Novel Simulation-based Awake Fiberoptic Intubation Curriculum: Pilot Study

Awake fiberoptic intubation is a critical skill of emergency physicians in scenarios where rapid sequence intubation may be impossible or catastrophic. While the equipment to perform awake fiberoptic intubation has become more readily available to emergency physicians, inadequate training and lack of confidence are often cited as barriers to performing the procedure. To address this, we created and studied a simulation-based awake fiberoptic intubation curriculum with the goal of improving physicians' performance of this skill.

A procedural checklist was developed and iteratively refined among EM, anesthesiology, and critical care physicians. An instructional video was created based on this checklist. Participants viewed the instructional video and underwent supervised deliberate practice on a manikin and bronchoscopy simulator using a rapid-cycle deliberate practice paradigm with 1:1 supervision from an instructor. Comparisons were made between a pre-test and a three-month post-test. We evaluated participants using calculated simulator metrics, the Objective Structured Assessment of Technical Skill global rating scale (GRS), a checklist, and pre- and post-intervention self-assessment.

We collected data from 46 participants. Observed performance using the GRS improved from 22.5 (standard deviation 4.5) to 28.8 (6.3) (P < .001). Time from scope insertion to verbalized passage of the endotracheal tube on the simulator decreased from a mean of 147.0 (148.3) seconds to 84.6 (39.1) seconds (P = .01). Participants reported improved self-assessed performance compared with others at their stage of training, 3.7 (1.5) to 5.0 (1.2), P < .001, and their reported confidence performing the procedure increased from 3.0 (1.5) to 5.1 (1.2), P < .001. No significant difference was seen among checklist scores.

In this novel simulation-based awake fiberoptic intubation curriculum, subjective and objective performance improvements were observed at three months. Learners who participated in the course reported feeling more confident and capable of performing awake fiberoptic intubation and being satisfied with the curriculum.