Teaching basic fiberoptic intubation skills in a simulator: initial learning and skills decay.
OBJECTIVE
Generally, novices are taught fiberoptic intubation on patients by attending anesthesiologists; however, this approach raises patient safety concerns. Patient safety should improve if novice learners are trained for basic skills on simulators. In this educational study, we assessed the time and number of attempts required to train novices in fiberoptic bronchoscopy and fiberoptic intubation on simulators. Because decay in skills is inevitable, we also assessed fiberoptic bronchoscopy and fiberoptic intubation skill decay and the amount of effort required to regain fiberoptic bronchoscopy skill.


METHODS
First, we established attempt- and duration-based quantitative norms for reaching skill proficiency for fiberoptic bronchoscopy and fiberoptic intubation by experienced anesthesiologists (n = 8) and prepared an 11-step checklist and a 5-point global rating scale for assessment. Novice learners (n = 15) were trained to reach the established skill proficiency in a Virtual Reality simulator for fiberoptic bronchoscopy skills and a Human Airway Anatomy Simulator for fiberoptic intubation skills. Two months later, novices were reassessed to determine decay in learned skills and the required time to retrain them to fiberoptic bronchoscopy proficiency level.


RESULTS
Proficiency in fiberoptic bronchoscopy skill level was achieved with 11 ± 5 attempts and after 658 ± 351 s. After 2 months without practice, the time taken by the novices to successful fiberoptic bronchoscopy on the Virtual Reality simulator increased from 41 ± 8 to 68 ± 31 s (P = 0.0138). Time and attempts required to retrain them were 424 ± 230 s and 9.1 ± 4.6 attempts, respectively.


CONCLUSIONS
Novices were successfully trained to proficiency skill level. Although fiberoptic bronchoscopy skills started to decay within 2 months, the re-training time was shorter.
Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson St., Louisville, KY, 40202, USA. rklati01@louisville.edu.|Paris Simulation Center, Office of Medical Education, University of Louisville School of Medicine, Louisville, KY, USA. rklati01@louisville.edu.|Outcomes Research Consortium, Louisville, USA. rklati01@louisville.edu.
Rana
R
K Latif
Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Alexander
A
Bautista
Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
Xinyuan
X
Duan
Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Aurel
A
Neamtu
Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
Dongfeng
D
Wu
Outcomes Research Consortium, Louisville, USA.|Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Anupama
A
Wadhwa
Outcomes Research Consortium, Louisville, USA.|Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Ozan
O
Akça
D001999:Bronchoscopy / Q000193:education*; D003198:Computer Simulation; D005336:Fiber Optic Technology / Q000193:education*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007858:Learning
Education; Intubation; Patient simulation; Skill decay