Comparison of a dichotomous versus trichotomous checklist for neonatal intubation

Lindsay Johnston, Taylor Sawyer, Akira Nishisaki, Travis Whitfill, Anne Ades, Heather French, Kristen Glass, Rita Dadiz, Christie Bruno, Orly Levit, Marc Auerbach

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: To compare validity evidence for dichotomous and trichotomous versions of a neonatal intubation (NI) procedural skills checklist. Methods: NI skills checklists were developed utilizing an existing framework. Experts were trained on scoring using dichotomous and trichotomous checklists, and rated recordings of 23 providers performing simulated NI. Videolaryngoscope recordings of glottic exposure were evaluated using Cormack-Lehane (CL) and Percent of Glottic Opening scales. Internal consistency and reliability of both checklists were analyzed, and correlations between checklist scores, airway visualization, entrustable professional activities (EPA), and global skills assessment (GSA) were calculated. Results: During rater training, raters gave significantly higher scores on better provider performance in standardized videos (both p < 0.001). When utilized to evaluate study participants’ simulated NI attempts, both dichotomous and trichotomous checklist scores demonstrated very good internal consistency (Cronbach’s alpha 0.868 and 0.840, respectively). Inter-rater reliability was higher for dichotomous than trichotomous checklists [Fleiss kappa of 0.642 and 0.576, respectively (p < 0.001)]. Sum checklist scores were significantly different among providers in different disciplines (p < 0.001, dichotomous and trichotomous). Sum dichotomous checklist scores correlated more strongly than trichotomous scores with GSA and CL grades. Sum dichotomous and trichotomous checklist scores correlated similarly well with EPA. Conclusions: Neither dichotomous or trichotomous checklist was superior in discriminating provider NI skill when compared to GSA, EPA, or airway visualization assessment. Sum scores from dichotomous checklists may provide sufficient information to assess procedural competence, but trichotomous checklists may permit more granular feedback to learners and educators. The checklist selected may vary with assessment needs.

Original languageEnglish (US)
Article number645
JournalBMC medical education
Issue number1
StatePublished - Dec 2022

All Science Journal Classification (ASJC) codes

  • Education


Dive into the research topics of 'Comparison of a dichotomous versus trichotomous checklist for neonatal intubation'. Together they form a unique fingerprint.

Cite this