title: Fiberoptic orotracheal intubation on anesthetized patients: do manipulation skills learned on a simple model transfer into the operating room?
abstract: BACKGROUND
  With increasing pressure to use operating room time efficiently, opportunities for residents to learn fiberoptic orotracheal intubation in the operating room have declined. The purpose of this study was to determine whether fiberoptic orotracheal intubation skills learned outside the operating room on a simple model could be transferred into the clinical setting.
  
  
  METHODS
  First-year anesthesiology residents and first- and second-year internal medicine residents were recruited. Subjects were randomized to a didactic-teaching-only group (n = 12) or a model-training group (n = 12). The didactic-teaching group received a detailed lecture from an expert bronchoscopist. The model-training group was guided, by experts, through tasks performed on a simple model designed to refine fiberoptic manipulation skills. After the training session, subjects performed a fiberoptic orotracheal intubation on healthy, consenting, anesthetized, paralyzed female patients undergoing elective surgery with predicted "easy" laryngoscopic intubations. Two blinded anesthesiologists evaluated each subject.
  
  
  RESULTS
  After the training session, the model group significantly outperformed the didactic group in the operating room when evaluated with a global rating scale (P < 0.01)and checklist (P0.05). Model-trained subjects completed the fiberoptic orotracheal intubation 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).
  
  
  CONCLUSIONS
  Fiberoptic orotracheal intubation skills training on a simple model is more effective than conventional didactic instruction for transfer to the clinical setting. Incorporating an extraoperative model into the training of fiberoptic orotracheal intubation may greatly reduce the time and pressures that accompany teaching this skill in the operating room.
authors.affiliation: Centre for Research in Education, Department of Anesthesia, Mt Sinai Hospital, Univesity of Toronto, Ontario, Canada.
authors.forename: V N
authors.initials: VN
authors.lastname: Naik
authors.forename: E D
authors.initials: ED
authors.lastname: Matsumoto
authors.forename: P L
authors.initials: PL
authors.lastname: Houston
authors.forename: S J
authors.initials: SJ
authors.lastname: Hamstra
authors.forename: R Y
authors.initials: RY
authors.lastname: Yeung
authors.forename: J S
authors.initials: JS
authors.lastname: Mallon
authors.forename: T M
authors.initials: TM
authors.lastname: Martire
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation; D001296:Audiovisual Aids; D002983:Clinical Competence; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008953:Models, Anatomic; D013663:Teaching