Longitudinal acquisition of endotracheal intubation skills in novice physicians

Abstract

Little is known about the acquisition of intubation skills among novice physicians during their one-year clinical training. Our primary objective was to determine the changes in the intubation skills of novice physicians between prior to the clinical training and after completion of the clinical training. We used data of a prospective longitudinal multicenter data registry developed to investigate factors associated with the improvement of intubation skills among novice physicians. The study participants included 90 postgraduate year 1 physicians in 2015–2016. We used 4 simulation scenarios based on the devices used (direct laryngoscope [DL] and Airway scope [AWS]) and difficulty of intubation (normal and difficult scenarios). As a marker of the intubation skills, we used the force applied on the maxillary incisors and the tongue with each intubation. We compared the data obtained prior to clinical training with those obtained after completion of one-year clinical training. When using DL, compared to prior, significantly less force were applied on the maxillary incisors and the tongue after clinical training in the normal scenario (28.0 N vs 19.5 N, p < 0.001, and 11.1 N vs 8.4 N, p = 0.004). Likewise, when using AWS, compared to prior, significantly less force were applied on the tongue after clinical training in the normal scenario (22.0 N vs 0 N, p < 0.001). The force on the tongue decreased after clinical training but not significant. These associations persisted in the difficult airway scenario. These findings suggest that force applied on oral structures can be quantified as a marker of intubation skills by using high-fidelity simulators, and the assessment of procedural competency is recommended for all novice physicians prior to performing intubation in the clinical setting to improve the quality of emergency care.

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

“…Moreover, the maximum applied force on incisor and tongue did not differ across seniority. The forces measured in the current study were much higher than in previous studies [4,6,23]. This could be explained by the use of different simulators and the sensitivity of the force measurement set up.…”

“…Intubation may also be evaluated by additional indicators such as applied force and glottic view that could affect patient outcome [2]. Proficient physicians should be able to adjust their techniques according to patients' conditions to maintain an airway and provide ventilation within a short period [3]; their force applied on the incisor should be minimized during intubation with any technique [4][5][6], and they should be able to obtain a good laryngeal view [7]. In general, the success of intubation is associated with the patient's condition, intubation devices used, and physicians' level of competence [3].…”

Endotracheal tube-mounted camera-assisted intubation versus conventional intubation in intensive care: a prospective, randomised trial (VivaITN)

“…The first-attempt success rate of intubation depends on physicians’ experience and increases with physicians’ training [ 29 – 31 ]. In our study, patients were intubated by attending physicians or fellows with several years of experience in airway management.…”

Post operative sore throat: Comparison between Macintosh versus Video Laryngoscope in patients intubated by trainee anaesthetists - A Randomised Control Trial

“…This definitely gets aggravated in patients being intubated by trainees. 11 As mentioned earlier, the use of VDL in this scenario is logical to overcome these issues. The learning curve is short and one can get easily trained for it.…”

“…This could be added advantage if used by trainees. 11 …”