Intubation Competence During Neonatal Fellowship Training

Abstract

Objectives: To characterize neonatal-perinatal medicine fellows' progression toward neonatal intubation procedural competence during fellowship training.

Methods: Multi-center cohort study of neonatal intubation encounters performed by neonatal-perinatal medicine fellows between 2014 through 2018 at North American academic centers in the National Emergency Airway Registry for Neonates. Cumulative sum analysis was used to characterize progression of individual fellows' intubation competence, defined by an 80% overall success rate within 2 intubation attempts. We employed multivariable analysis to assess the independent impact of advancing quarter of fellowship training on intubation success.

Results: There were 2297 intubation encounters performed by 92 fellows in 8 hospitals. Of these, 1766 (77%) were successful within 2 attempts. Of the 40 fellows assessed from the start of training, 18 (45%) achieved procedural competence, and 12 (30%) exceeded the deficiency threshold. Among fellows who achieved competence, the number of intubations to meet this threshold was variable, with an absolute range of 8 to 46 procedures. After adjusting for patient and practice characteristics, advancing quarter of training was independently associated with an increased odds of successful intubation (adjusted odds ratio: 1.10; 95% confidence interval 1.07-1.14).

Conclusions: The number of neonatal intubations required to achieve procedural competence is variable, and overall intubation competence rates are modest. Although repetition leads to skill acquisition for many trainees, some learners may require adjunctive educational strategies. An individualized approach to assess trainees' progression toward intubation competence is warranted.

FIGURE 1

CUSUM curve for tracheal intubation by NPM fellows. The lines demonstrate the learning curves of individual fellows, represented by different colors. The h1 and h0 lines demonstrate upper and lower control limits. Success is displayed as a decrease in CUSUM. A priori defined competency criteria was met if the fellow crossed h0, whereas deficiency occurred if the fellow crossed h1.

FIGURE 2

Intubation success rates with 95% confidence intervals by fellowship training quarter. Data are presented from 2297 intubation encounters performed by 92 NPM fellows. Success was defined as successful intubation within 2 attempts.