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Current Practices in Airway Training: An Analysis of Airway Curriculum Across
AOA & ACGME Accredited Emergency Medicine Residency Programs
Petrarca, M, D.O., Zabbo C, D.O., FACEP, FAAEM
Kent Hospital, Emergency Medicine Residency Program, Warwick, RI.
Introduction: Emergency physicians are experts in airway management. We examine
current practices in United States emergency medicine residency airway training in order
to understand the training practices that create experts in our field of medicine.
Methods: An electronic survey was emailed to program directors of AOA and ACGME
accredited emergency medicine residency programs. Email contact information for a
total of 188 programs was obtained directly from the AOA and ACGME match websites
or by following links from these websites. This electronic survey was emailed to all 188
of these programs and made available for completion from July 30, 2011 to December
20, 2011. Results were kept anonymous.
Results: We received 64 electronic responses for a response rate of 34% (64/188).
Responses were obtained from ACGME, AOA, and ACGME/AOA dual accredited
programs with percent responses of 73% (47/64), 23% (15/64), and 3% (2/64)
respectively. Programs typically placed strong emphasis on dedicated airway training
lecture hours. The mode range for annual dedicated lecture hours was greater than 10
hours but less than 20 hours, with 31% (20/64) of programs within this range.
A minority of programs, 28% (18/64), reported the utilization of a formal airway
course which was typically an in-house course or one sponsored by an educational
consortium between the program and a medical school. Notably, over 50% of the
programs utilized cadaveric labs including human, porcine, or sheep. In keeping with
the increased role of simulation training within medical education, 81% of programs
reported that their program or institution has a simulation lab, with 73% (47/64) requiring
residents to complete simulation curriculum.
Programs were also surveyed regarding the approximate numbers of airway
procedures completed by typical residents within the program. The full results are
available within the comprehensive result section. Notably, 84% (54/64) of programs
reported that their typical resident will only perform 20 or less pediatric intubations during
their training with 38% (24/64) performing 10 or less pediatric intubations. Rather
alarmingly, 41% of programs (26/64) reported that a typical resident will complete one or
less cricothyrotomies, and 48% (31/64) will perform one or less fiberoptic intubations.
Conclusion: There is variation in airway curriculum across emergency medicine
residency programs. Common themes across most programs include, a respectable
number of dedicated lecture hours, supplementation of airway training within the
operating room, use of cadaveric labs, and use of simulation training.
Target areas for improvement in emergency medicine resident training include
placing more emphasis on pediatric airway management, requiring all residents to
complete a targeted number of fiberoptic intubations, and requiring all residents to
complete simulation training especially with airway training techniques that are
infrequently utilized within each respective program such as cricothyrotomies.