Critical care fellows get advanced training in day-long ‘Airwaypalooza’

Recently, every one of our twelve fellows in the Pulmonary and Critical Care Fellowship program got the day off from their usual clinical duties in order to attend a new training session designed by Kevin Doerschug, MD, Director of UI Health Care’s Medical Intensive Care Unit (MICU), and Allison Wynes, ARNP, Lead APP in the MICU.

The pair envisioned what some were calling “Airwaypalooza,” a series of simulated scenarios that would challenge and teach trainees new skills in advanced airway management. Doerschug and Wynes were joined by Charles Rappaport, MD, and Raul Villacreses, MD, both clinical assistant professors in the Division of Pulmonary, Critical Care, and Occupational Medicine. [Both also served as Chief Residents in 2015-16.]

By coincidence, the Airwaypalooza faculty were increased by two when Alexander Niven, MD, internist and pulmonologist at Mayo Clinic, and David Bowton, MD, FCCM, FCCP, professor emeritus of Wake Forest School of Medicine, happened to be in the area and available. Doerschug and Wynes connected with both of these instructors through their shared membership as Fellows in the American College of Chest Physicians (CHEST). The four of them have been faculty for over ten years at the national CHEST Difficult Airway Management Simulation Course, which served as a model for the University of Iowa course.

The morning began in the Center for Procedural Skills and Simulation (CPSS), which moved in 2020, with a brief didactic session led by Doerschug. And then, the trainees divided into groups and fanned out into the mock patient and operating rooms for guidance in specific skills. In one scenario, trainees had to work to prepare a patient in need of a cricothyrotomy. Doerschug reminded them that this procedure is “a rare event that we always dread,” but they needed to be prepared how to “handle this till the cavalry arrives.”

In each of the scenarios, the trainers engineered a mixture of smooth and rocky circumstances that required the trainees to stay alert, asking questions, and working as a team. Coordinators from outside the room were capable of digitally manipulating vitals to suddenly spike blood pressures or drop blood oxygen saturation levels. Meanwhile a trainer might mimick the kind of persistent and troubling cough that could interfere with a clinician’s efforts. In another instance, a trainer verbally simulated displays of bias against the patient that had to be navigated just as expertly as the patient’s worsening condition.

In addition to the procedural aspects of the simulations, the scenarios also focused on what Doerschug called “crew resource management,” simulation speak for team training, he said. Nurses and respiratory therapists from MICU joined the trainees to more closely replicate the team interactions during real ICU crises. “The motto ‘a team that trains together wins together’ has never been more applicable.”

Throughout each scenario, the trainees stayed focused, adapting to new stimuli, while working toward their common goal. After each scenario, the trainer debriefed the team, noting key moments that revealed strengths to build on and areas of needed improvement.

Thanks to the all the trainers and participants, to the industry sponsors who provided some of the equipment used, and to the excellent staff in the CPSS, who produced a vivid and pulse-quickening experience for our learners.

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