Written by Jason Lesnick
Spoon Feed
This RCT found that just-in-time coaching increased first pass success prior to infant intubations by inexperienced clinicians in the operating room.
Train doctors more like athletes
Intubating infants is a high stakes, low frequency procedure in the ED. First pass success (FPS) matters, because more attempts are associated with serious complications – trauma, aspiration, hypoxia, bradycardia, and cardiac arrest. This single center RCT randomized 172 trainees (fellows, residents, SRNAs) from 10 programs to receive just-in-time preoperative coaching, including manikin use within 1 hour of intubation vs. standard unstructured intraoperative instruction by attending pediatric anesthesiologists prior to intubating infants ≤ 12 months old in operating rooms. The primary outcome was FPS with secondary outcomes looking at complication rates, cognitive load, and competency metrics.
515 intubations were analyzed. Overall, FPS was 91.4% (212/232) in the trainee treatment group and 81.6% (231/283) in the control group: OR 2.42 (95%CI 1.45 to 4.04, P=0.001). FPS with VL was 91.9% (193/210) in the treatment arm versus 81.9% (181/221); OR 2.58 (95%CI 1.48 to 4.5, P=0.001). FPS with DL was 86.4% (19/22) in the treatment group versus 80.7% (50/62): OR 1.61 (0.42 to 6.2, P=0.49). Secondary outcomes found decreased cognitive load (as measured by the NASA-TLX) and increased competency, but no statistically significant difference between complications.
How will this change my practice?
This study was performed in OR patients where having coaching sessions immediately before these predictable procedures is much easier to plan. However, I could see keeping a few procedure teaching kits around the department and, when applicable, I will adjust my practice to attempt to have learners perform a practice rep prior to doing a procedure.
Source
Coaching inexperienced clinicians before a high stakes medical procedure: randomized clinical trial. BMJ. 2024 Dec 16;387:e080924. doi: 10.1136/bmj-2024-080924. PMID: 39681397
