Sains Malaysiana 50(11)(2021): 3455-3465

http://doi.org/10.17576/jsm-2021-5011-27

Evaluation of the Confidence and Competency of House Officers in Rapid Sequence Intubation (ECCHO-RSI) in Emergency Department of Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre during COVID-19 Pandemic

(Penilaian Keyakinan dan Kekompetenan Pegawai Perubatan dalam Intubasi Urutan Pantas (ECCHO-RSI) di Jabatan Kecemasan Hospital Canselor Tuanku Muhriz, Pusat Perubatan Universiti Kebangsaan Malaysia semasa Pandemik COVID-19)

KEVIN CHUING SHEN WONG¹, AHMAD KHALDUN ISMAIL¹*, SITI SARAH MD ZHAHIR¹, IDA ZARINA ZAINI¹

¹Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

Received: 1 February 2021/Accepted: 14 September 2021

ABSTRACT

Rapid sequence intubation (RSI) is a procedural skill that house officers (HO) in Malaysia need to learn during their training in emergency department (ED) posting. This study aimed to evaluate the confidence and competency of HO in RSI after completed training in the ED of a university hospital during the COVID-19 pandemic. A prospective cross-sectional study was conducted among 44 HO. When they begin their posting in ED, a pre-test was done with a questionnaire to evaluate their knowledge and confidence level. A post-test was conducted three months later with a similar questionnaire. They underwent an objective structured clinical examination to evaluate their skill. A feedback survey form was filled in by the HO regarding their satisfaction in training in emergency rotation. The mean score for pre-test and post-test were 8.75 ± 3.005 and 14.86 ± 2.258, respectively (P = 0.000). There was an improvement in knowledge level and confidence level between pre-test and post-test (all P = 0.000). 43.2% were competent in knowledge, while 65.9% were competent in skill. 35 house officers filled in the feedback survey form. It showed that 42.9% (n = 15) were very satisfied and 28.6% (n = 10) were satisfied with the training in ED. There was an improvement in knowledge and confidence level in RSI among the HO after ED rotation. The clinical exposure in intubating real patients was limited among HO due to the COVID-19 pandemic. The training of HO for RSI in ED needs to be further improvised to optimize their learning process.

Keywords: COVID-19; internship and residency; rapid sequence intubation; teaching and learning; workplace learning

ABSTRAK

Intubasi Urutan Pantas (RSI) adalah kemahiran prosedur yang perlu dipelajari pegawai perubatan siswazah (PPS) di Malaysia semasa menjalani latihan di Jabatan Kecemasan (ED). Kajian ini bertujuan untuk menilai tahap keyakinan dan kecekapan melakukan RSI dalam kalangan PPS yang telah melengkapkan latihan di jabatan kecemasan sebuah hospital universiti semasa pandemik COVID-19. Kajian prospektif ini dijalankan dalam kalangan 44 PPS di ED. Semasa mereka memulakan latihan di ED, ujian pra dilakukan dengan borang soal selidik untuk menilai tahap pengetahuan dan keyakinan mereka dalam RSI. Selepas tiga bulan, ujian pasca dijalankan dengan soal selidik. Mereka menduduki pemeriksaan klinikal berstruktur objektif RSI untuk menilai tahap kemahiran mereka. Borang tinjauan maklum balas diisi oleh HO mengenai kepuasan mereka mengenai latihan di ED. Skor min ujian pra dan ujian pasca masing-masing adalah 8.75 ± 3.005 dan 14.86 ± 2.258 (P = 0.000). Terdapat peningkatan tahap pengetahuan dan keyakinan antara ujian pra dan ujian pasca (semua P = 0.000). 43.2% (n = 19) mempunyai kompetensi dalam pengetahuan, sementara 65.9% (n = 29) kekompetenan dalam kemahiran. 35 PPS mengisi borang tinjauan maklum balas. Keputusan menunjukkan bahawa42.9% (n = 15) sangat berpuas hati dan 28.6% (n = 10) berpuas hati dengan latihan di ED. Kajian ini menunjukkan bahawa setelah menjalani latihan di ED, terdapat peningkatan dalam tahap pengetahuan dan keyakinan dalam RSI dalam kalangan PPS. Pendedahan klinikal untuk intubasi pesakit sebenar adalah terhad dalam kalangan PPS disebabkan pandemik COVID-19. Latihan PPS untuk RSI di ED perlu diperbaiki untuk pembelajaran yang optimum.

Kata kunci: COVID-19; intubasi; latihan siswazah; pembelajaran di tempat kerja; pengajaran dan pembelajaran

REFERENCES

Abd Samat, A.H., Isa, M.H., Sabardin, D.M., Jamal, S.M., Jaafar, M.J., Hamzah, F.A., Mahmud, A., Sanip, A., Syed Ali, S.M. & Saiboon, I.M. 2020. Knowledge and confidence level among emergency healthcare workers in airway management and resuscitation of suspected COVID-19 patients: A cross sectional study in Malaysia. Annals of the Academy of Medicine, Singapore 49(9): 643-651.

Cleland, J., Mckimm, J., Fuller, R., Taylor, D., Janczukowicz, J. & Gibbs, T. 2020. Adapting to the Impact of COVID-19: Sharing stories, sharing practice. Medical Teacher 42(7): 772-775.

Cucinotta, D. & Vanelli, M. 2020. WHO Declares COVID-19 a Pandemic. Acta Biomedica 91(1): 157-160.

Hall, A.K., Nousiainen, M.T., Campisi, P., Dagnone, J.D., Frank, J.R., Kroeker, K.I., Brzezina, S., Purdy, E. & Oswald, A. 2020. Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic. Medical Teacher 42(7): 756-761.

Kory, P.D., Eisen, L.A., Adachi, M., Ribaudo, V.A., Rosenthal, M.E. & Mayo, P.H. 2007. Initial airway management skills of senior residents: Simulation training compared with traditional training. CHEST 132(6): 1927-1931.

Krejcie, R.V. & Morgan, D.W. 1970. Determining sample size for research activities. Educational and Psychological Measurement 30(3): 607-610.

Lateef, F. 2010. Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma, and Shock 3(4): 348-352.

Makwana, H.D., Suthar, N.N., Gajjar, M.P. & Thakor, A.V. 2016. Developing competency in interns for endotracheal intubation: An educational article. International Journal of Applied and Basic Medical Research 6(3): 201-204.

Malaysian Medical Council. 2008. A Guidebook for House Officers. Kuala Lumpur: Malaysian Medical Council.

Mohd Saiboon, I., Jaafar, M.J., Ahmad, N.S., Nasarudin, N.M., Mohamad, N., Ahmad, M.R. & Gilbert, J.H. 2014. Emergency skills learning on video (ESLOV): A single-blinded randomized control trial of teaching common emergency skills using self-instruction video (SIV) versus traditional face-to-face (FTF) methods. Medical Teacher 36(3): 245-250.

Toy, S., Mckay, R.S., Walker, J.L., Johnson, S. & Arnett, J.L. 2017. Using learner-centered, simulation-based training to improve medical students' procedural skills. Journal of Medical Education and Curricular Development 4: 2382120516684829.

Walls, R.M. 2012. Rapid sequence intubation. In Manual of Emergency Airway Management, 4th ed., edited by Walls, R.M. & Murphy, M.F. Philadelphia (PA): Lippincott Williams & Wilkins. p. 221.

Yang, D., Wei, Y.K., Xue, F.S., Deng, X.M. & Zhi, J. 2016. Simulation-based airway management training: Application and looking forward. Journal of Anesthesia30(2): 284-289.

*Corresponding author; email: khaldun_ismail@yahoo.com