W. Rook, N. Marsden, K. Thomas

Birmingham Women's and Children's NHS Foundation Trust, UK

Introduction and Aims

A recent national survey of anaesthetic trainees showed that although trainees feel confident managing extubation of children over 10yrs of age, the majority do not feel confident extubating those under 5 years old [1]. The same survey found trainees lacked confidence in managing paediatric airway emergencies.


To address this concern, we have developed a simulation package which covers these areas. We used a Plan, Do, Study, Act approach to iteratively develop and improve a half day course addressing trainees needs.


Cycle one: As a group of interested trainees, with expert guidance, we devised a course programme; An Airway Lecture, three novel simulation scenarios (Laryngospasm at extubation, anaphylaxis, opiate-induced airway obstruction) delivered with lo-fidelity equipment, and an ‘expert debrief’. We delivered it to four Stage-2 anaesthetic trainees each with around 3 months of tertiary paediatric experience. We studied feedback, which indicated that the most useful aspects were the realistic scenarios, and opportunities for open discussion with the expert at debrief. Areas for improvement were fidelity of the simulation-monitoring, the airway lecture, and more specific guidance. Additionally, the trainees felt the course would have been helpful earlier in their tertiary paediatric anaesthesia placements.

Cycle two: We planned an improved course programme, including a tracheostomy emergency simulation, a more interactive airway lecture, and better availability of quick reference emergency guidelines. We delivered the programme to five stage-2 trainees in the first 2 weeks of their placements. Again, feedback indicated the scenarios were useful and realistic, but that the airway lecture was less useful. Additionally, they indicated that the debrief for each scenario could include a more formalised ‘mini-tutorial’.

Cycle three; We again, improved the course programme, removing the airway lecture all together, and including 4 mini-tutorials covering the evidence and guidelines underlying the management of each emergency. It was delivered to another five stage-2 trainees in the first 2 weeks of their placements. Feedback indicated that the addition of mini-tutorials was a positive step, but that increasing the fidelity of the simulations could improve the quality of the experience. Additionally, the trainees felt a scenario involving a neonate would be a useful addition.

Discussion/Conclusion and Next Steps

Cycle four will involve a number of changes; moving from a classroom base, to an unused theatre to improve fidelity, running the programme in a different hospital to test it’s ‘exportability’, and adding a neonatal scenario to the simulation programme. Ultimately, we will provide a packaged, exportable, half day simulation programme for use by paediatric anaesthetists in our region to address trainees’ confidence managing paediatric airway emergencies, thus improving patient care.


[1] – Rook, W. et al. (2023) Evaluation of trainee confidence in paediatric extubation and their access to educational resources: a national survey. Poster DAS23-P1.42, Difficult Airway Society Annual Scientific Meeting, Birmingham, UK.


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