Training technical and nontechnical skills for managing unexpected difcult airways in anesthesia!

Michaela Kolbe, Mona Weiss, Gudela Grote (ETH Zurich)! Bastian Grande, Axel Knauth, Micha Dambach, Adrian Marty, Donat R. Spahn (University Hospital Zurich)"

ComTrain"
Combined training of technical and non-technical skills " For managing unexpected difcult airway situations" For doctors and nurses " Simulation-based" Ongoing project"

Why focusing on unexpected difcult airway situations?"

Most common cause of anesthetic death or brain damage; associated with severe morbidity and mortality (Abernathy et al., 2010)" So far considered only from perspective of single anesthesia care provider - the fact that it involves more than just one single anesthesiologist (= Team) not yet acknowledged" Teamwork likely to break down during stress (Driskell et al., 1999)"

ComTrain "
!! Training teams as they occur in daily
anesthesia life (i.e., residents, nurses, attendings if possible)" skills"

!! Training technical & non-technical !! Training via simulation (e.g., unexpected

difcult intubation; CVCI; using SimMan (Laerdal)) and structured debrieng!

Non-technical skills"
CRM-principles (Rall & Gaba, 2005)" Anaesthetists NonTechnical Skills (ANTS) (Fletcher et al., 2003)" Previous research of the effectivity of anesthesia teams (e.g.., Knzle et al., 2010a,b; Kolbe et al., 2011; Manser et al., 2009)"

Technical skills"

Structured Debrieng!
based on ..."
... Guided team self-correction (Smith-Jentsch et al., 2008)" ... Advocacy & Inquiry (Rudolph et al., 2007)" ... Systemic questioning (Kriz, 2010)"

Structured Debrieng"

Structured Debrieng"

Structured Debrieng"

Evaluating ComTrain"
Evaluating team training outcomes !
(Salas et al., 2009; Weaver et al., 2011): " Measures under construction ... "

Ongoing video analysis ... " NGSE (Chen et al., 2001)" SAQ (Modak et al., 2007)"

Evaluating team training:"

Complete course" Debrieng"

End-of-course critique (Baker et al., 2005)" OSAD (Arora et al., in press)" DASH (Simon et al., 2009)"

First Conclusions"
!! !! !! !!
Self-efcacy signicantly increases after training - this suggests a positive effect of the combined debrieng methods that engage a proactive and engaging learning environment" The structured debrieng is perceivd as encouraging and stimulating pointing to a fruitful integration of different debrieng techniques" The combined technical and non-technical training is evaluated as highly relevant and applicable to the work context" While the training has only moderate or no effects on most safety attitudes, perceptions of teamwork climate decrease after training might be due to a more critical judgement of teamwork; safety attitudes no good criterion for assessing training impact (Cooper et al., 2008)" Both residents and nurses benet from a combined technical and nontechnical skills training"

!!

Thank you "