Predicting Trainee Clinical Success From Performance at Simulated Endotracheal Intubation
| Autor: | Jericho A. Hallare, A. Teodora Dinescu, Nathan Delson, Randolph H. Hastings, Rodney A. Gabriel, Preetham Suresh, Benjamin Lurie, Viridiana J. Tapia |
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| Rok vydání: | 2020 |
| Předmět: |
Esophageal intubation
medicine.medical_specialty medicine.diagnostic_test Laryngoscopy Epidemiology business.industry Medicine (miscellaneous) Endotracheal intubation Laryngoscopes Manikins Clinical success Education Patient safety Modeling and Simulation Anesthesiology Emergency medicine medicine Intubation Intratracheal Humans Observational study Clinical Competence Prospective Studies Airway business |
| Zdroj: | Simulation in healthcare : journal of the Society for Simulation in Healthcare. 16(6) |
| ISSN: | 1559-713X |
| Popis: | INTRODUCTION Multiple attempts and failure at endotracheal intubation (ETI) are common for inexperienced practitioners and can cause patient morbidity. A test to predict a provider's likelihood of success at patient ETI could assist decisions about training. This project investigated whether trainees' performance at laryngoscopy on airway mannequins predicted their laryngoscopy outcomes in patients. METHODS Twenty-one consenting first-year anesthesiology residents, emergency medicine residents, and medical students enrolled in this prospective, observational study. They performed laryngoscopy and ETI with a curved laryngoscope on 4 airway mannequins. Metrics included peak dental force, procedure duration, esophageal intubation, laryngeal view, and first-pass ETI success on the mannequins. Trainee data from 203 patient ETIs were collected over a roughly 2-month period centered around the simulation test. Multivariable logistic regression analyzed the relationship of mannequin metrics, participant experience, and a patient difficult airway score with trainee ETI outcomes in patients. RESULTS Median trainee first-pass success rate at patient ETI was 63%, the rate of ETI problems was 16%, and the esophageal intubation rate was 6%. Laryngoscopy peak dental force, first-pass ETI success, and duration on individual mannequins were significant predictors of patient ETI first-pass success. Metrics from 2 of the 4 mannequins predicted ETI problems. DISCUSSION Performance metrics from simulated laryngoscopy predicted trainee outcomes during patient ETI. First-pass success and ETI problems affect patient safety and are related to trainee skill. Mannequin laryngoscopy tests could identify trainees who would benefit from additional practice. The metrics could be surrogate end points in research to optimize simulated laryngoscopy training. |
| Databáze: | OpenAIRE |
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