Average Intubation # In Residency

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Vigileo

Vigileo

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Hello all. I’m actually a pulm/CCM fellow, but I’m interested in airway management by non-anesthesia physicians. What number of intubations would you all say the average EM resident graduates with? We are more similar to you all in the types of patients and intubations we do compared to anesthesia, so it’s a good benchmark and informative. Thanks!


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I must have done over 300 without exaggeration. On my Gen. Surg month, I tubed the patient, left, scrubbed in, assisted, and closed.
 
Guestimating = 50 in anesthesia in med school, 50-75 in anesthesia in residency, 100+ in EDs in residency? I'm low-balling those numbers, could be higher than that. Plus a handful or two on off service rotations, floor codes, ICUs.


If only non-invasive wasn't so great for CHF/COPD I could have had more! I coulda been a contender!
 
I have done almost more as an attending. I have probably intubated probably 50-100 pts in the past 5 months.

That what happens when you take a job where you are the "airway doctor" for the ED, the entire five floor of the hospital and all three of the ICUs.
 
I did about 100 in EM residency.


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This number is pretty useless. Most video assisted intubations are so easy I can guide a brand new third year medical student through it.

The real question that matters is: how many DIFFICULT intubations did you do? Difficult intubations are humbling and really make you rethink everything. They also prepare you for the next one. If you aren’t doing difficult intubations with blood and vomit everywhere and pieces of flesh hanging off from trauma all the while people are screaming and all hell is breaking loose, then you are missing out on real training.

I’d rather someone who had 75 difficult intubations in residency intubate me over someone who had 400 easy ones. It’s like learning to play a video game on hard and then playing it again on easy, boring.
 
Its important to have enough to get the basics down before all the chest pounding over difficult intubations. I did a bunch as a med student but I still don't feel entirely comfortable even after several hundred until I see that end tidal
 
I had roughly 40 as a med student and ~110 as a resident
 
Uhhhh.....I'm not sure I had anywhere near as many as many people in this thread. I guess I could go back and find my logs and get the exact number. Whatever it was, it was "enough."

Bipap has had a serious dent on this such that EM does a lot less intubations than it used to for medical issues, so I think most of those done in residency are now trauma patients. So if you don't have much trauma at your residency, you might not get that many.

The real numbers issue for most EM residents is peds intubations. We could all use a few more of those.
 
Tenk said:
This number is pretty useless. Most video assisted intubations are so easy I can guide a brand new third year medical student through it.

The real question that matters is: how many DIFFICULT intubations did you do? Difficult intubations are humbling and really make you rethink everything. They also prepare you for the next one. If you aren’t doing difficult intubations with blood and vomit everywhere and pieces of flesh hanging off from trauma all the while people are screaming and all hell is breaking loose, then you are missing out on real training.

I’d rather someone who had 75 difficult intubations in residency intubate me over someone who had 400 easy ones. It’s like learning to play a video game on hard and then playing it again on easy, boring.
Click to expand...

I know a few newly graduated attendings who haven't used DL since they were an intern on anesthesia.

Even scarier is the fact that they graduated with probably <20 successful DL attempts.
 
Tenk said:
This number is pretty useless. Most video assisted intubations are so easy I can guide a brand new third year medical student through it.

The real question that matters is: how many DIFFICULT intubations did you do? Difficult intubations are humbling and really make you rethink everything. They also prepare you for the next one. If you aren’t doing difficult intubations with blood and vomit everywhere and pieces of flesh hanging off from trauma all the while people are screaming and all hell is breaking loose, then you are missing out on real training.

I’d rather someone who had 75 difficult intubations in residency intubate me over someone who had 400 easy ones. It’s like learning to play a video game on hard and then playing it again on easy, boring.
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I think you have a good point. Depending on where and how you train, it can be hard to get difficult tubes. It's important for residents to attempt as many difficult airways as possible, and overall, I think many ED programs are good about letting residents have at least one attempt on the difficult intubations before having someone else try. Those are the intubations that have considerable learning opportunity.

On a side note, I don't think many people outside of the ED realize that we frequently intubate patients as they are crashing. As a resident on day one, I was expected to handle all procedures for my patients, within reason of course. But when I did my anesthesia rotations as a student and resident I got bumped from anything but the most uncomplicated cases.

I had multiple conversations that went something like this as a resident in the OR:

CRNA: I better tube this lap appy patient (who is completely stable) myself since they haven't been npo. It will be an RSI.

