Learning to manage tracheostomy-related emergencies: a pilot study comparing three teaching strategies for junior doctors in intensive care.

BACKGROUND

In intensive care settings, doctors face low-frequency and high-stakes events such as tracheostomy-related emergencies. Junior doctors must learn to manage these situations to ensure patient safety, yet they often lack clinical exposure to such critical events. Clinical teachers should develop methods that provide enough learning opportunities while remaining feasible in terms of workload. This study compared three strategies for teaching junior doctors to manage tracheostomy-related emergencies in intensive care unit (ICU). METHOD: In this pilot study, conducted in the ICU of Lausanne University Hospital, twenty-four junior doctors were randomized into three groups: Group A: Access to a printed algorithm; Group B: E-learning, including the algorithm with access to a toolbox; Group C: Flipped classroom course, including a short low-fidelity simulation. Performance was assessed through pre- and post-intervention sessions consisting of three tracheostomy-related simulation scenarios. A modified Delphi method was used to develop a performance assessment tool consisting of an evaluation scale for each scenario. Knowledge was also assessed before and after the intervention through a multiple-choice questionnaire. The primary outcome was the Global Performance Score (GPS), calculated for each teaching method by summing the performance scale scores across the three simulation scenarios as the total score across all scenarios, after the intervention.

RESULTS

The GPS significantly improved after the intervention in the three groups (Group A: M = 141, SD = 22 vs. M = 116, SD = 16.7 p = 0.008; Group B: M = 157, SD = 14 vs. M = 110.1, SD = 17.3 p = 0.008; Group C: M = 171.9, SD = 20.1 vs. M = 99.4, SD = 16 p = 0.008). There was a trend for a higher post-intervention GPS in Group B as compared to Group A (p = 0.105), and in Group C as compared to Group B (p = 0.279). By contrast, post-intervention GPS was significantly higher in Group C as compared to Group A (p = 0.021).

CONCLUSION

The flipped classroom strategy, combined with a brief simulation, yielded the highest post-intervention score. This strategy appears promising for junior doctors learning to manage low-frequency critical events, such as tracheostomy-related emergencies. Further research should explore its feasibility at larger scale, confirm the results in a larger population of learners with adequately powered studies and the applicability of such a teaching approach to other critical events.