Innovations in anesthesia education: the development and implementation of a resident rotation for advanced airway management Nouveautes dans la formation en anesthesie: le developpement et la mise en œuvre d'un systeme de stages de prise en charge avancee des voies aeriennes pour residents
Bibliographic record
Abstract
Purpose This article incorporates the following objectives: to review the current evidence regarding the occurrence and management of difficult airways, to outline the role for alternative technology in the management of the difficult airway, to provide a rationale for structured airway rotations in anesthesia residency training, to discuss the barriers to establishing the rotations, to outline issues that must be considered and resolved to enhance these rotations, and to share the experience we have gained over the last decade of offering an airway rotation in the Department of Anesthesiology at the University of Ottawa. Principal findings The incidence of difficult laryngoscopy and intubation has not changed in recent times. Persistent attempts at direct laryngoscopy are associated with low success rates and patient complications. The early use of alternative devices improves the likelihood of success in airway management and reduces the potential for patient injury. Alternative airway management devices are increasingly available to Canadian anesthesiologists, and there is an expectation that anesthesiologists will possess the necessary skills to safely manage the difficult airway with these alternative devices. Conclusions Anesthesia training programs must provide residents with the skill sets necessary for safe independent practice in airway management. The changes in the scope and reality of residency training have exposed limitations in the traditional mentoring model of residency training; consequently, many programs have responded by offering sub-specialty rotations. In particular, advanced airway management rotations are being offered increasingly to residents in the Canadian training programs. Considerations and strategies to develop and implement a structured airway management program during anesthesia residency are discussed. Resume Objectif Cet article integre les objectifs suivants : passer en revue les donnees probantes actuelles concernant l’incidence et la prise en charge des voies aeriennes difficiles, resumer le role des technologies alternatives dans la prise en charge des voies aeriennes difficiles, proposer une justification pour la mise en œuvre de stages structures pour la prise en charge des voies aeriennes durant la residence en anesthesie, presenter les obstacles a la mise en place de stages, exposer les questions a prendre en compte et a regler pour ameliorer les stages, et faire part de l’experience que nous avons acquise au cours des dix dernieres annees dans le cadre d’un systeme de stages pour la prise en charge des voies aeriennes au sein du departement d’anesthesiologie de l’Universite d’Ottawa. Constatations principales L’incidence de cas de laryngoscopie et d’intubation difficiles n’a pas change recemment. Des tentatives repetees de laryngoscopie directes sont associees a des taux faibles de reussite et a des complications pour les patients. L’utilisation precoce d’appareils alternatifs ameliore la probabilite de reussite de la prise en charge des voies aeriennes et reduit le potentiel de lesions chez le patient. Les anesthesiologistes canadiens ont de plus en plus acces a des dispositifs alternatifs de prise en charge des voies E. Crosby, MD (&) A. Lane, FCARCSI Department of Anesthesiology, University of Ottawa, The Ottawa Hospital – General Campus, Suite 1401, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada e-mail: ecrosby@sympatico.ca 123 Can J Anesth/J Can Anesth (2009) 56:939–959 DOI 10.1007/s12630-009-9197-4
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.029 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".