Supplemental Materials 1

Airway Management Boot Camp Curriculum

The Airway Management Boot Camp is designed to teach all aspects of basic airway management. The expected audience is post graduate year (PGY) 1 and PGY 2 anesthesia residents who require basic airway management skills as part of their training and job duties. The audience also includes emergency medicine, internal medicine and critical care residents, anesthesia assistants and certified registered nurse anesthetists. This is an intensive introductory course. The goal is to prepare trainees for clinical care with a mastery of skills in basic airway management that can be demonstrated on a manikin as well as competency in performing the skills on patients under direct supervision. The curriculum is intended to be completed within 1-2 weeks. The table below demonstrates the Model Curriculum for Airway Management Boot Camp – presented as a curriculum map that relates the goals and objectives to educational experiences and competency assessment.*

Model Curriculum for Airway Management Boot Camp

Goal Objective Educational Measure ACGME Materials/Experience Competencies** Understand The trainee should be able to: Lecture Quiz Medical Knowledge basic airway • Describe and recognize basic • Basic airway anatomy anatomy airway anatomy during Patient care: laryngoscopy including the Online self-learning module • Technical skills - tongue, oropharynx, tonsillar • Basic airway anatomy airway management pillars, posterior pharynx, • Oral and nasopharyngeal epiglottis, vallecula, arytenoids airways Practice based learning and vocal cords. and Improvement: • Recognize how airway structures • Self-directed appear from the perspective of a learning laryngoscopist standing at the patient’s head or viewed from the front of the patient. • Describe the physiology and anatomy of airway obstruction with sleep apnea, muscle relaxation after induction of anesthesia, and laryngospasm.

Understand The trainee should be able to able PBLD Quiz Medical Knowledge the to: • Choosing the right airway overarching • List basic options for airway management technique Patient care: principles of management such as a • Technical skills - airway spontaneously ventilating patient Lecture airway management management with a nasal or oropharyngeal • Airway assessment airway in place, mask ventilation, Practice based learning SGA placement or endotracheal Online self-learning module and Improvement: intubation. • Basic airway management • Self-directed • Compare and contrast the pros techniques learning and cons of basic airway • Approach to airway management techniques. management • Describe how patient and surgical • Predictors of difficult Interpersonal and factors affect different airway ventilation and intubation Communication Skills: management plans. • Communication with • Compare and contrast different Hands-on simulation session other professionals techniques for predicting difficult • Airway assessment mask ventilation and intubation. Operating room experience – trainee goals: • Perform 5 assessments of patient airways under faculty supervision and determine the thyromental distance, neck circumference, mouth opening, neck extension, and assign Mallampati score.

Develop The trainee should be able to: PBLD Quiz Medical Knowledge competency in • Describe the physiology of • Routine and high-risk airway preoxygenation/denitrogenation. extubation Simulation - checklist Patient care: management • Utilize different techniques to assessment • Technical skills - in patients preoxygenate/denitrogenate Lecture A checklist is used in airway management who do not patients • Endotracheal intubation: conjunction with hands- have a • List indications and preparation, planning, and on simulation sessions. Practice based learning difficult contraindications of nasal and technique The trainee must achieve and Improvement: airway oropharyngeal airway placement. • Routine and high risk a score of 20 from a • Self-directed • Properly place nasal and extubation maximum score of 25 learning oropharyngeal airways. for skill performance on • Understand the differences among Online self-learning modules a manikin. various BVM systems. • Oxygenation • Nasal and Interpersonal and • Perform mask ventilation on • Nasal and oropharyngeal oropharyngeal Communication Skills: anesthetized patients. airways airway placement • Communication with • Describe how SGA provide • BVM ventilation • BVM ventilation other professionals ventilation and are seated in the • SGA insertion and • SGA insertion and pharynx. removal removal • Correctly place a SGA in a • Direct laryngoscopy and • Direct laryngoscopy manikin. intubation and intubation • Correctly place a SGA in • Video laryngoscopy and • Video laryngoscopy anesthetized patients. intubation and intubation • List and correctly perform the • Rapid sequence induction • Rapid sequence steps for direct laryngoscopy and and intubation induction and intubation on a manikin • Extubation intubation • Perform direct laryngoscopy and • Extubation intubation on anesthetized Hands-on simulation sessions patients. • Nasal and oropharyngeal • Preform intubation using a video airway insertion Patient Care - laryngoscope on a manikin • BVM ventilation entrustment scale