Me: Huh? Pactically all the intubations I do in my own department are RSI. And they are never npo. And they are usually actively trying to die while I intubate them. I never get to intubate stable patients, so RSI with little to no advanced notice is how EM residents learn to intubate from day one. It's actually our wheelhouse in regard to airway. I don't know squat about this elective intubation stuff in the OR during which you push a little propofol, bag them, and then tube them.

CRNA: watch me, and maybe you can try the next one.

Back to the original point. I'm starting to think our airway training in is unique. I wonder if CRNAs, and maybe anesthesiologists, learn on stable simple airways early on while difficult airways are handled by more experienced people. I wonder if the intubations an ICU fellow performs provide the same type of experience one gets as an ER resident. I doubt it it, but then again I suppose they probably get enough experience intubation they type of patients whether will intubate as an attending. That's probably what matters most.

I think other departments honestly don't believe that not only are ER residents expected to handle nearly all airways, they are actually given priority and encouraged to make the first attempt at a difficult intubation in a crashing patient before someone more senior takes over if needed.

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Tenk said:
This number is pretty useless. Most video assisted intubations are so easy I can guide a brand new third year medical student through it.

The real question that matters is: how many DIFFICULT intubations did you do? Difficult intubations are humbling and really make you rethink everything. They also prepare you for the next one. If you aren’t doing difficult intubations with blood and vomit everywhere and pieces of flesh hanging off from trauma all the while people are screaming and all hell is breaking loose, then you are missing out on real training.

I’d rather someone who had 75 difficult intubations in residency intubate me over someone who had 400 easy ones. It’s like learning to play a video game on hard and then playing it again on easy, boring.
Click to expand...
I lost some good shoes in residency on those difficult intubations.

For anyone just starting their training: Even if you use VL on every intubation, 1) Use a blade that allows you to DL and turn the screen away from you, specifically ask your attending to not tell you what they see on the screen unless you ask for help. This means avoiding the hyperangulated blades (classic Glidescope or the CMAC D blade). 2) Always have an actual DL setup on the table as a backup.

Our community standard is essentially VL if available, so I use a MAC attachment on the VL and just do direct visualization. Screen is there if needed. DL is always next to me.
 
Psai said:
Its important to have enough to get the basics down before all the chest pounding over difficult intubations. I did a bunch as a med student but I still don't feel entirely comfortable even after several hundred until I see that end tidal
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Yeah, but aren't you in anesthesia? You guys do a ton of intubations. All the time. We don't do them as often, and we aren't as graceful or slick as you probably are. But when we do them, they are in critically I'll patients with or without difficult airways features. We don't get to plan much in advance. We have to be ready for whatever comes through the door, which exposure early and often to difficult airways.

It's not about chest pounding. It's about training ER residents to handle the sickest, most unstable patients when they show up. That's the whole goal of an EM residency.

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As an anesthesia doc, I am kind of compelled to answer this question, too. I remember when sitting in a meeting at the hospital where I trained was trying to determine "How many intubations does someone need before they can perform the procedure unsupervised in emergent situations?"

I laughed out loud when people threw out numbers like 20 or 30 or even 50. I graduated with something like 1500-2000 intubations which included >100 awake fiberoptic intubations, hundreds of asleep fiberoptic intubations, light wands, VL (glidescope, CMAC), bullards, 1000 DLs, etc.

In our ED for Level 1 trauma's the ED resident gets the first look. Always. It's good for their training, because these airways are the typical airway experience for them in real practice. They aren't pre-oxygenated NPO patients in the OR like many of ours. (That said, I find it humerous when people insinuate that we don't see bloody, vomiting, or anatomically altered airways in anesthesia).

One thing I find interesting is this: When I step outside of the OR and help supervise critical care fellows or ED residents perform intubations and serve as their back-up, I am often astounded by how little they have looked into the patient. The airway algorithm for any specialty starts with Awake versus Asleep intubation. The awake intubation is almost never considered outside of the operating room and I am more than often called to rescue an airway that shouldn't have been induced in the first place. Emergent and urgent airways are different animals. A lot of people consider them one and the same.

I cannot count the number of times a CC fellow has been unable to tell me the airway exam on a patient before induction. In fact, we've had a patient get induced for an intubation in the ICU who was found to have 1) a wired mouth, 2) significant neck radiation preventing any cervical spine motion, etc, etc.

Main point: I think there is a giant pissing contest when it comes to intubations and the patients ultimately lose, in the end. I think that our fields could help each other produce better training instead of having toes getting constantly stepped on.
 
