title: Laryngoscopic intubation: learning and performance.
abstract: BACKGROUND
  Many healthcare professionals are trained in direct laryngoscopic tracheal intubation (LEI), which is a potentially lifesaving procedure. This study attempts to determine the number of successful LEI exposures required during training to assure competent performance, with special emphasis on defining competence itself.
  
  
  METHODS
  Analyses were based on a longitudinal study of novices under training conditions in the operating room. The progress of 438 LEIs performed by the 20 nonanesthesia trainees was monitored by observation and videotape analysis. Eighteen additional LEIs were performed by experienced anesthesiologists to define the standard. A generalized linear, mixed-modelling approach was used to identify key aspects of effective training and performance. The number of tracheal intubations that the trainees were required to perform before acquiring expertise in LEI was estimated.
  
  
  RESULTS
  Subjects performed between 18 and 35 laryngoscopic intubations. However, statistical modeling indicates that a 90% probability of a "good intubation" required 47 attempts. Proper insertion and lifting of the laryngoscope were crucial to "good" or "competent" performance of LEI. Traditional features, such as proper head and neck positions, were found to be less important under the study conditions.
  
  
  CONCLUSIONS
  This study determined that traditional LEI teaching for nonanesthesia personnel using manikin alone is inadequate. A reevaluation of current standards in LEI teaching for nonanesthesia is required.
authors.affiliation: Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Julian T
authors.initials: JT
authors.lastname: Mulcaster
authors.forename: Joanna
authors.initials: J
authors.lastname: Mills
authors.forename: Orlando R
authors.initials: OR
authors.lastname: Hung
authors.forename: Kirk
authors.initials: K
authors.lastname: MacQuarrie
authors.forename: J Adam
authors.initials: JA
authors.lastname: Law
authors.forename: Saul
authors.initials: S
authors.lastname: Pytka
authors.forename: David
authors.initials: D
authors.lastname: Imrie
authors.forename: Chris
authors.initials: C
authors.lastname: Field
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007828:Laryngoscopy / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D015233:Models, Statistical