Overall Approaches to Airway Training

A well-designed airway management training program works for trainee, supervisor, and patient. Trainees should advance their skills from initial training not involving actual patients to carefully supervised practice in clinical settings. In general, the better prepared the trainee is for the clinical practice setting the more likely they will succeed and the more valuable the actual hands-on practice becomes. Trial and failure is a bad approach with a laryngoscope or any device. “Learn as you go” is not helpful for trainee confidence and skill acquisition, and also works poorly for the supervisor, and the patient. Emergency airway management and intubation following rapid sequence intubation should be last in the training program, since this is the clinical setting of greatest patient risk.

An ideal, step-wise approach for airway training that ensures patient safety and optimizes the learning experience for trainees:

1. Intensive web-based training reviewing the basics of laryngeal and airway anatomy, including drawings and imaging through a myriad of modalities (endoscopy, stroboscopy, video laryngoscopy, Airway Cam imaging of direct laryngoscopy, etc.).
   
   
2. A unified, “best-practice” approach to each ventilation and intubation technique, and a detailed “best-practice” introduction to each device.  As trainees interact with different supervisors each supervisor can share their own approaches for a given technique, but every trainee should have a foundation that is agreed upon and public.  Once this is mastered, trainees can then expand their skills and learn different ways of performing the different techniques.
   
   
3. Mannequin training, ideally using at least two different mannequins, so trainees learn not just one idealized airway appearance and one mechanical response.
   
   
4. Cadaver training, if available.
   
   
5. Testing to verify a solid foundation of anatomy and “best-practice.”  Opportunity to detect and rectify deficiencies in understanding, mechanics, or other operator variables. Trainees should also have testing of visual acuity testing, accommodation-distance testing, and identification of ocular dominance.
   
   
6. Observing and learning airway anatomy in Otorhinolaryngology clinics (fiberoptic nasoendoscopy, stroboscopy, etc.).
   
   
7. Practice on live patients in the operating room, in elective anesthesia settings.  Mask and supraglottic ventilation is ideally practiced in this setting, and perhaps the most valuable component of anesthesia rotations.
   
   
8. Performing airway procedures in emergency settings, but on routine cases, and using first-line devices (laryngoscopes, video laryngoscopes, and other relatively straightforward, rigid instruments).
   
   
9. Performing advanced airway techniques in challenging, emergency situations (critically ill patient where first-pass success is absolutely required, or more technically challenging techniques: awake flexible fiberoptic intubation, surgical airway, etc.).