Simulation training in endotracheal intubation in a pediatric residency

Abstract

Background: Airway management and endotracheal intubation are essential skills for pediatric residents. Simulation-based technology is used for training residents but it remains unclear whether high fidelity simulation results in better retention of skills compared to low fidelity. The study assesses high fidelity simulation of endotracheal intubation and traditional low fidelity training in improving pediatric residents' knowledge retention and technical skills; and if the difference translates into higher real time intubation success rates. Methods: Second and third year pediatric residents were randomized into high fidelity (intervention) or low fidelity simulation (control) groups. Airway management and intubation skills were taught using a didactic lecture and demonstration on low fidelity mannequins. Knowledge was assessed before randomization (T0) and 6 months after training (T6). Other outcome measures were: 1) airway management and intubation skills at T6 and T12 (12 months later) and 2) successful intubation of actual patients by T12. Results: 10 out of 11 residents completed the intervention. Theoretical knowledge improved for both groups. Participants made less mistakes (M) overtime: M (T0) =3.2 and M (T6) =2.6 for the intervention group, and M (T0) =4 and M (T6) =2.40 for the control. There was no significant effect of fidelity on intubation skills or the number of successful intubations recorded in logbooks (all p >0.05). In some instances intubation skills showed regression over time. Conclusion: High fidelity simulation showed no impact on residents' airway management and intubation skills. Retention of theoretical knowledge persisted over time while practical skills remained at baseline or declined.