title: Simulator training improves fiber-optic intubation proficiency among emergency medicine residents.
abstract: OBJECTIVE
  The objective was to observe how a workshop using a virtual reality bronchoscopy simulator and computer-based tutorial affects emergency medicine (EM) resident skill in fiber-optic intubation.
  
  
  METHODS
  In this observational before-and-after study, EM resident performance on three simulated pediatric difficult airway cases was observed before and after a short computer-based tutorial and 10 minutes of self-directed practice. The primary outcome was the total time required to place the endotracheal tube (ETT), secondary outcomes included the number of endoscope collisions with mucosa, and a calculated efficiency score measuring the proportion of time participants spent looking at correct central airway structures. Nonparametric Wilcoxon signed rank tests compared performance on the first versus the repeat attempt for each of the three simulated cases. Participants were surveyed regarding their assessments of the experience.
  
  
  RESULTS
  Significant decreases in median procedure times and number of scope collisions and increases in median efficiency scores were seen for Cases 1 and 2. Case 3 showed no significant changes in outcomes between first and repeat attempts. Participants positively assessed the training and felt that its use would improve clinical practice.
  
  
  CONCLUSIONS
  Participation in a simulation-based fiber-optic intubation skill workshop can improve fiber-optic intubation performance rapidly among EM residents. Future research should evaluate if this enhanced performance translates to improved clinical performance in the emergency department (ED).
authors.affiliation: Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA. emily.s.binstadt@healthpartners.com
authors.forename: Emily
authors.initials: E
authors.lastname: Binstadt
authors.forename: Scott
authors.initials: S
authors.lastname: Donner
authors.forename: Jessie
authors.initials: J
authors.lastname: Nelson
authors.forename: Thomas
authors.initials: T
authors.lastname: Flottemesch
authors.forename: Cullen
authors.initials: C
authors.lastname: Hegarty
mesh_terms: D001999:Bronchoscopy; D002983:Clinical Competence; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D013663:Teaching / Q000379:methods; D014584:User-Computer Interface