: These results suggest that simulator-based, task-orientated time measurement may not be a good indicator of FOI performance in the clinical setting.
1 American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269–77.[Medline]
2 Henderson JJ, Popat MT, Latto IP, Pearce AC; Difficult Airway Society. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59: 675–94.[Medline]
3 Koppel JN, Reed AP. Formal instruction in difficult airway management. A survey of anesthesiology residency programs. Anesthesiology 1995; 83: 1343–6.[Medline]
4 Wood PR, Dresner M, Lawler PG. Training in fibreoptic tracheal intubation in the north of England. Br J Anaesth 1992; 69: 202–3.
5 Goldmann K, Steinfeldt T. Acquisition of basic fiberoptic intubation skills with a virtual reality airway simulator. J Clin Anesth 2006; 18: 173–8.[Medline]
6 Naik VN, Matsumoto ED, Houston PL, et al. Fiberoptic orotracheal intubation on anesthetized patients: do manipulation skills learned on a simple model transfer into the operating room? Anesthesiology 2001; 95: 343–8.[Medline]
7 Rowe R, Cohen RA. An evaluation of a virtual reality airway simulator. Anesth Analg 2002; 95: 62–6.
8 Aggarwal R, Tully A, Grantcharov T, et al. Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG 2006; 13: 1382–7.
9 Datta V, Bann S, Beard J, Mandalia M, Darzi A. Comparison of bench test evaluations of surgical skill with live operating performance assessments. J Am Coll Surg 2004; 199: 603–6.[Medline]
10 Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 2004; 91: 146–50.[Medline]
11 Seymour NE, Gallagher AG, Roman SA, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002; 236: 458–63.[Medline]
12 Reznick R, Regehr G, MacRae H, Martin J, McCulloch W. Testing technical skill via an innovative «bench station » examination. Am J Surg 1997; 173: 226–30.[Medline]
13 Morgan PJ, Cleave-Hogg D, Guest CB. A comparison of global ratings and checklist scores from an undergraduate assessment using an anesthesia simulator. Acad Med 2001; 76: 1053–5.[Medline]
14 Morgan PJ, Cleave-Hogg D, DeSousa S, Tarshis J. High-fidelity patient simulation: validation of performance checklists. Br J Anaesth 2004; 92: 388–92.
15 Scavone BM, Sproviero MT, McCarthy RJ, et al. Development of an objective scoring system for measurement of resident performance on the human patient simulator. Anesthesiology 2006; 105: 260–6.[Medline]
16 Fried GM, Feldman LS, Vassiliou MC, et al. Proving the value of simulation in laparoscopic surgery. Ann Surg 2004; 240: 518–25.[Medline]
17 Bandi V, Munnur U, Braman SS. Airway problems in patients with rheumatologic disorders. Crit Care Clin 2002; 18: 749–65.[Medline]
18 Issenberg SB, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10–28.[Medline]
19 Fried GM. Lessons from the surgical experience with simulators: incorporation into training and utilization in determining competency. Gastrointest Endosc Clin N Am 2006; 16: 425–34.[Medline]
20 Crosby E. Modelling the difficult airway--how real is faking it? (Editorial). Can J Anesth 2002; 49: 448–52.
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