KGflyboy said:
Yeah, but aren't you in anesthesia? You guys do a ton of intubations. All the time. We don't do them as often, and we aren't as graceful or slick as you probably are. But when we do them, they are in critically I'll patients with or without difficult airways features. We don't get to plan much in advance. We have to be ready for whatever comes through the door, which exposure early and often to difficult airways.

It's not about chest pounding. It's about training ER residents to handle the sickest, most unstable patients when they show up. That's the whole goal of an EM residency.

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Click to expand...

We get those patients all the time. Critically ill patients are a dime a dozen. It's not just prop tube coffee
 
Psai said:
We get those patients all the time. Critically ill patients are a dime a dozen. It's not just prop tube coffee
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I'm sure you do. I'm not suggesting otherwise. I'm suggesting we don't get the volume of tubes, but when we do it the patients are nearly all universally critically ill (not that critically ill correlates with difficult airways).

What percentage of tubes in the OR overall go in patients with respiratory failure or severe shock? Pretty low I imagine since most surgeries are contraindicated during vfib, shock, and so on prior to some level of resuscitation. ER residents learn on those patients from the beginning. It's not chest pounding. It's just the nature of the field.

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The Physician Philosopher said:
As an anesthesia doc, I am kind of compelled to answer this question, too. I remember when sitting in a meeting at the hospital where I trained was trying to determine "How many intubations does someone need before they can perform the procedure unsupervised in emergent situations?"

I laughed out loud when people threw out numbers like 20 or 30 or even 50. I graduated with something like 1500-2000 intubations which included >100 awake fiberoptic intubations, hundreds of asleep fiberoptic intubations, light wands, VL (glidescope, CMAC), bullards, 1000 DLs, etc.

In our ED for Level 1 trauma's the ED resident gets the first look. Always. It's good for their training, because these airways are the typical airway experience for them in real practice. They aren't pre-oxygenated NPO patients in the OR like ours.
Click to expand...

This. I agree completely. I don't mean to start a pissing match, so hopefully no one takes it that way. I'm merely suggesting comparing the intubations in the ER to intubations in the ICU or in the OR during training are not the same. I'm sure you guys do crazy numbers of bloody of vomit filled airways based on the large numbers of overall airways you do. We do far fewer airways, but they are likely to be just as you described each time.

I made a comparison to other fields not understanding each other's training and day to day jobs, and I think that is pretty apparent when residents go to the OR and are told not to do the urgent appy because it is an RSI case. It is also apparent when someone assumes you don't get blood filled airways.

I think resident intubation education will improve when we understand each other better. ER residents will never get 1000 tubes in residency like may be feasible in your field, so they need to focus on the types of procedures most relevant.

We have an anesthesiologist who loves to teach ER residents. He is happy to let them practice fiber optic, awake, or whatever other skills they don't often get to practice.

Nobody wants their first fiber optic or awake intubation to be as an attending without backup. The best place to learn that is in the OR with you. Hands down. I hope we all agree on that.
 
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if you're unhappy with the crna telling you not to tube, you should bring it up with them.
 
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Psai said:
if you're unhappy with the crna telling you not to tube, you should bring it up with them.
Click to expand...

My point was never directed at a particular experience with a specific individual. My point was:

1. Intubations in the ICU, OR, and ED in residency will all provide vastly different experiences and result in different skill sets, which was related to the original post.

2. There are multiple people in anesthesia, ICU, and other fields that have no clue what types of intubations ER residents and attendings typically do. I'm sure this works both ways.

3. My example was representative of a common sentiment in anesthesia when ER residents rotate through, which is not going to improve by saying something to an individual CRNA. The issue is a lack of understanding of each other's fields.

4. I did say something at the time. I think I covered that pretty well in my first post.

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KGflyboy said:
CRNA: I better tube this lap appy patient (who is completely stable) myself since they haven't been npo. It will be an RSI.

Me: Huh? Pactically all the intubations I do in my own department are RSI. And they are never npo. And they are usually actively trying to die while I intubate them. I never get to intubate stable patients, so RSI with little to no advanced notice is how EM residents learn to intubate from day one. It's actually our wheelhouse in regard to airway. I don't know squat about this elective intubation stuff in the OR during which you push a little propofol, bag them, and then tube them.

CRNA: watch me, and maybe you can try the next one.

Back to the original point. I'm starting to think our airway training in is unique. I wonder if CRNAs, and maybe anesthesiologists, learn on stable simple airways early on while difficult airways are handled by more experienced people. I wonder if the intubations an ICU fellow performs provide the same type of experience one gets as an ER resident. I doubt it it, but then again I suppose they probably get enough experience intubation they type of patients whether will intubate as an attending. That's probably what matters most.
Click to expand...

