# Teaching Foundation Doctors How to Manage Tracheostomy Emergencies

## TL;DR

A short educational program improved junior doctors' knowledge and confidence in handling tracheostomy emergencies, with effects lasting a month.

## Contribution

A targeted educational intervention combining lecture and simulation improved FY1 doctors' emergency tracheostomy management skills.

## Key findings

- Only 25% of FY1 doctors correctly identified tracheostomy vs. laryngectomy pre-intervention.
- Simulation and lecture improved correct responses across all tested domains.
- Knowledge improvements were sustained one month after the intervention.

## Abstract

Background and objective

Tracheostomies are increasingly common in both acute and long-term clinical settings. As more and more patients with tracheostomies are being managed on general wards, Foundation Year 1 (FY1) doctors - often the first responders - require competency in managing life-threatening tracheostomy emergencies. This study aimed to investigate whether a short, targeted educational intervention can improve FY1 doctors' knowledge and confidence in this area.

Methods

A single-centre pilot educational intervention was delivered to 34 FY1 doctors in a UK teaching hospital. The intervention included a 30-minute lecture on surgical airway anatomy and the National Tracheostomy Safety Project (NTSP) algorithm, followed by small-group, high-fidelity simulation scenarios. To evidence improvement in knowledge, a quasi-experimental, single-arm study was undertaken, involving assessment of FY1s' knowledge via a written examination at three time points: pre-educational intervention, immediate post-educational intervention, and one month after the educational intervention.

Results

Baseline knowledge was poor, with only eight (25%) of 32 FY1 doctors correctly identifying the difference between tracheostomy and laryngectomy, 14 (41%) correctly identifying the breathing route in laryngectomy patients, and only 11 (10%) of the 103 proposed management actions when managing a tracheostomy emergency actions they suggested were specifically correct. Post-intervention, correct responses rose across all domains, with sustained improvements seen one month later for the answers to the second and third questions.

Conclusions

An educational intervention combining didactic teaching with simulation improved and sustained FY1 doctors’ knowledge and preparedness for dealing with tracheostomy emergencies. Despite limitations such as sample size and knowledge-based assessments, these findings suggest that this was a successful pilot intervention. Future efforts should include broader implementation and performance-based assessments.