How Many Intubations Are Needed for Skill Proficiency?

August 28, 2019

Written by Clay Smith

Spoon Feed
We may need to perform about 3 or supervise about 5 endotracheal intubations (ETI) per year to maintain procedural proficiency.

Why does this matter?
When a procedure is performed infrequently, skills may decay over time. This may lead to bad patient outcomes. How often do we need to perform or supervise ETI to be proficient?

Less than I thought…
They assessed proficiency and scored 44 emergency physicians using a simulation model. They then went back into the charts over the preceding 2 years to see how many intubations the physician performed or supervised. There was good correlation between both the frequency of ETIs performed or supervised and simulated ETI score proficiency; r = 0.6 for both (a correlation coefficient of 0.6 is considered strong). They found, using receiver operator characteristic (ROC) curve analysis, that performing 3 or supervising 5 ETIs predicted a proficient score with sensitivity 90% and specificity in the 60% range. The big weakness of this study was that there was no validated ETI proficiency test; so, they made one up. However, the items assessed make sense, and make a nice safety checklist to boot. Anyway, if you don’t have much opportunity to perform or supervise ETIs, you may want to do some airway courses or cadaver labs. For the past couple of years, I have done numerous intubations with various techniques and devices in our airway lab to make sure I don’t lose the feel and skill of ETI even though at our level one trauma center we do a fair number each year.

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