Fibreoptic airway training: correlation of simulator performance and clinical skill

Simulation centres, where trainees can practise technical procedures on models of varying fidelity, provide a training option that allows them to acquire skills in a controlled environment prior to clinical performance. It has been proposed that the time to complete a simulator task may translate to proficiency in the clinical setting. The objective of this study was to determine whether time to complete a simulator task translates to clinical fibreoptic manipulation (FOM) performance.

Thirty registered respiratory therapists at a teaching hospital were recruited as subjects for a single-blinded randomized trial. Subjects were randomized to training on either a low fidelity (n = 15) or high fidelity (n = 15) model. After training, each subject was tested for the time required to complete a specific task on his/her respective model. Subjects then performed a fibreoptic orotracheal intubation (FOI) on healthy, consenting, and anesthetised patients requiring intubation for elective surgery. Performance was measured independently by blinded examiners using a checklist and global rating scale (GRS); and time was measured from insertion of the fibreoptic scope to visualization of the carina. Data were analyzed using Spearman rank order correlation coefficients.

There was no correlation between the time to complete a task on either the high or low fidelity simulators, and the clinical FOI performance as assessed by a checklist, GRS, and time to complete the FOM (all P = NS).

These results suggest that simulator-based, task-orientated time measurement may not be a good indicator of FOI performance in the clinical setting.