Learning Curve Evaluation of Endotracheal Intubation in High-fidelity Manikin.

Abstract

Objective: To construct learning curve of endotracheal intubation procedure and to determine the minimal attempts of performing intubation in high-fidelity manikin in order to reach an acceptable success rate (90% probability of successful intubation).

Method: We designed this longitudinal study. The participants were 78 fifth-year medical students with no previous experience in endotracheal intubation. All subjects were taught using conventional lecture, animated video and manikin demonstration prior to perform this procedure in high-fidelity manikin. The primary outcome was the number of intubation that each subject performed to archive 2 consecutive successful intubations. By using generalized linear mixed model, the learning curve was constructed and further indicated the minimal number of attempts to reach an acceptable success rate. The secondary outcomes were pressure applied to tongue and upper incisors.

Results: Participants performed 2 to 8 intubations. However, learning curve indicated that 90% and 100% probability of successful intubation required at least 3 and over 8 attempts, respectively. The average time required to intubation was 103.6 Seconds. The average pressure applied to tongue and upper incisors were 30.9 and 51.3 Newtons, consecutively.

Conclusion: We apply group level of learning curve to show the variation of a group of learners’ paths through a given learning domain and therefore can determine the minimum attempts. Nevertheless the individual level of learning curve should be further studied to make manifest a single person’s progress toward his/her competence.