title: Simulation as a set-up for technical proficiency: can a virtual warm-up improve live fibre-optic intubation?
abstract: BACKGROUND
  Fibre-optic intubation (FOI) is an advanced technical skill, which anaesthesia residents must frequently perform under pressure. In surgical subspecialties, a virtual 'warm-up' has been used to prime a practitioner's skill set immediately before performance of challenging procedures. This study examined whether a virtual warm-up improved the performance of elective live patient FOI by anaesthesia residents.
  
  
  METHODS
  Clinical anaesthesia yr 1 and 2 (CA1 and CA2) residents were recruited to perform elective asleep oral FOI. Residents either underwent a 5 min, guided warm-up (using a bronchoscopy simulator) immediately before live FOI on patients with predicted normal airways or performed live FOI on similar patients without the warm-up. Subjects were timed performing FOI (from scope passing teeth to viewing the carina) and were graded on a 45-point skill scale by attending anaesthetists. After a washout period, all subjects were resampled as members of the opposite cohort. Multivariate analysis was performed to control for variations in previous FOI experience of the residents.
  
  
  RESULTS
  Thirty-three anaesthesia residents were recruited, of whom 22 were CA1 and 11 were CA2. Virtual warm-up conferred a 37% reduction in time for CA1s (mean 35.8 (SD 3.2) s vs. 57 (SD 3.2) s, P<0.0002) and a 26% decrease for CA2s (mean 23 (SD 1.7) s vs. 31 (SD 1.7) s, P=0.0118). Global skill score increased with warm-up by 4.8 points for CA1s (mean 32.8 (SD 1.2) vs. 37.6 (SD 1.2), P=0.0079) and 5.1 points for CA2s (37.7 (SD 1.1) vs. 42.8 (SD 1.1), P=0.0125). Crossover period and sequence did not show a statistically significant association with performance.
  
  
  CONCLUSIONS
  Virtual warm-up significantly improved performance by residents of FOI in live patients with normal airway anatomy, as measured both by speed and by a scaled evaluation of skills.
authors.forename: S T
authors.initials: ST
authors.lastname: Samuelson
authors.affiliation: Department of Anesthesiology.
authors.forename: G
authors.initials: G
authors.lastname: Burnett
authors.affiliation: Department of Anesthesiology.
authors.forename: A J
authors.initials: AJ
authors.lastname: Sim
authors.affiliation: Department of Anesthesiology, UCLA David Geffen School of Medicine, 757 Westwood Plaza #3325, Los Angeles, CA 90024, USA.
authors.forename: I
authors.initials: I
authors.lastname: Hofer
authors.affiliation: Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA, and.
authors.forename: A D
authors.initials: AD
authors.lastname: Weinberg
authors.affiliation: Department of Anesthesiology.
authors.forename: A
authors.initials: A
authors.lastname: Goldberg
authors.affiliation: Department of Anesthesiology.
authors.forename: T S
authors.initials: TS
authors.lastname: Chang
authors.affiliation: Department of Anesthesiology.
authors.forename: S
authors.initials: S
authors.lastname: DeMaria
mesh_terms: D000704:Analysis of Variance; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D018592:Cross-Over Studies; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method
keywords: airway management; computer simulation; motor skills; warm-up exercise