Fibreoptic intubation experience among Western Australian anaesthesia trainees

Fibreoptic intubation (FOI) is an essential skill expected of specialist anaesthetists. With advances in alternative techniques for managing difficult airways, training opportunities for FOI have diminished. We sought to investigate the cumulative number of FOIs performed by anaesthesia trainees and assess their confidence in both independently performing and teaching FOI. An online survey was emailed to all registrars and provisional fellows working in Western Australian (WA) anaesthesia departments. There were 224 surveys sent and 100 (44.6%) respondents. The median cumulative number of FOIs was 5 (interquartile range (IQR) 0-30), with trainee registrars performing a median of 4 (IQR 0-20) and provisional fellows performing 18 (IQR 9.0-27.5) FOIs. The trainees rarely performed FOIs unsupervised, as 98.7% of trainee registrar and 88.6% of provisional fellow FOIs had level 1-2 supervision. Confidence to teach or independently perform FOI was low, even among provisional fellows. The Pearson correlation coefficient between the number of awake FOIs and confidence was 0.751. Extrapolating from these responses, the number of awake FOIs required for trainees to feel very confident in independent awake FOI was 19 (R² = 0.564, P < 0.001). Fibreoptic bronchoscopy simulator use was common (72%); however, completion of an awake fibreoptic course was low (32%). This survey found FOI among trainee and provisional fellow respondents in WA to be infrequent, and confidence to independently perform or teach an awake FOI to be low. We recommend increasing opportunities for awake FOI and implementing an advanced airway management course to help address this gap in anaesthesia training.