A Multicenter Study of Pulmonary Critical Care Trainees' Perception of Airway Management Training during Fellowship

Background: There is significant variability in airway management training among pulmonary and critical care medicine (PCCM) fellows. Objective: To assess the airway management training of PCCM fellows, specifically evaluating the role of the institutional approach to intubations (anesthesia-predominant primary operators vs. PCCM-predominant) to the overall fellows' educational experience. Methods: We performed a survey of PCCM fellows at 14 institutions to assess the perceptions of airway management training. Summary statistics were used to analyze the Likert scale responses. Based on our hypothesis of a relationship of a fellow's experience to the institutional approach to intubations, we stratified responses based on whether the primary operator for airway management for critically ill patients was generally anesthesiology or PCCM providers. Statistical significance was determined using either t testing (after converting Likert-style responses to continuous variables) or analysis of variance for categorical variables (P< 0.05). Results: Respondents included 132 fellows across 14 PCCM programs (47% response rate), spanning all fellowship years (29% in first year [n = 38], 31% in second year [n = 41], 26% in third/fourth year [n = 34]). Seventy percent (n = 80) of fellows were very or somewhat satisfied with their airway management training. In fellows training where anesthesia providers primarily perform airway management (29% [n = 34]), satisfaction with training was significantly lower, as was the self-assessment of one's airway management skills. The location of airway management experience in anesthesia-predominant programs was mainly the operating room (69% [n = 22]), versus mainly in the intensive care unit for PCCM-predominant programs (94% [n = 77]). The number of completed intubations was lower for fellows in anesthesia- predominant programs (P = 0.02). Conclusion: We found significant differences in fellows' experiences in airway management based on the institutional approach to intubations (anesthesia-predominant primary operators vs. PCCM-predominant). Ongoing focus on strategies to optimize competency-based airway management training is needed, particularly at programs where anesthesia involvement limits the amount of clinical exposure.