Development Strategies in Medical Education

Introduction
Airway management includes a set of maneuvers and medical procedures that are performed to prevent and relieve airway obstruction [1].Airway management is usually divided into two basic and advanced categories [2].Many medical professionals rarely perform advanced airway management, which raises concerns about maintaining competency in this intervention.
In emergency medicine, the educational focus should be on learning how to manage common disorders and uncommon diseases that are potentially life-threatening [6]. Airway management training for medical students in universities can lead to saving people›s lives [7]. Considering the importance of airway management and given the fact that in some cases the person who appears at the patient›s bedside is a medical intern and that this ability is needed throughout the working period of a doctor, the evaluation of the airway management knowledge and practice of medical interns are very important. Therefore, the present study aims to investigate the effect of airway management workshop on the skills of medical interns in Zahedan, southern Iran.

Methods
The study population consists of the interns in the emergency medicine who had participated in the airway management workshop held by emergency medicine professors in Ali Ibne Abitalib Tertiary Care Hospital in Zahedan in 2022. Of these, 80 eligible medical interns were selected. The data collection tools included a demographic form (surveying gender, length of internship, overall grade point average [GPA] and type of university) and an airway management checklist. This checklist had two sections: airway establishment (total score= 19) and intubation (total score= 26). The total score of the overall checklist was between 0 and 45.
The emergency medicine workshop is a two-month course in which about 20 students participate. In this course, various trainings including splinting, suturing, airway management training, etc. are given by two permanent emergency medicine professors in the skill lab of Ali Ibne Abitalib Hospital in Zahedan. Before starting the training, a pre-test was taken from the interns using the Emergency Procedures Quick Reference Guide (EPQRG). The training classes were held in the form of one hour of theoretical learning and two hours of practical learning. In the one-hour theoretical learning class, explanations are given about airway management by the specialist using educational videos presented by a projector. In the practical training class, various maneuvers to open the airway (head tilt-chin lift, jaw-thrust, oral airway intubation, and placement of LMA, etc.) were performed on the moulage. Each student performed the procedures individually under the supervision of the emergency medicine professor. The students› skills were measured again one week after the class (post-test phase) using the EPQRG checklist. At the end, the final score of the interns was measured based on the scores: done (full points), incomplete (half of points), and not done (zero points). The difference between scores before and after participating in the workshop was considered as the final score.

Results
Participants were 37 female (46.2%) and 43 male (53.8%) interns;50 (62.5%) were studying in the governmental university and 39 (48.8%) were at the end of their internship period. The GPA of interns was 15.73±0.88. There was a significant difference between the skill scores of interns before and after participating in the airway management workshop (P<0.001). There was no significant difference between the skill scores before and after education based on gender (P=0.351). Based on the results of Kruskal-Wallis test, the skill score difference between pretest and posttest phases was not significant based on the duration of the internship period (P=0.321) or the type of university (P=0.213).The results of Spearman›s correlation showed a significant relationship between the skill score difference of interns and their GPA (P=0.002).

Conclusion
The results of the present study showed is a significant difference between the skill scores of interns in Zahedan before and after participating in the airway management workshop. Their scores increased after participating in the workshop. By identifying the effective factors in increasing and improving the airway management skills of interns, we can train more capable doctors in future with clinical skills for effective treatment of patients.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Zahedan University of Medical Sciences (Code: IR.ZAUMS.REC.1401.132)

Funding
This study was funded by Zahedan University of Medical Sciences.

Authors' contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declare no conflict of interest

Acknowledgements
The authors would like to thank the deputy for research of Zahedan University of Medical Sciences for their support and all the interns who participated in this study for their cooperation.


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