Paediatric airway management and simulation training: the Australian otolaryngology trainee experience

Background: Paediatric airway problems present a challenging and stressful situation. Literature regarding education, training, clinical support, and confidence of ear, nose and throat (ENT) trainees to manage the paediatric airway is limited. Simulation can complement surgical training by developing technical and nontechnical skills in a safe environment. This study explores the clinical experience, confidence, and use of simulation by Australian ENT trainees in paediatric airway management to identify current challenges and direct future training.Methods: A voluntary survey was distributed to all Australian ENT trainees. The survey included four parts: (I) participant demographics; (II) the clinical experience of trainees; (III) confidence ratings in technical skills and clinical situations; (IV) training and simulation. Relationships between trainee confidence, clinical experience and utility of simulation were explored.Results: The survey acquired 21 responses out of 80 trainees. Clinical experience data, primary operator numbers and reported self-confidence for paediatric airway management-specific technical skills and clinical situations were recorded. Of the total respondents, 52% thought their training had provided adequate paediatric airway management and technique exposure, including all surgical education and training (SET) 5 trainees (n=3/3) and the majority of SET 3 (n=5/6) and SET 4 (n=2/3). The majority of participants who responded "no" were early in training at SET 1 or 2 (n=8/9). All respondents rated simulation as useful for airway foreign body removal and difficult intubation. Most respondents (>80%) rated simulation of paediatric microlaryngoscopy, rigid bronchoscopy, intubation, and tracheostomy insertion as 'useful' or 'very useful'. Conclusions: This study provides an insight into the Australian ENT trainee experience in paediatric airway management. Final year trainees had good overall primary operator experience in a variety of common technical skills. This correlated to higher levels of confidence in these situations. As expected, junior SET trainees had less experience and confidence in paediatric airway. Assessing confidence and competence would be useful to guide further research and training needs. Perceptions on the use of simulation were highly positive with 100% of respondents considering it as an effective medium to learn. To increase exposure and confidence, simulation scenarios can be used to complement surgical training by allowing trainees to develop their skills in a safe environment.