Tracheal resection and primary anastomosis is a relatively uncommon procedure.  Team based, high-fidelity simulation is an ideal way to teach and maintain the necessary technical and non-technical skills needed during critical periods of this procedure.  The surgical and anesthetic management is technically demanding, requiring a high level of collaboration and communication between the surgical and anesthesiology teams.  We developed a scenario that incorporated a technically challenging surgical task with the complex airway management decision-making. Tasks and objectives for learners were linked to Royal College objectives of training and CanMEDS roles (Medical Expert, Collaborator, Professional and Communicator).

The scenario was developed by experts from thoracic surgery, thoracic anaesthesia, and medical education/simulation.  The scenario was 12 minutes, with a 30 minute debrief discussing technical and non-technical aspects of the learners’ performance.  The scenario involved two concurrent tasks: (1) end-to-end anastomosis of a porcine trachea, emphasizing surgical technique and (2) management and troubleshooting of oxygen desaturation following three successive periods of apnea and cross-field ventilation, emphasizing anaesthetic management and team communication. The physical model consisted of a transected porcine trachea, draped as a surgical field, laid on top of the Laerdal SimMan.

Learners filled out pre-and-post scenario questionnaires scored on a 5-point Likert scale, related to the familiarity of the techniques of tracheal anastomosis and cross-field ventilation. Mean scores increased (from 2.5 to 3) with regards to familiarity and comfort with the technique. Trainees strongly agreed (5) that the simulation was relevant to their practice, realistic, and that they gained knowledge and confidence from participating in the session.

This scenario highlights the utility of high-fidelity simulation for learning techniques of primary tracheal anastomosis and cross-field ventilation, for practice of non-technical crisis resource management skills, and confirms the feasibility of the scenario.  Future studies will assess how this translates into the real clinical environment

Multidisciplinary simulation of primary tracheal anastomosis and cross-field ventilation – scenario development and feasibility assessment