Advanced Training Module in Difficult Airway Management

JOB DESCRIPTION

&

PROSPECTUS

Advanced Training Module in Difficult Airway Management

(Airway Fellow)

Nuffield Department of Anaesthetics

John Radcliffe Hospitals NHS Trust

 

Education Supervisor

Dr Shaun Scott

Dr Alex Marfin

Consultants

Dr Stuart Benham

Dr Mridula Rai

Dr Jenny Thompson

Dr Sabeena Sharma

Clinical Lecturer & Simulation trainer

Imogen Davies

July 2009

INTRODUCTION

There have been significant advances in the management of patients with difficult airways.  Recent recommendations suggest that training in airway management should be structured with provision of basic and advance modules.   The College syllabus stresses the importance of difficult airway management training particularly fibreoptic intubation techniques, in various specialty modules.

A group of Consultants in the Nuffield Department of Anaesthetics have set up excellent service provision for difficult airway management, in particular fibreoptic intubation techniques.  The group are also well known for their organisation of local, regional and national fibreoptic and difficult airway workshops. 

This advanced training would provide the Fellow with a wealth of clinical experience in airway management particularly in fibreoptic intubation techniques.  This clinical experience will be backed up by audit, research and risk management issues. The Fellow will be actively encouraged to participate in provision of training involving both the classroom and theatre teaching (A list of courses and workshops available locally and in the region is provided at the end of this prospectus).

This Fellowship programme will be for a period of six months but may be tailored to suit the needs of individuals to accommodate periods of up to one year.  The Advanced Training is for trainees In Programme in the Oxford Deanery only and is at the SpR 4 year. Appointment is in open competition and selection is by interview. There will be an on-call commitment on the normal SpR4/5 rota.

On completion of the programme the Fellowship should have provided the trainee with a level of knowledge and experience for competent independent management of difficult airway problems especially awake fibreoptic intubation.  The trainee should have been actively involved in audit, research and teaching and should have reached a level of competence suitable to take up a post of Consultant Anaesthetist with an interest in difficult airway management. 

PROGRAMME

It is anticipated that the trainee will be allowed three days per week dedicated to this module.  The time will be spent with a named group of Consultant Anaesthetists with an interest in difficult airway management.  Most of this time will include clinical management. One day per week may be allowed for research/audit. The Fellow is required to provide one day per week of service to the department on ‘non airway’ lists.  The weekly allocation will vary depending on the time off periods allowed for a EWTD compliant rota.

ON-CALL The trainee will be a member of the SpR4/5 on-call group.

TEACHING The trainee will be expected to get involved in classroom teaching on airway techniques to colleagues in the Department and doctors in other specialties.  Additionally they will be expected to be involved in training of difficult airway techniques especially fibreoptic intubation techniques in the operating theatre and in workshops. A list of available opportunities is given at the end of this prospectus. However, new ideas are always encouraged.

AUDIT There are ongoing audit projects which the trainee will be expected to become part of.  Encouragement will be given to the trainee to start new audit projects.

RESEARCH The Airway group has a good track record of conducting, presenting and publishing clinical research in airway related topics. The trainee will be expected to participate in ongoing research projects and expected to set up new research projects of their own.  Ideas will be given but trainees will be encouraged to come up with their own ideas.  Every help will be provided in submitting protocols to the Ethics Committees and setting up clinical studies in the theatre. 

GUIDELINES FOR DIFFICULT AIRWAY MANAGEMENT

The Difficult Airway Society1 produced in 2004 guidelines for the unanticipated difficult tracheal intubation in non-obstetric adult patient2. These were based on evidence (314 references) and consensus. The Fellow is expected to familiarise with these and provide training and teaching related to these guidelines to other trainees and theatre staff.

1. www.das.uk.com

2. J.J Henderson, M.T Popat, I.P. Latto, A.C. Pearce. Difficult airway society guidelines for management of the unanticipated difficult intubation. Anaesthesia 59, Jul 2004: 675-94

 

DELIVERY OF TRAINING

The training targets will be achieved using a number of training methods.

Individual Training Plan: To focus on the specific needs of the individual within the framework of the post.

Supervised Clinical Practice: The majority of training will take place in the operating theatre.  All trainees will be supervised by a Consultant, the level of responsibility being increased with experience according to the trainee’s progress.

Regular Tutorials: Consultant staff will deliver a structured tutorial programme on a weekly basis. Trainees participate generally by producing their own presentation. Tutorial takes place in Anaesthetic department every Friday morning

Academic Department Meetings: These are held once a month during each academic term.

Personal Tutors: Each trainee will be offered a personal tutor.

Appraisal & Assessment: Appraisals will be conducted by the Personal Tutor on a regular basis.  A formal assessment of the training will take place at the end of the attachment.

Log Book: Trainees will be expected to maintain a log book along Royal College guidelines.

Study Leave Funds will be available according to national recommendations and trainees are encouraged to attend appropriate programmes.

TRAINING PLAN AND TRAINING AGREEMENT

The trainee will meet with the educational supervisor to agree the individual training plan following the period of induction; this will be tailored to suit the individual needs of the trainee.  It will take account of clinical, interpersonal and management skills and knowledge. Trainees will be required to give their agreement to the training programme and confirm their commitment to participate fully in the training and appraisal process.

