Current Status of Advanced Airway Training in the UK: A Survey of Advanced Airway Trainees

Background: “Choosing the safest technique for airway management may not necessarily be the anaesthetist's most familiar. It may be necessary to seek the assistance of colleagues with specific skills”. Executive Summary, 4th National Audit Project (NAP4), 2011. The 4th National Audit Project (NAP4) is the largest study of major complications in airway management ever conducted in the United Kingdom (UK). It collected data between September 2008 and August 2009 and the findings were published in March 2011. The commonest cause of adverse events reported to NAP4, identified by both reporters and reviewers, was poor judgement, followed by lack of education and training. In the 2010 training curriculum the Royal College of Anaesthetists (RCOA) updated the competencies required for the mandatory higher, and optional advanced training modules in airway management, to be offered by all schools of anaesthesia (SOA). The aim of subspecialty training is to train and educate the experts of the future, to enable the management of a range of complex major head and neck surgeries and gain mastery of a variety of advanced airway techniques and devices. In the UK, despite the RcoA competency framework, there is no national accreditation system to provide quality control for the head and neck anaesthesia/advanced airway management fellowships that are delivered by individual schools. This lack of standardisation potentially could lead to inconsistencies in the quality of training. We undertook a survey to assess the current status of head and neck anaesthesia/advanced airway management subspecialty advanced training in the UK. Methods: We contacted all the Schools of Anaesthesia in the UK. The “Airway Fellows” and advanced airway trainees, current and of the previous 18 months, were identified. A questionnaire addressed to the airway fellow was electronically distributed and kept active for 90 days. Results: Of the 28 Schools of Anaesthesia in the UK, 23 offer advanced airway training. On average, each fellow performed approximately 14 (2-21) awake and 16 (6-31) asleep fibreoptic intubations, 3 (0-11) cases of jet ventilation and 1 (0-4) needle cricothyroidotomy per 6-month period. The number of supervised uses of video laryngoscopes, cricothyroidotomy, jet ventilation, and flexible fibreoptic scopes were lower than that believed to be required to attain proficiency in these techniques (Johnstone and Roberts 1989; Bulletin RCOA March 2009, Issue 54). Conclusion: Our findings show a wide variation in clinical, teaching and research activity amongst the airway fellows who responded. However, as shown by the wide discrepancy in the number of procedures performed; the experience of videolaryngoscopy, jet ventilation and cricothyroidotomy was not the same and airway fellowships appeared to offer different levels of experience and opportunities. We hope to standardise and improve advanced airway training across the UK by creating a Difficult Airway Society endorsed syllabus and guidance for all the Schools of Anaesthesia.