Nathanson et al. make a case for “career-long mandatory training” for rare but potentially fatal anaesthetic events and that this should be implemented and funded as a matter of urgency [1]. Despite having less than half the reported combined clinical years of anaesthesia experience of the sagacious authors, we echo their sentiment, with a particular focus on mandatory training for airway emergencies. The 7th National Audit Project (NAP7) demonstrated that airway complications occur commonly and ‘airway failure’ was reported to account for 30% of airway complications in cases surveyed [2]. Notably, such complications resulted in a significant number of cardiac arrests, deaths and adverse outcomes [2].

A recent Health Services Safety Investigations Body report described the tragic case of a 12-year-old boy with an anticipated difficult airway who died due to failed airway management, including multiple attempts at videolaryngoscopy and an emergency front-of-neck airway [3]. The report made several recommendations, including that the Royal College of Anaesthetists (RCoA) and other key stakeholders, provide guidance on requirements to update airway skills regularly, but did not propose how this could be mandated.

Therefore, we wish to consider two key areas: how mandatory training could be mandated; and what training is required, recognising potential benefits and challenges (Table 1). As Nathanson et al. highlight, the pathway or organisation with the authority to mandate training is opaque. In the UK, the General Medical Council may be best placed to do so [1], but the time required and the practicalities of delivery could be limiting factors. The RCoA could consider recommending training within its Guidelines for the Provision of Anaesthetic Services, but these would simply be guidelines rather than mandatory. A multi-organisation scoping exercise led by the RCoA is currently ongoing and may be a proactive step forward. However, until formalised mandatory training by a responsible authority is implemented widely, a bottom-up approach may be necessary. This could include evidence of airway training for annual sign-off or revalidation, as well as leadership for implementing this from the Airway Leads Network. Clinical Leads and Directors should embrace and enforce regular training in their departments and ensure dedicated time and resources to support delivery. Importantly, this will require clinicians themselves to take ownership of their training and actively seek opportunities for continuing development.

We believe that mandatory training should extend to technical skills training in frequently used airway equipment, such as videolaryngoscopes – particularly those used in the clinician's usual place of work – as well as procedures, such as awake tracheal intubation, to maintain proficiency. Worryingly, NAP7 found that a lack of familiarity with or misuse of airway equipment may have contributed to cardiac arrest in some cases, supporting the need for specific training. With ever-evolving devices and technology, we have an obligation to keep pace and familiarise ourselves with the tools of our trade through regular training and competency assessment. While we are under no illusions that mandatory training has challenges, the benefits should far outweigh them (Table 1).

Nathanson et al. give more than just sage advice, and we stand firmly behind their call to action [1]. As anaesthetists, expertise in airway management should be both guaranteed and maintained. Mandating regular training may be the way to achieve this. This will require a change in the status quo and concerted efforts from relevant stakeholders, starting with clinicians themselves, to ensure the necessary resources, infrastructure and support systems are in place to achieve this. Nathanson et al. quoted Oscar Wilde, who also suggested, “Experience is simply the name we give our mistakes.” We believe that experience should be the name we give for training to avoid mistakes.

Nathanson 等人为罕见但可能致命的麻醉事件提供了“终身强制性培训”的理由，并且应该紧急实施和资助 [1]。尽管睿智的作者报告的麻醉临床经验总和不到一半，但我们赞同他们的观点，特别关注气道紧急情况的强制性培训。第 7 次国家审计项目 （NAP7） 表明，气道并发症常见，据报道，在调查病例中，“气道衰竭”占气道并发症的 30% [2]。值得注意的是，此类并发症导致大量心脏骤停、死亡和不良结局 [2]。

卫生服务安全调查机构（Health Services Safety Investigations Body）最近的一份报告描述了一例悲惨病例，一名12岁男孩因气道管理失败而死亡，包括多次尝试进行视频喉镜检查和紧急前颈气道检查[3]。该报告提出了几项建议，包括皇家麻醉师学院 （RCoA） 和其他主要利益相关者就定期更新气道技能的要求提供指导，但没有提出如何强制要求。

因此，我们希望考虑两个关键领域：如何强制进行强制性培训;以及需要哪些培训，认识到潜在的好处和挑战（表 1）。正如 Nathanson 等人所强调的那样，有权强制培训的途径或组织是不透明的。在英国，医学总委员会可能是这样做的最佳人选 [1]，但所需的时间和交付的实用性可能是限制因素。RCoA 可以考虑在其提供麻醉服务指南中推荐培训，但这些只是指南，而不是强制性的。由 RCoA 领导的多组织范围界定活动目前正在进行中，这可能是向前迈出的积极一步。然而，在主管机构正式实施强制性培训之前，可能需要采取自下而上的方法。这可能包括用于年度签字或重新验证的气道培训证据，以及 Airway Leads Network 实施此培训的领导能力。临床主管和主任应该接受并加强他们部门的定期培训，并确保有专门的时间和资源来支持交付。重要的是，这将要求临床医生自己对他们的培训负责，并积极寻求持续发展的机会。

我们认为，强制性培训应扩展到常用气道设备的技术技能培训，例如视频喉镜——尤其是临床医生通常工作地点使用的那些——以及清醒气管插管等程序，以保持熟练程度。令人担忧的是，NAP7 发现，在某些情况下，不熟悉或滥用气道设备可能会导致心脏骤停，这支持了特定培训的必要性。随着设备和技术的不断发展，我们有义务通过定期培训和能力评估来跟上步伐并熟悉我们的行业工具。虽然我们并不幻想强制性培训会带来挑战，但好处应该远远大于它们（表 1）。

Nathanson 等人提供的不仅仅是明智的建议，我们坚定地支持他们的行动呼吁 [1]。作为麻醉师，应保证并保持气道管理方面的专业知识。强制定期培训可能是实现这一目标的方法。这将需要改变现状，并需要相关利益相关者的共同努力，从临床医生本身开始，以确保必要的资源、基础设施和支持系统到位以实现这一目标。Nathanson 等人引用了 Oscar Wilde 的话，后者也建议：“经验只是我们给错误起的名字。我们认为，经验应该是我们给培训的代名词，以避免错误。