Simulator training improves fiber-optic intubation proficiency among emergency medicine residents

Objectives: The objective was to observe how a workshop using a virtual reality bronchoscopy simulator and computer-based tutorial affects emergency medicine (EM) resident skill in fiber-optic intubation. Methods: In this observational before-and-after study, EM resident performance on three simulated pediatric difficult airway cases was observed before and after a short computer-based tutorial and 10 minutes of self-directed practice. The primary outcome was the total time required to place the endotracheal tube (ETT), secondary outcomes included the number of endoscope collisions with mucosa, and a calculated efficiency score measuring the proportion of time participants spent looking at correct central airway structures. Nonparametric Wilcoxon signed rank tests compared performance on the first versus the repeat attempt for each of the three simulated cases. Participants were surveyed regarding their assessments of the experience. Results: Significant decreases in median procedure times and number of scope collisions and increases in median efficiency scores were seen for Cases 1 and 2. Case 3 showed no significant changes in outcomes between first and repeat attempts. Participants positively assessed the training and felt that its use would improve clinical practice. Conclusions: Participation in a simulation-based fiber-optic intubation skill workshop can improve fiberoptic intubation performance rapidly among EM residents. Future research should evaluate if this enhanced performance translates to improved clinical performance in the emergency department (ED).