TRAINING FACILITIES AND RESOURCES

Library facilities

The Cairns Library at the Radcliffe Infirmary specialises in the neurosciences with a comprehensive range of current journals.  The Nuffield Department of Anaesthetics library at the Radcliffe Infirmary is also available to trainees and has a full range of anaesthetic textbooks and journals.  The Cairns Library at the John Radcliffe Hospital is a multi-disciplinary library and can be accessed 24 hours and 365 days a year with appropriate security clearance. There is a free access to many electronic journals

USEFUL RESOURCES

Airway training and teaching organised for local trainees and theatre staff:


  • Introductory advanced airway lecture for new SpRs 1/2: Organised twice a year and consists of 2 presentations and many advanced airway workshop stations. It takes place in the department on a Tuesday afternoon (February and August). It is conducted by a group of consultants and previous airway fellows.
  • Department Advanced Airway Training: This is a one to one training aimed for junior SpRs. Trainees have the opportunity to practice airway skills recommended in the Difficult Airway Society Guidelines. Organised by Dr Mridula Rai usually on a  Monday afternoon.

  • Oxford Simulator Centre - www.oxsim.ox.ac.uk

  • Simulator Training: The Kadoorie centre at level 3, John Radcliffe hospital has a high-tech simulator room. The SimMan simulator has been used to train on the Difficult Airway Society guidelines. This has been provided by Dr Ahmed Chekairi on Tuesdays morning and has been attended by junior doctors and anaesthetic nurses.
  • Anaesthetic nurses and ODP airway training: In order to help maintain and improve airway skills among the theatre ancillary, the airway group has contributed by organising dedicated airway sessions. Dr Shaun Scott has taken the lead in organising these sessions.

Regional Airway training: 

Oxford Regional Airway Group (ORAG) founded by a group of consultants with special interest in airway in Oxford Deanery to establish and promote airway teaching, training and research within the Oxford region. Two regional meetings are organised every year. More information could be accessed on: www.orag.co.uk

One of the major achievements of this group is the launching of airway fellowship programme in district general hospitals. It has initially started in Reading, Northampton followed in February 2006 and Slough started its 1st Airway Fellowship  in August 2006. 

Regional Airway Workshops:


-     Oxford: Regional SHO airway training day, John Radcliffe, Oxford. Study day for SHOs in the Oxford region. It has consisted of lectures and practical skills. Faculty is generally made of consultants from the region and previous airway fellows. Dr Jenny Thompson is the organiser.

-    Milton Keynes: Aims at training local trainees basic and advanced airway skills; organised by Dr Hamid Manji.

-      Northampton: Organised their fist Airway Workshop in June 2006. Consultants, and trainees from local anaesthetic department and Milton Keynes attended the workshop; this is organised by Dr Mike Goodwin.

 -    Kettering: Kettering airway management workshop: aims at training basic airway skills to non-Anaesthetic trainees (Surgeons, Medics, Nurses and Paramedics); It is organised by Dr Ravi Dravid.

 -      Banbury: Oxford Basic Airway Skills Course Organiser's: This one-day workshop is for Consultant and SAS Anaesthetists wishing to set up a Basic Airway Skills© Course in their Region. Organised by Dr Asima Bokhari.

-     Reading: Royal Berkshire Hospital has been organising workshops for local anaesthetic consultants and trainees. The organiser is Dr Atul Kapila.

     Another course is organised mutually by Anaesthetists and ENT surgeons aims at teaching airway and anaesthetics skills for shared airway.

-    Slough: Wrexham Park have already organised their 7th Advanced Airway Workshop this June 2006. It is aimed at consultants and trainees from local department. Pig cadavers are used for training on needle and surgical cricothyrotomy. The organiser is Dr Jairaj Rangasami

 

National Airway Workshops organised by the Oxford Airway Group

 

-   Oxford Difficult Airway workshop: Very popular workshop, which attracts delegates from all over the UK. The faculty is made of local, regional and national airway experts. It is generally organised in March every year. The 11th workshop was organised this year at St Catherine College. Airway fellows are encouraged to teach on the course. Organised by Dr Mansukh Popat and Dr Stuart Benham

-    Oxford Training the Trainers Workshop: Probably the only one of its kind in the UK, which aims to teach consultant trainers. It consists of lectures and demonstration workshops. Airway Fellows have contributed by presentation and by running work stations. Organised in March by Dr Mansukh Popat and Dr Stuart Benham.  

-    Oxford Paediatric Difficult Airway Workshop: This is a unique airway course for paediatric airway management. 2nd course organised this year has proven a success.

Course Organisers Dr David Mason, Dr Mansukh Popat, Dr Stuart Benham.

Difficult Airway Society main meetings:

       -    DAS Annual Meeting: Dublin 5th-6th October 2006: www.dasdublin2006.com

       -    DAS Annual Meeting: Portsmouth 21-23 November 2007

Dr M Popat               (updated by Dr Chekairi in June 2006)