Residents’ Acquisition of Fiberoptic Orotracheal Intubation Skills. Naik et al. (page 343)

According to Naik et al. , fiscal restraints have put pressure on hospitals to increase operating room turnover, resulting in less available time for attending staff to teach resident anesthesiologists the skills for performing fiberoptic orotracheal intubation (FOI), an advanced airway skill. Therefore, the researchers designed a randomized study to compare two methods of teaching FOI skills. First-year anesthesiology residents and first-and second-year internal medicine residents were randomized to either a didactic-teaching-only group (n = 12) or a model-training group (n = 12). All study participants first received a 10-min instrument orientation conducted by three expert bronchoscopists, during which time they familiarized themselves with the fiberoptic bronchoscope. In a pretest, they were all required to manipulate the fiberoptic bronchoscope through a series of syringe barrels contained in a covered wooden model under fiberoptic vision. Observers blinded to group assignment scored the performance of participants on this task.

Residents in the didactic-teaching group then received a 45-min lecture by an expert bronchoscopist who emphasized proper handling and usage of the bronchoscope for FOI. The model-training group spent 45 min practicing FOI skills with the guidance of experts on the “choose-the-hole” model with different syringe barrel combinations. Both groups were then posttested on their skills, and within 10 days of their training, all subjects were tested in the operating room on their ability to perform FOI in an anesthetized and paralyzed patient.

All patients were healthy females scheduled for elective surgery. Three anesthesiologists were present for all studies. The study anesthesiologist intervened if the patient’s blood pressure or heart rate was not maintained within 20% of baseline measurements, if pulse oximetry decreased below 94%, or if a maximum of 210 s passed before intubation occurred. Two of the anesthesiologists present scored each resident on their performance. Pass ratings were given if the evaluators thought the subject could perform a second FOI without additional training. Subjects in the model-training group completed FOI significantly faster than did those in the didactic-teaching group and also received higher global rating assessment scores. Seventy-five percent of those in the model training group passed, whereas only 33% in the didactic teaching group passed. Incorporating simple models into training of FOI outside the operating room may help to reduce the time and pressures that accompany teaching this skill in the operating room for the first time and result in cost-effective use of resources.