In this editorial Stuart Marshall and Nicholas Chrimes discuss the challenges for both trainee and consultant anaesthetists in achieving and maintaining 'mastery' in airway management techniques. Particular issues highlighted include:
- The potential inconsistencies of the traditional apprenticeship model for airway training.
- The difficulties for consultants in gaining structured training in new techniques
- The impact of the supraglottic airway on opportunities for trainees to learn basic airway skills
- The inadvertent consequence of safer working hours on the number of cases to which trainees are exposed
- The potential paradoxical effect that a disproportionate emphasis on CICO training could have on the incidence of inappropriate CICO Rescue
- The importance of emphasising non-technical skills in emergency airway management
- The crucial role of interprofessional team training
- Incorporating training with implementation tools such as the Vortex Approach to facilitate prevention of, and priming for, CICO Rescue
- The importance of anaesthetists training in conjunction with other specialists involved in airway management, such as emergency medicine and intensive care, to promote exchange of ideas and avoid divergent practice.
The authors take the possibly controversial position that not all anaesthetists necessarily need to possess the full set of airway skills and that skills could instead be divided into core and specialised techniques. Criteria for delineating core from specialised skills are outlined. The ability to perform CICO Rescue is highlighted as a core skill which all anaesthetists must possess.
The challenges of ensuring that such a tiered system of airway skills would not limit ready access of patients to these techniques when they are required is also discussed.