Anesthesiologists’ airway management expertise: Identifying subjective and objective knowledge gaps

BACKGROUND: Failure in airway management continues to cause preventable patient harm, and the recommended continuing education is challenged by anaesthesiologists´ unknown knowledge gaps. This study aimed to identify anaesthesiologists´ subjective and objective knowledge gaps as well as areas where anaesthesiologists are incorrect and unaware.

METHODS: An adaptive E-learning programme with 103 questions on adult airway management was used for subjective and objective assessment of anaesthesiologists´ knowledge. All anaesthesiologists in the Capital Region of Denmark were invited to participate.

RESULTS: The response rate was 67% (191/285). For preoperative planning, participants stated low confidence (subjective assessment) regarding predictors of difficult airway management in particular (69.1-79.1%). Test scores (objective assessment) were lowest for obstructive sleep apnoea as a predictor of difficult airway management (28.8% correct), with participants being incorrect and unaware in 33.5% of the answers. For optimisation of basic techniques, the lowest confidence ratings related to patient positioning and prediction of difficulties (57.4-83.2%), which agreed with the lowest test scores. Concerning advanced techniques, videolaryngoscopy prompted the lowest confidence (72.4-85.9%), while emergency cricothyrotomy resulted in the lowest test scores (47.4-67.8%). Subjective and objective assessments correlated and lower confidence was associated with lower test scores: preoperative planning [r = -0.58, P < 0.001], optimisation of basic techniques [r = -0.58, P = 0.002], and advanced techniques [r = -0.71, P < 0.001].

CONCLUSION: We identified knowledge gaps in important areas of adult airway management with differing findings from the subjective and objective assessments. This underlines the importance of objective assessment to guide continuing education.