title: Validation of a difficult endotracheal intubation simulator designed for use in anaesthesia training.
abstract: There is a need for a validated endotracheal intubation trainer that has variable difficulty settings for the training and assessment of medical practitioners. In this study three anatomical modifications were retrofitted to a commercial manikin and then validated. These modifications included restricted movements of the mandible as well as changes to the upper incisors. A total of 130 participants comprising specialists, trainees and medical students volunteered for this study. Validity was tested using randomised between-groups comparison of the time taken to intubate the manikin on all settings. Overall, and at each setting, there was a significant difference between the times to intubation among the three levels of experience (P<0.001). Novices were more than 12 times more likely to fail than experts (odds ratio [OR] 12.4, 95% confidence intervals [CI] 3.8, 41.8,P<0.001). The median time to intubation for all three groups changed significantly between settings 1 (easiest) and 4 (most difficult), novice 18 seconds (CI 8.9, 27.1,P<0.001), intermediate 15 seconds (CI 6.5, 23.5,P=0.001), and expert 9 seconds (CI 0.4, 17.6,P=0.04). The novice group was significantly different from the expert group at all attempts (P<0.002), and from the intermediates at all attempts apart from the third (P=0.055). The time for the novice and intermediate groups improved significantly by the fourth attempt, novice 15 seconds (CI 5.4, 24.6,P=0.002) and intermediate 10 seconds (CI 1.0, 19.0,P=0.03). Other aspects of validity were also satisfied during this study. A high degree of validity was established for these modifications, which can be retrofitted to an existing manikin and then used for teaching or assessment.
authors.affiliation: GP Registrar, Ovens Medical Group, Wangaratta, Victoria.
authors.forename: S
authors.initials: S
authors.lastname: Brettig
authors.affiliation: Consultant Anaesthetist, Adelaide, South Australia.
authors.forename: M
authors.initials: M
authors.lastname: Shurgott
authors.affiliation: Senior Biostatistician, Flinders University, Adelaide, South Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Quinn
authors.affiliation: Professor, Anaesthesia and Pain Medicine, Flinders University, Adelaide, South Australia.
authors.forename: H
authors.initials: H
authors.lastname: Owen
mesh_terms: D000776:Anesthesiology / Q000193:education*; D006801:Humans; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008348:Manikins; D013997:Time Factors
keywords: intubation, laryngoscopes, simulation