Assessing the impact of comprehensive training curriculum on management of unanticipated difficult airway among anaesthesia resident doctors in a resource constraint setting: A before and after implementation study using Kirkpatricks model

There is significant gap in our approach to training and preparedness especially dealing in crisis situation of rare events such as unanticipated difficult airway. The question is,  how do we bridge that gap and ensure our residents are equipped with the knowledge, skills and confidence to tackle even the most challenging situations? High fidelity simulation scenario based teaching complement traditional way of teaching where students can acquire technical as well as non-technical skills to deal with unanticipated difficult airway effectively.

Research question:

Does comprehensive training curriculum on management of unanticipated difficult airway impact acquisition and retention of skills (technical and non-technical) among anesthesia residents?

Hypothesis:

H1: Implementation of comprehensive training curriculum will positively affect the attitude and confidence of anaesthesia trainee to handle airway emergencies in real world

H2: Implementation of comprehensive training curriculum on management of unanticipated difficult airway will decrease the total procedural time (time from declaring CICO situation to confirmation of ventilation)

H3: Implementation of comprehensive training curriculum on unanticipated difficult airway management will have no effect on retention of skills.

P: Resident Doctors of our Institute who have completed 12 months of training (2nd year and 3rd year JRs)

I: Comprehensive training curriculum on management of unanticipated difficult airway

C: Before and after intervention

O: Impact on skills and behavior to deal with unanticipated difficult airway in real-life (Kirkpatrick’s level 1 to 3)

Outcome assessment:

Following this, the training curriculum effectiveness will be assessed by Kirkpatrick model.

KP 1(reaction)- A Google form consisting of set of questionnaire will be given to all participants to gather feedback. (appendix 8)

KP2 (learning)-  A semi-structured interview of participants will be recorded and then themes will be prepared out of those interview transcripts to see the learning of participants from the curriculum. Simultaneously improvement in individual skills will be assessed by comparing data at 2 weeks to that at baseline. Retention of skills will be evaluated by comparing subjective and objective rating at 6 months from 2 weeks.

KP3 (behaviour): All the proforma filled up by the participants and observers between phase 2 and 3 will be evaluated by both the faculties to see the change in behaviour and practice of participant to handle airway emergencies.

Phase (time frame)

Description

|Preparation (15 days)

Course material, scenario script, simulation area, participants, faculty training, embedded participants training, rehearsal

|Baseline (after 1 week of preparation)

Simulation scenario- subjective and objective assessment

|Phase 1 (After 3 days)

Didactic lectures, vortex cognitive aid, video demonstration, demonstration on volunteers and manikins, practice on task trainer

|Phase 2 (After 2 weeks)

Simulation scenario- subjective and objective assessment, structured debriefing

|Self-evaluation and observation at real patient care

|Phase 3 (After 6 months)

Simulation scenario- subjective and objective assessment, structured debriefing.

|Evaluation

Using Kirkpatrick Model level 1, 2 and 3

|Data collection and analysis