Achieving Competency in Fiber-Optic Intubation Among Resident Physicians After Higher- Versus Lower-Fidelity Task Training: A Randomized Controlled Study

• Published in: Anesthesia and analgesia Vol. 137; no. 1; pp. 200 - 208
• Main Authors: Melvin, Martina T, Siddiqui, Naveed T, Wild, Evan, Parotto, Matteo, Perelman, Vsevolod S, You-Ten, Kong Eric
• Format: Journal Article
• Language: English
• Published: United States 01.07.2023
• Subjects: Clinical Competence; Computer Simulation; Fiber Optic Technology; Humans; Internship and Residency; Intubation, Intratracheal; Learning Curve; Physicians
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000006283

The high-fidelity ORSIM (Airway Simulation Ltd) and the low-fidelity wooden-block fiber-optic task trainers allow users to familiarize themselves with the psychomotor skills required to manipulate the fiber-optic scope. This single-center study aimed to compare residents' performance of fiber-optic intubation after 2 different types of task training. Twenty-four residents with experience of <8 fiber-optic intubations were randomized to either the ORSIM or a wooden-block task trainer. In a single teaching session, the resident performed 20 fiber-optic intubations on their assigned task trainer. This implied simulator competence. In the 4 months after this training, all subjects then attempted to perform a fiber-optic intubation on an American Society of Anesthesiologists (ASA) I or II anesthetized patient whose airway was preoperatively assessed as normal. The primary outcome was the cumulative sum (CUSUM) learning curves obtained as the residents trained on their respective task trainers. Secondary outcomes included: the mean time (in seconds) to perform each of the 20 fiber-optic intubations on their assigned task trainer, the total simulator training time, global rating scale score, checklist score, and time to carina when performing fiber-optic intubation on the patient. The CUSUM analysis showed that the ORSIM group achieved simulator competence faster. The mean time to perform fiber-optic intubation was shorter in the ORSIM group. A 2-way analysis of variance (ANOVA) test suggests that the combined effect of group (wooden-block or ORSIM) and time is statistically significant ( P < .05).Total training time (mean, 899 s ± 440 s vs 1358 s ± 405 s; 95% confidence interval [CI], 100.46-818.54; P = .01) was also significantly better in the ORSIM group.No significant difference was found between the 2 groups ( P > 0) in terms of global rating scale, checklist score, and time to reach the carina ( P >.05) when performing the fiber-optic intubation on the patient. ORSIM showed superiority in terms of the CUSUM learning curve in reaching competence faster in fewer attempts. There was no statistically significant difference in residents' performance when translated to clinical practice on a patient. This information should assist course directors when choosing task trainers for fiber-optic intubation training programs.