Training activity information
Details
Advise a clinical colleague on the application of the equipment available for a patient with a difficult airway
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Difficult airway trolley contents and their uses
- Trolley checklists and protocols and a critical care scientist’s role within these
- Patient centred care and support
- Communication with patients, relatives and the clinical team
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to advising a colleague on the application and practical use of equipment (e.g., video laryngoscope, cricothyrotomy kit) for a difficult airway scenario.
- Consider how the learning outcomes apply, specifically in relation to appraising respiratory techniques and advising on appropriate techniques, communicating clearly under pressure, and managing risk by ensuring appropriate and safe equipment application.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific scope of advice expected (e.g., focusing on technical setup and application vs. procedural steps) and the critical pieces of equipment available in your setting.
What is your prior experience of this activity?
- Think about what you already know about different types of equipment used for managing difficult airways, such as video laryngoscopy blades or rescue airway devices.
- Consider possible challenges you might face during the activity, such as clearly explaining the complex application of a piece of rescue equipment (e.g., a specific bougie technique) or ensuring the colleague fully understands the setup under pressure.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if the colleague asks about a procedure (e.g., surgical airway) or equipment application that falls outside of routine respiratory support.
- Acknowledge how you feel about embarking on this training activity, particularly regarding your confidence in identifying and explaining the application of difficult airway equipment.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as improving your ability to articulate the purpose and application of different airway equipment or linking equipment selection to specific difficult airway challenges, drawing upon previous experiences.
- Identify the specific insights you hope to gain into the nuances of applying different equipment in real-world difficult airway scenarios, perhaps through observing or assisting in setting up an emergency intubation trolley.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of airway management or advising colleagues.
- Identify important information you need to consider before embarking on the activity, such as reviewing the academic content on airway management equipment, or familiarising yourself with the specific contents and quick reference guides of the local difficult airway cart/trolley.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst advising a colleague on the application of difficult airway equipment (e.g., video laryngoscopes, rescue devices)?
- Are you encountering situations such as:
- The colleague asks about the application of a piece of equipment that you have reviewed but have not yet seen used in practice (e.g., a specific bougie or supraglottic device)?
- The clinical scenario presented involves highly unusual anatomical challenges or severe patient instability, complicating the routine application of the advice?
- Unexpected questions arise regarding infection control protocols for the rapid preparation or post-use sterilisation of the difficult airway equipment?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to advising on equipment steps or communicating critical safety points?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the advice to consult the quick reference guide located on the difficult airway trolley to verify the specific application steps
- Adapting your explanation to use clearer analogies or visual references to ensure the colleague fully understands the complex application technique
- How are you feeling in that moment? For instance, are you finding it difficult to provide accurate, concise advice under pressure? Is it affecting your confidence in managing uncertainty regarding ancillary equipment?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully clarifying the necessary application steps and safety checks for the equipment? Or are you needing support because the complexity of the clinical scenario requires advice on advanced techniques that necessitates a senior airway expert’s input?
- What are you learning as a result of the unexpected development? For example, are you mastering efficient resource checking (e.g., knowing the location of the procedure guide)? Or gaining insight into the factors that determine appropriate equipment selection in rapid airway management?
On action
What happened?
- Begin by summarising the key steps you took when advising the clinical colleague on the application of difficult airway equipment.
- Consider specific events, actions, or interactions which felt important, such as the colleague’s specific questions about video laryngoscope technique or how you referred to the emergency intubation trolley contents.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting your communication to simplify the technical steps for using a rescue device when the colleague appeared confused.
- How did you feel during this experience, e.g., did you feel knowledgeable about the equipment or challenged by the need to secure clarity under pressure?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding advising colleagues on complex equipment. What strengths did you demonstrate, e.g., clear articulation of the safety checks required for the cricothyrotomy kit?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific mechanism of a recently introduced rescue device?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in advising on equipment application in high-stakes scenarios?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether the advice should extend to the procedural steps or only the application of the equipment, and how you reacted to this.
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to conducting a thorough review of specific difficult airway equipment manuals.
- What will you do differently next time you approach advising on difficult airway equipment, for instance, by proactively using quick reference guides or visual aids during the discussion to support understanding?
- Do you need to practise any aspect of the activity further, such as explaining the application of non-routine airway equipment or key learning outcomes related to appraising techniques for respiratory function?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of observing actual difficult airway procedures requiring video laryngoscopy and specialised rescue devices since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, the rapid deterioration of a patient during intubation forced you to re-evaluate the speed and clarity of your initial advice on equipment application during your first attempt at this training activity.
- Considering what you understand about time-critical management and the function of rescue equipment now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your advisory communication regarding the application of difficult airway equipment based on further learning and experiences? For example, how you proactively reviewed and integrated the local colour-coded system for selecting blade sizes on different video laryngoscopes based on further learning.
- Has discussing the difficulty of using cricothyrotomy kits or the impact of unfamiliar equipment on the critical care team’s response with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior anaesthetist about a near-miss due to miscommunication regarding bougie usage refined your understanding of the critical need for unambiguous advisory communication.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent advisory and observation experiences, contributed to your overall confidence and ability in clearly articulating the application and setup of difficult airway equipment, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in clearly linking specific difficult airway devices (e.g., video laryngoscopes) to their required technical setup now enables you to confidently advise a clinical colleague on equipment application during an OCE assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to advising colleagues on critical airway equipment? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Airway Specialist immediately when a colleague requests advice on procedural steps or complex clinical decision-making regarding the use of rescue devices, recognising this requires clinical judgment outside advisory scope.
- Looking holistically at your training journey, how has this initial difficult airway equipment advisory experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to appraising techniques to maintain patient respiratory function and communicating effectively? For example, how this foundational experience has supported your development in translating technical equipment knowledge into clear, actionable clinical advice under pressure.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Appraise techniques to maintain patient respiratory function, advising on appropriate techniques for the clinical scenario. |
| # 5 |
Outcome
Communicate effectively with the patient and the multi-disciplinary team. |
| # 6 |
Outcome
Practice safely, managing risk in all elements of patient care. |