title: Learning curves for bag-and-mask ventilation and orotracheal intubation: an application of the cumulative sum method.
abstract: BACKGROUND
  In this study, the authors determined the success and failure rates for interns learning bag-and-mask ventilation and orotracheal intubation. Their goal was to determine the amount of experience needed to perform these procedures correctly.
  
  
  METHODS
  The authors recorded 695 bag-and-mask ventilations and 679 orotracheal intubations performed by 15 inexperienced interns during their 3 month-long anesthesia rotations. Learning curves for each procedure for each intern were constructed with both the standard and risk-adjusted cumulative sum methods. The average number of procedures required to attain a failure rate of 20% was estimated for each technique.
  
  
  RESULTS
  Fourteen of 15 interns attained acceptable failure rates at bag-and-mask ventilation after 27 +/- 13 procedures, with a median (95% confidence interval) of 25 (15-32) procedures to cross the decision limit when considering all 15 interns. Nine of 15 interns attained acceptable failure rates at orotracheal intubation after 26 +/- 8 procedures, with a median of 29 (22-not estimable) procedures to cross the limit when considering all interns. The proportion of interns who attained acceptable failure rates for mask ventilation was greater than for tracheal intubation (93% vs. 60%, P = 0.025). Overall, our interns achieved a bag-and-mask ventilation failure rate of 20% or better after a median of 25 procedures; approximately 80% of interns achieved the goal after 35 procedures or less.
  
  
  CONCLUSIONS
  Participating interns developed mask ventilation skills faster than orotracheal intubation skills, and there was more variability in the rate at which intubation skills developed. A median of 29 procedures was required to achieve an 80% orotracheal intubation success rate.
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Komatsu
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kasuya
authors.forename: Hisanori
authors.initials: H
authors.lastname: Yogo
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Edward
authors.initials: E
authors.lastname: Mascha
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Yang
authors.forename: Makoto
authors.initials: M
authors.lastname: Ozaki
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D017214:Laryngeal Masks; D007828:Laryngoscopy / Q000379:methods*; D007858:Learning