Evaluation of Tracheal Intubation Skill Acquisition in Junior Residents During Anesthesiology Training: An Observational Study

Abstract

Background: Anesthesiology training during the residency program is a requirement for junior residents; however, due to only one or two months of anesthesiology training, the experiences of junior residents tend to vary from individual to individual. Furthermore, the decision of skill acquisition level is left to the discretion of a clinical teacher. In most studies, researchers evaluate tracheal intubation based on the number of experiences, success rate, and time required for tracheal intubation. It is difficult to standardize because conditions for tracheal intubation rely on information about a patient's airway and individual surgical cases. For this reason, it is also difficult to determine clear criteria for tracheal intubation proficiency. We hypothesized that skill acquisition level can be clarified by evaluating tracheal intubation training of junior residents.

Methods: An observational study was conducted on 31 junior residents who participated in the junior residency training in the department of anesthesiology. This research was conducted at our simulation center between November 2021 and March 2023. On the first day of anesthesiology training, participants performed a series of procedures, from tracheal intubation to the connection of artificial respiration, following the orientation for airway management with a simulator. During these procedures, each participant's movement and laryngoscopy maneuver within the mouth were recorded on video; later, specialist physicians evaluated each performance using an evaluation sheet. On the last day of the two-month training period, participants repeated the same procedures as on the first day of anesthesiology training. Total score based on the evaluation sheet was selected as the primary endpoint, and the time required for tracheal intubation and scores by objectives were selected as the secondary endpoints. Furthermore, questionnaires were administered before and after anesthesiology training. Multiple regression analysis was used to analyze questionnaire results, which determined if there is a causal relationship between variables affecting participants' satisfaction in anesthesiology training.

Results: The scores were compared between before and after anesthesiology training. When compared to the scores before anesthesiology training, the total score showed a significant increase (8.9±8.5, 95% CI (5.8-12.1), p<0.01), and the score in the time required for tracheal intubation showed a significant decrease after anesthesiology training (58.9±49.7, 95% CI (40.6-77.2), p<0.01). According to the questionnaire results from before and after anesthesiology training, a factor that affected an increase in the score of tracheal intubation skills was the time required for tracheal intubation (adjusted R²=0.1, Akaike information criterion (AIC)=87.5). Factors that affected participants' satisfaction in anesthesiology training were affiliated department, number of skills experienced, and skills' satisfaction (adjusted R²=0.56, AIC=68.5).

Conclusions: We verified the hypothesis that tracheal intubation skill acquisition following anesthesiology training can be visualized by using the evaluation sheet. In the future, it is necessary to consider management that can experience various skills based on the points of airway management education in the junior residency training. In addition, it is also necessary to establish an education system that can increase interest in anesthesiology training.

Keywords: advance practice nurse; airway management; medical education; simulation training; task shifting.

Figure 1. Comparison of the difference in total score and time taken before and after training

n=31; paired t-test

Figure 2. Correlation heatmap between the goals in the evaluation form and each indicator

Figure 3. Path diagram: factors that affect the level of satisfaction with anesthesia training

β: regression coefficient