Developing Modules to Train Anesthesiology Residents & Medical Students in a Lung Isolation Technique

One-lung ventilation (OLV) can be accomplished by using ether a double-lumen endotracheal tube (DLT) or a bronchial blocker. Patient factors, surgical requirements and the anesthesiologist's expertise influence technique choice. Bronchial blockers are in general less traumatic, safer to place, and suitable in a wider variety of scenarios than DLTs, but require greater technical skill. We designed a study to determine whether trainees can achieve OLV using a bronchial blocker on completion of a 4-week multimodal training module.

Anesthesia residents and medical students took part in didactic (lecture and video) and clinical simulation training. During simulation training, participants practiced placing a bronchial blocker under supervision until they performed the technique satisfactorily. Trainees could then practice independently as often as they wished. A skills check was performed during the supervised and after the independent practice; feedback was provided. For more advanced learners, practical clinical training was continued in the operating room. Assessments data (test scores and skills checks) were analyzed using the t-test.

Difference between pre-test and post-test scores (didactics) was statistically significant (p=0.02) as was the number of skills checks items satisfactorily demonstrated by the 14 participants on the first supervised attempt and the last independent practice (simulation; p<0.01). All eight who performed one-lung isolation in the operating room were technically proficient in achieving adequate OLV to the satisfaction of the supervising attending anesthesiologist.

This multimodal standardized teaching module which incorporates didactics, simulation training, and, for more advanced trainees, practical clinical experience, improves trainees' knowledge and skills in bronchial blocker placement and OLV.