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Training technical and non-technical skills for managing
unexpected difficult airways
in anesthesiaMichaela Kolbe, Mona Weiss, Gudela Grote (ETH Zurich)
Bastian Grande, Axel Knauth, Micha Dambach, Adrian
Marty, Donat R. Spahn (University Hospital Zurich)
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ComTrainCombined training of technical
and non-technical skills
For managing unexpecteddifficult airway situations
For doctors and nurses
Simulation-basedOngoing project
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Why focusing on unexpected
difficult 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 acknowledgedTeamwork likely to break down during stress
(Driskell et al., 1999)
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ComTrain
! Training teamsas they occur in dailyanesthesia life (i.e., residents, nurses,
attendings if possible)! Training technical & non-technical
skills! Training via simulation (e.g., unexpected
difficult intubation; CVCI; using SimMan(Laerdal)) and structured debriefing
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Non-technical skillsCRM-principles (Rall &
Gaba, 2005)Anaesthetists Non-
Technical Skills (ANTS)(Fletcher et al., 2003)Previous research of the
effectivity of anesthesia
teams (e.g.., Knzle etal., 2010a,b; Kolbe et al.,
2011; Manser et al.,
2009)
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Technical skills
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Structured Debriefing
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Structured Debriefing
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Structured Debriefing
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First Conclusions! Self-efficacy significantly increases after training - this suggests a
positive effect of the combined debriefing methods that engage aproactive and engaging learning environment
! The structured debriefing is perceivd as encouraging and stimulating -pointing to a fruitful integration of different debriefing techniques
! The combined technical and non-technical training is evaluated ashighly relevant and applicable to the work context
! While the training has only moderate or no effects on most safetyattitudes, perceptions of teamwork climate decrease after training -
might be due to a more critical judgement of teamwork; safetyattitudes no good criterion for assessing training impact (Cooper et al.,
2008)! Both residents and nurses benefit from a combined technical and non-
technical skills training
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Thank you