As an anesthesiologist I've supervised a lot of ER residents who come through for an anesthesiology rotation. I'd probably never allow one to perform an RSI on a patient - we're doing an RSI for a reason and there's high liability on my end if something goes wrong. I'm sympathetic to the need/desire to do as many intubations as possible, including more complicated ones... but a visitor's education isn't my primary goal if there's any big concern for my patient's safety. There's a lot that can go wrong during intubation even in very skilled hands. That, and we anesthesiologists tend to be exceptionally conservative. And I don't want to get sued as much as you don't want yourself to get sued.

Also note there is a lot to be learned from doing straightforward intubations with patients in the OR. There's often enough time for me to point out subtle technique tips (good tongue sweep, good mouth opening, proper head position, proper stance, etc). Having someone with experience pointing these things out can be invaluable to overall technique. I'd say it's like having a tennis pro coach you on your swing.

There's also much to be learned in the OR beyond intubation. Mask ventilation and LMA placement are also ultra-important and under-appreciated things to learn regarding airway management. I've noticed recently that the ER residents have been very receptive to discussions on physiology, vasopressors, central/A-lines, etc. Overall I've been very impressed by the ER residents that come through - they have been eager to learn, have a good work ethic, and are easy to get along with.
 
kidthor said:
As an anesthesiologist I've supervised a lot of ER residents who come through for an anesthesiology rotation. I'd probably never allow one to perform an RSI on a patient - we're doing an RSI for a reason and there's high liability on my end if something goes wrong. I'm sympathetic to the need/desire to do as many intubations as possible, including more complicated ones... but a visitor's education isn't my primary goal if there's any big concern for my patient's safety. There's a lot that can go wrong during intubation even in very skilled hands. That, and we anesthesiologists tend to be exceptionally conservative. And I don't want to get sued as much as you don't want yourself to get sued.

Also note there is a lot to be learned from doing straightforward intubations with patients in the OR. There's often enough time for me to point out subtle technique tips (good tongue sweep, good mouth opening, proper head position, proper stance, etc). Having someone with experience pointing these things out can be invaluable to overall technique. I'd say it's like having a tennis pro coach you on your swing.

There's also much to be learned in the OR beyond intubation. Mask ventilation and LMA placement are also ultra-important and under-appreciated things to learn regarding airway management. I've noticed recently that the ER residents have been very receptive to discussions on physiology, vasopressors, central/A-lines, etc. Overall I've been very impressed by the ER residents that come through - they have been eager to learn, have a good work ethic, and are easy to get along with.
Click to expand...

Very good points. There are a lot of techniques to learn in the OR to improve techniques, skill, and knowledge.

Your thoughts on the RSI seem common in anesthesia. It illustrates how different thoughts are in different fields. Interns are doing RSI from day 1 in the ED. That's pretty much the only method of intubation they get much experience with before they rotate in your department. An attending in the ED would virtually never take an intubation attempt from the resident. Hereditary angioedema swelling up? Probably the resident. Facial trauma with cervical spine injury? Probably the resident. Stab would to the neck with expanding hematoma? Probably the resident. In fact, interns can successfully handle those airways with appropriate backup to help if needed.

Liability is not a big concern
during an intubation in the ED. If someone stops breathing and needs tubed, it's pretty hard to make that situation much worse. It could happen though.

Residents intubate at night in our ICU without attendings present. The only way we can make that happen safely is by giving them supervised practice with all types of airways early and often.
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I think you're exaggerating quite a bit. Every anesthesiologist rotates through emergency medicine and we get called to the majority of airways during training.
 
Psai said:
I think you're exaggerating quite a bit. Every anesthesiologist rotates through emergency medicine and we get called to the majority of airways during training.
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Not a bit, those examples I gave were all performed by interns at my hospital within the last 6 months. EM is an awesome field with a lot of cool procedures right from the start, so it's no mystery why it's so popular right now. I can only think of one time anesthesia was present for an intubation at my hospital during my shift recently, and it was because I was concerned for a tracheal injury and needed someone to trouble shoot and bronch well after the tube had already been placed by the resident. Anesthesia is present at maybe 2% of ED intubations where I've worked.

I recently had a patient whose electronic cigarette blew up and ignited her O2 and cannula. She was talking and alert but had signs of airway swelling and inhalational burns. Intern put the tube in like a champ on the first attempt. No one was surprised. Just another day in the ED.

