Justin_Milligan_EMERGENT_AIRWAY_ABSTRACT_(1)

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SURGICAL RESIDENT TRAINING: A SURVEY OF RESIDENT EXPOSURE AND PERCEIVED COMPETENCE WITH
EMERGENT SURGICAL AIRWAYS
Justin Milligan M.D. New Hanover Regional Medical Center, Wilmington, NC; Michael Zeigler M.D. New Hanover
Regional Medical Center, Wilmington, NC; William Powers M.D. New Hanover Regional Medical Center,
Wilmington, NC; Elizabeth Acquista M.D. FACS New Hanover Regional Medical Center, Wilmington, NC
BACKGROUND: The restructuring and implementation of surgery resident education continues to evolve.
Increasing criticism of the ability to train general surgeons in this new day of work hour restrictions and falling case
numbers has emphasized the importance of evaluating the opportunities in place that allow residents to the gain
exposure to and comfort with performing as well round general surgeons after residency. Establishing a surgical
airway in an unstable and decompensating patient is one of the many demanding tasks that a surgeon is called on
to perform and therefore should be one in which every general surgery resident is comfortable with.
OBJECTIVE: The goal of this study is to assess and evaluate, from the perspective of the residents, the exposure to
and the perceived skill and comfort level with the management of the emergent surgical airway
METHODS: General surgery residents (Post graduate years [PGY] 1-5) from New Hanover Regional Medical Center
in Wilmington, NC participated in an anonymous online survey. The questionnaire included 10 questions to include
gender of trainee, trauma center designation level, post graduate year, exposure to and performance of
cricothyroidotomy, percutaneous tracheostomy, and open tracheostomy, and finally the perceived comfort level
with performing and managing an emergent surgical airway. Data was compiled electronically and analyzed with
SAS 9.4 using Fisher’s Exact test.
RESULTS/CONCLUSIONS: A total of 21 residents completed the online survey. Our study demonstrated that
through PGYs 1-5 an increasing level of exposure and education was directly correlated with increased perceived
ability and ultimately adequate comfort level in independently managing the emergent surgical airway. The use of
anonymous online survey has wide reaching capabilities and may potentially allow a more thorough evaluation of
how well General Surgery residents are being trained. The limitations of the above study are that it was only
administered at a single center and success and comfort were subjectively measured. We plan to expand on the
survey as well as administer the study to Surgical Residency programs across then nation, potentially to include
additional specialties (Anesthesia/Emergency Medicine).
How many cricothyroidotomies have
you performed?
How many percutaneous
tracheostomies have you
performed?
25
Median Procedures
Median Procedures
5
4
3
2
2
1
1
0
0
20
15
15
10
4
5
0
0
0
0
PGY PGY PGY PGY PGY
1
2
3
4
5
PGY 1 PGY 2 PGY 3 PGY 4 PGY 5
6
Median Procedures
20
20
5
5
5
4
3
3
2
2
1
0
0
PGY 1
PGY 2
PGY 3
PGY 4
PGY 5
PGY 1
(N=4)
Characteristics
How many open tracheostomies have
you performed?
PGY
2
(N=6)
PGY 3
(N=5)
PGY 4
(N=3)
PGY 5
(N=3)
P-value
Please select the statement that best describes your proficiency in creating an emergency airway of any type.
I can perform the actions associated with
this skill without assistance, and others may
come to ask for my help.
0 (0.0)
0
(0.0)
0 (0.0)
1 (33.3)
3
(100.0)
I can usually perform this skill independently,
but may need help from an expert from time
to time.
0 (0.0)
5
(83.3)
4
(80.0)
2 (66.7)
0
(0.00)
I need help when performing this skill
2
(50.0)
1
(16.7)
1
(20.0)
0 (0.0)
0 (0.0)
I cannot perform this skill
2
(50.0)
0
(0.0)
0 (0.0)
0 (0.0)
0 (0.0)
0
(0.00)
5
(83.3)
5
(100.0)
3
(100.0)
3
(100.0)
Resident feels competent to independently
perform an emergency airway procedure.
0.0008
0.0021
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