• Perform intubation using a video • SGA insertion and assessment*** The trainee must achieve laryngoscope on an anesthetized removal an entrustment score of patient • Direct laryngoscopy and “reactive supervision” • Understand the general principles intubation when performing the of the induction of general skill on patients. anesthesia and how intubation fits • Video laryngoscopy and • Nasal and in the sequence of steps. intubation oropharyngeal • Induce general anesthesia and • Rapid sequence induction airway placement perform direct laryngoscopy and and intubation • BVM ventilation intubation. • Extubation • Understand the general principles Patient Care - of rapid sequence induction of Operating room experience- entrustment scale general anesthesia and how trainee goals: assessment intubation fits in the sequence of • Perform BVM ventilation The trainee must achieve steps. on 20 patients after the an entrustment score of • Perform rapid sequence induction induction of anesthesia “direct supervision” and intubation on a manikin • Place 5 SGA in patients when performing the • Describe the pitfalls associated after the induction of skill on patients. with extubation and the anesthesia importance of developing an • Perform induction of • Placement and extubation plan. anesthesia and direct removal of SGA • List the steps to perform laryngoscopy and • Direct laryngoscopy extubation correctly. intubation in 10 routine, and intubation • Correctly perform routine uncomplicated patients • Video laryngoscopy extubation on uncomplicated • Perform induction of and intubation patients. anesthesia and intubation • Rapid sequence using a video induction and laryngoscope 5 routine, intubation uncomplicated patients • Routine extubation • Perform rapid sequence induction of anesthesia and direct laryngoscopy intubation on 5 anesthetized patients • Perform routine extubation on 10 uncomplicated anesthetized patients

ACGME - Accreditation Council for Graduate Medical Education PBLD – Problem based learning discussion

SGA – Supraglottic airway

BVM- Bag-valve-mask

* The items called for in the curriculum were published in the Anesthesia Toolbox, an online collaborative of over 60 anesthesia programs (https://www.youtube.com/channel/UCBEuFKE_6zXioN3HQ1LbHog). **This column lists the relevant ACGME sub competencies addressed by each goal and objectives ***Procedural skill competency or patient care entrustment is assessed with a “direct observation of clinical skills tool” which has 5 rating levels that reflect how much supervision the trainee required during performance of the skill: Supervisor did activity, direct supervision, reactive supervision, available if needed or independent practice

Airway Boot Camp Study Guide and Schedule

The curriculum map associates the learning goals and objectives with the education sessions to achieve the objectives. The assessment tools allow the evaluation of achievement of competency. The Study Guide and Schedule organizes the educational sessions and material into a weekly schedule that is logically sequenced to help trainees gradually build competency (educational sessions build upon one another). Presented here is an example of a weekly schedule for the airway boot camp.

Week 1

• Self-guided learning o Basic airway anatomy o Oxygenation/denitrogenation o Nasal and oropharyngeal airways o BVM ventilation equipment and mask ventilation o Basic airway management techniques o Direct laryngoscopy o Video laryngoscopy and intubation o Quiz associated with each online module

• Faculty Sessions o Lecture . Basic airway anatomy . Endotracheal intubation, preparation, planning, technique o Half-day simulation (SIM) session with manikins . Nasal and oropharyngeal airways . BVM ventilation equipment and mask ventilation . Direct laryngoscopy and intubation . Video laryngoscopy and intubation o Operating Room Experience – trainee goals: . Practice BVM ventilation on uncomplicated anesthetized patients . Manage obstructed airways during induction and practice placement of nasal and oropharyngeal airways . Practice direct laryngoscopy and intubation on uncomplicated anesthetized patients (use video laryngoscope to aid instructor on what is being visualized by the student) . Practice video laryngoscopy and intubation on uncomplicated anesthetized patients o Competency assessment . Airway Boot Camp Week 1 Quiz . Checklist during simulation and entrustment scale during patient care o Nasal and oropharyngeal airways o BVM ventilation o Direct laryngoscopy o Video laryngoscopy

Week 2

• Self-guided learning o Approach to airway management o Predictors of difficult ventilation and intubation o Rapid sequence induction and intubation o Extubation o SGA insertion and removal o Quiz associated with each online module

• Faculty Sessions o PBLD . Choosing the right airway management technique . Routine and high-risk extubation o Lecture . Airway Assessment o Half-day SIM Session with manikins . Airway Assessment . SGA insertion and removal . Rapid sequence induction and intubation . Routine extubation o Operating Room Experience – trainee goals: . Practice airway assessments for predictors of difficult mask ventilation or intubation on 5 patients in the preoperative area . Perform 10 airway assessments with at least one risk factor for difficult mask ventilation or intubation . Practice SGA insertion and removal on anesthetized patients . Perform rapid sequence induction and intubation . Practice extubation routine uncomplicated patients o Competency Assessment . Airway Boot Camp Week 2 Quiz . Checklist during simulation and entrustment scale during patient care o Performing an airway assessment o Rapid sequence induction and intubation patient care o Routine extubation o SGA insertion and removal