In fact, if I call anyone, it's usually ENT. We call the ENT resident if we think a surgical airway is reasonably likely to be needed. If the ENT residents aren't able to arrive in time, the ED resident gets to do it.

Who do you think does chest tubes, lumbar punctures, arthrocentesis, lateral canthotomies, and even emergent thoracotomies? Always the resident first. I can't think of any time I've ever seen an attending take one of those procedures without giving the resident first chance.
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Psai said:
I think you're exaggerating quite a bit. Every anesthesiologist rotates through emergency medicine and we get called to the majority of airways during training.
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You get called to the majority of airways in the ED? I feel like that's pretty unusual. I can count on one hand the number of times I had an anesthesiologist present in the ED while intubating as a resident.
 
Psai said:
I think you're exaggerating quite a bit. Every anesthesiologist rotates through emergency medicine and we get called to the majority of airways during training.
Click to expand...

Difference between a community EM residency and University based residency. LOL. I rarely, if ever, see an anesthesiologist in the ED. Its like seeing ortho in the ED for a colles fracture reduction or a shoulder reduction.
 
gamerEMdoc said:
I'd say most of our residents get in the 100 range of tubes. By then they start passing them on to junior residents and med students and just supervise them.
Click to expand...

Are all of these 100 tubes all RSI, bleeding vomiting airways in crashing patients like the intern above is trying to say? I doubt it, unless it's iatrogenic
 
95% of intubations during my career have been RSI.

In terms of the # of tubes in crashing patients, many of them are. The ones that aren’t are the ones they do on anesthesia as an intern. Those are a much more controlled setting obviously. In the ED, when you are tubing someone, it is rarely a stable person with great pulmonary reserve and perfectly normal anatomy who was fasting for the past 12 hours.
 
Psai said:
Are all of these 100 tubes all RSI, bleeding vomiting airways in crashing patients like the intern above is trying to say? I doubt it, unless it's iatrogenic
Click to expand...

Essentially all intubations in the ER are RSI. The number of times I called anesthesia in residency was 2. Most airways in the ED are deemed difficult from a physiologic, albeit not anatomic, standpoint - because the most common indications are hypoxic respiratory failure, arrest, trauma, OD/metabolic derangement, shock.
 
I've been on a couple EM interviews this season, and was quoted about 100 intubations and 100 central lines per graduating resident. Also around 1-2 cric. Not sure about chest tubes or other procedures though.
 
gamerEMdoc said:
Difference between a community EM residency and University based residency*. LOL. I rarely, if ever, see an anesthesiologist in the ED. Its like seeing ortho in the ED for a colles fracture reduction or a shoulder reduction.
Click to expand...

*Not any university based residency I ranked highly. Most of the older programs have total control over airway in the department.
 
So in "real life" I've seen anesthesia twice in my 7.5 years since finishing residence perform an intubation in the ED.

Both times I thanked them 🙂
 
TrailRun said:
I've been on a couple EM interviews this season, and was quoted about 100 intubations and 100 central lines per graduating resident. Also around 1-2 cric. Not sure about chest tubes or other procedures though.
Click to expand...

Every resident gets 1-2 crics?
 
gamerEMdoc said:
Difference between a community EM residency and University based residency. LOL. I rarely, if ever, see an anesthesiologist in the ED. Its like seeing ortho in the ED for a colles fracture reduction or a shoulder reduction.
Click to expand...

I know you weren’t picking on my university program, but I have never seen anesthesia in our ED, unless they were an intern rotating through. As others have mentioned, we will rarely call ENT if needed.
 
Psai said:
Are all of these 100 tubes all RSI, bleeding vomiting airways in crashing patients like the intern above is trying to say? I doubt it, unless it's iatrogenic
Click to expand...

All of our airways are RSI. Sometimes, it is delayed sequence, but I rarely intubate without a paralytic and we never intubate what would be the equivalent of an elective surgical pt, because why?

I am curious what sort of stable patient do you believe gets intubated in the ED?
 
I didn't mean to misconstrue my University/Community residency comments. I guess I was going for the fact that when there isn't an Anesthesia residency present (like many Community sites), there is no competition. I'm well aware that many University based programs have long ago won the fight to manage their own airways during trauma, etc.
 
TrailRun said:
I've been on a couple EM interviews this season, and was quoted about 100 intubations and 100 central lines per graduating resident. Also around 1-2 cric. Not sure about chest tubes or other procedures though.
Click to expand...

