Does seniority always correlate with simulated intubation performance? Comparing endotracheal intubation performance across medical students, residents, and physicians using a high-fidelity simulator

Abstract

Background Endotracheal intubation is crucial in emergency medical care and anaesthesia. Our study employed a high-fidelity simulator to explore differences in intubation success rate and other skills between junior and senior physicians. Methods We examined the performance of 50 subjects, including undergraduate students (UGY), postgraduate trainees (PGY), residents (R), and attending physicians (VS). Each participant performed 12 intubations (i.e. 3 devices x 4 scenarios) on a high-fidelity simulator. Main outcome measures included success rate, time for intubation, force applied on incisor and tongue, and Cormack Lehane grades. Results There was no primary effect of seniority on any outcome measure except success rate and Cormack Lehane grades. However, VS demonstrated shorter duration than medical students using Glidescope and direct laryngoscopy, whereas VS and R applied significantly more force on the incisor in the normal airway and rigid neck scenario respectively. Discussion Seniority does not always correlate with skill perfection in detailed processes. Our study suggests that the use of video laryngoscopy enhances the intubation success rate and speed, but the benefit only accrues to senior learners, whereby they applied more force on the incisor at a single peak under difficult scenarios. These findings are discussed in terms of psychological and cognitive perspectives. Conclusion Speed and safety are essential for high quality critical medical procedures. A tool should be designed and implemented to educate junior physicians with an emphasis on practice and efficiency, which should also contribute to updating senior physicians’ knowledge and competence by providing instant feedback on their performance. This type of fine-grained feedback could serve as a complement to traditional training and provide a sustainable learning model for medical education.

Simulation in contemporary medical education: Current practices and the way forward

“…Yau et al . [ 35 ] compared differences in intubation performance in success rate, time for intubation, force applied on incisor and tongue, and Cormac Lehane grades between medical students, residents, and junior and senior physicians on a high-fidelity simulator. They found that attending physicians were faster than medical students on intubation attempts.…”

Investigation of tracheal intubation operator and patients in difficult airway study

“…Their age and clinical experience is therefore varied and, because proficiency greatly affects the outcome, it seems necessary to specify who the operator was in the 374 videolaryngoscopic intubations. If possible, the operators of tracheal intubation should be limited to clinicians with similar clinical experience [2,3]. Furthermore, the operator should be at least a senior resident skilled in tracheal intubation, in order to reduce bias.…”