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LEARNING FIBEROPTIC INTUBATION ON A SIMPLE MODEL TRANSFERS TO THE O.R.

Department of Anesthesia & Centre for Research in Education, University Health Network & Mount Sinai Hospital, University of Toronto, 600 University Ave., Toronto, ON, M5G 1X5

INTRODUCTION

With increasing pressure to use operating room (OR) time efficiently, opportunities for residents to learn fiberoptic orotracheal intubation (FOI) in the OR have declined.¹ The purpose of this study was to determine whether FOI skills learned outside the OR on a simple model could be transferred into the clinical setting. To date, no studies have shown using validated instruments that technical skills learned on models transfer to patients in the OR.²

METHODS

Following IRB approval, first year anesthesiology residents and first and second year internal medicine residents were recruited. All subjects received a manual and watched a video detailing FOI. Subjects were randomized to a didactic teaching only group (n=12) or a model training group (n=12). The didactic group received a lecture from an expert bronchoscopist. The model group was guided, by experts, through tasks performed on a simple model designed to refine fiberoptic manipulation skills. Following the training, subjects performed a FOI on healthy, consenting, anesthetized and paralyzed female patients undergoing elective surgery with predicted "easy" laryngoscopic intubations. Two blinded examiners evaluated each subject's FOI performance using a validated checklist and global rating scale (GRS). Time to complete the task and success at achieving tracheal intubation were also documented.

RESULTS

The model group performed FOI significantly better than the didactic group in the OR when evaluated with the checklist and GRS (Figure 1). Model trained subjects also completed the task significantly faster than didactic trained subjects (p<0.01). Model trained subjects were also more successful at achieving tracheal intubation than the didactic group (p<0.005). Intra-operative inter-rater reliability was strong (Checklist: r = 0.87–0.99; GRS: r = 0.78-0.84).

View larger version (10K): [in this window] [in a new window]   Figure 1: Intra-operative FOI Assessment

FOI is an advanced airway skill taught during residency. This study suggests that FOI training on a simple model is more effective than conventional didactic instruction for transfer into the clinical setting. Incorporating an extra-operative model into the training of FOI may greatly reduce the time and pressures that accompany teaching this skill in the OR.

REFERENCES

1 Br J Anaesth 1992; 69: 202-3. [Abstract/Free Full Text]

2 Am J Surg 1999; 177: 167–70.[Medline]

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