title: Simulation-based training in flexible fibreoptic intubation: A randomised study.
abstract: BACKGROUND
  Flexible fibreoptic intubation (FOI) is a key element in difficult airway management. Training of FOI skills is an important part of the anaesthesiology curriculum. Simulation-based training has been shown to be effective when learning FOI, but the optimal structure of the training is debated. The aspect of dividing the training into segments (part-task training) or assembling into one piece (whole-task training) has not been studied.
  
  
  OBJECTIVE
  The aims of this study were to compare the effect of training the motor skills of FOI as part-task training or as whole-task training and to relate the performance levels achieved by the novices to the standard of performance of experienced FOI practitioners.
  
  
  METHODS
  A randomised controlled study.
  
  
  METHODS
  Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, between January and April 2013.
  
  
  METHODS
  Twenty-three anaesthesia residents in their first year of training in anaesthesiology with no experience in FOI, and 10 anaesthesia consultants experienced in FOI.
  
  
  METHODS
  The novices to FOI were allocated randomly to receive either part-task or whole-task training of FOI on virtual reality simulators. Procedures were subsequently trained on a manikin and assessed by an experienced anaesthesiologist. The experienced group was assessed in the same manner with no prior simulation-based training.
  
  
  METHODS
  The primary outcome measure was the score of performance on testing FOI skills on a manikin.
  
  
  RESULTS
  A positive learning effect was observed in both the part-task training group and the whole-task training group. There was no statistically significant difference in final performance scores of the two novice groups (P = 0.61). Furthermore, both groups of novices were able to improve their skill level significantly by the end of manikin training to levels comparable to the experienced anaesthesiologists.
  
  
  CONCLUSIONS
  Part-task training did not prove more effective than whole-task training when training novices in FOI skills. FOI is very suitable for simulation-based training and segmentation of the procedure during training is not necessary.
authors.affiliation: From the Centre for Clinical Education, University of Copenhagen and Capital Region of Denmark (PMN, PH, LK), Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (LR), and Department of Anesthesia and The Wilson Centre, University of Toronto and University Health Network, Toronto, Ontario, Canada (CR).
authors.forename: Philip M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: Lene
authors.initials: L
authors.lastname: Russell
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ringsted
authors.forename: Peter
authors.initials: P
authors.lastname: Hertz
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
mesh_terms: D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D005336:Fiber Optic Technology / Q000193:education* / Q000379:methods; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008348:Manikins; D018583:Pliability