I would never advertise the number of crics my residents get. If your program does 1-2 a year, fine. If you have a graduating class of residents with an aggregate 10-20, you have an airway education problem. Remember, it’s not just pure numbers when it comes to airway or even number of difficult airways, it’s focused education.
 
Psai said:
I think you're exaggerating quite a bit. Every anesthesiologist rotates through emergency medicine and we get called to the majority of airways during training.
Click to expand...
If you showed up at the majority of airways in the ED, that residency program would not be able to recruit any residents, and the ones that were there would get garbage training. If that was the case at my residency I wouldn't have come here.

One of the things I hate about our specialty is how much "creep" there is. The ED is ground zero for some of the coolest procedures in the hospital, but every service is always trying to come down and take away procedures. At our program, for years anesthesia has been trying to take over trauma airways, but our program leadership forbids it from happening. You guys get your own training in the OR and the unit, I don't get why people feel the need to be involved in the ED. I get it that ortho needs reductions for their training, and surgery needs some chest tubes, but there is virtually no need for anesthesia to ever come to a single airway unless they are asked to.

When an anesthesia resident is rotating through the ED and their patient needs an airway, it is absolutely theirs for the taking (similar to when we do our anesthesia rotation in the OR).

I don't come to the OR to help out when a case goes wrong, because that is your arena and I know you guys have the training to handle it and are better equipped than I am. Why that isn't reciprocated for the ED, I'm not sure. You guys have your expertise and your niche, you should let it go and allow the emergency physicians to handle emergency care. For me, part of this I think is the nature of me training at a 4 year academic EM program. I do sometimes envy those who are at unopposed community EM residencies for this reason. Those who are currently making your rank lists, keep this in mind.
 
racerwad said:
I know you weren’t picking on my university program, but I have never seen anesthesia in our ED, unless they were an intern rotating through. As others have mentioned, we will rarely call ENT if needed.
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I agree, I also train at a university program and we don't have anesthesia come to our airways. That being said, other residencies do exist in our institution and they do come to the ED to get their training experience, whether it's ortho getting reductions, ENT doing an NP scope, etc. We are fortunate that we still get plenty of exposure to these procedures and do a lot of them on our own, but I think we would get more if we didn't have to compete with them (in our own department nonetheless).

Can you imagine what would happen if I showed up to the MICU to place a central line for a patient?

I'm basically in the middle of second year slump at my residency program, so please excuse some of my bitterness.
 
TheComebacKid said:
I agree, I also train at a university program and we don't have anesthesia come to our airways. That being said, other residencies do exist in our institution and they do come to the ED to get their training experience, whether it's ortho getting reductions, ENT doing an NP scope, etc. We are fortunate that we still get plenty of exposure to these procedures and do a lot of them on our own, but I think we would get more if we didn't have to compete with them (in our own department nonetheless).

Can you imagine what would happen if I showed up to the MICU to place a central line for a patient?

I'm basically in the middle of second year slump at my residency program, so please excuse some of my bitterness.
Click to expand...

I love how people get so territorial in the ivory towers. If I wanted to go down to the MICU and place all the central lines the intensivist would say "Thank you very much" and let me have them. Same with MICU intubations, emergent deliveries etc. This squabbling over procedures simply doesn't exist except for everyone trying to get out of them!
 
TimesNewRoman said:
I would never advertise the number of crics my residents get. If your program does 1-2 a year, fine. If you have a graduating class of residents with an aggregate 10-20, you have an airway education problem. Remember, it’s not just pure numbers when it comes to airway or even number of difficult airways, it’s focused education.
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Agreed. The average number of cric’s per resident per year should average to 0. I’ve seen 1 cric in my career and never done one myself. I graduated with somewhere ~100 intubations. I don’t worry about doing RSI’s on anesthesia rotation. That’s the time to master basics. But to any anaesthesiologist in this thread discussing our RSI rate, in EM 95+% of intubations are in non-stable patients and done w/ RSI. To anyone in general asking my practice pattern: As a practicing attending I call anesthesia to assist w/ intubations maybe once a year (in the last 2.5 years at my current job, they assisted me in 2 cases: a bad angioedema case and a deteriorating lethargic 850 pound guy who was likely having a stroke. That was his actual weight, and I dont’ know if he was having a stroke because he couldn’t fit on our scanners). Awake intubations and nasal intubations are good things to have an assist on if it’s available.
 
Crics are required procedures, I'm sure the 1-2 you saw quoted was done in a SIM session so residents could graduate.
 
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