Learning curve for competency in flexible laryngoscopy

Objectives/Hypothesis: The purpose of our study was to identify the number of attempts required to attain competency in performing flexible laryngoscopy. Study Design: Cross-sectional prospective study. Methods: Fifteen medical students were recruited to perform flexible laryngoscopy on a mannequin. Each participant was given unlimited time and attempts to perform the procedure until considered competent by the evaluator for two consecutive attempts. Three evaluators used a flexible laryngoscopy checklist to score performance on each step of the procedure. Time required to perform the procedure was recorded, as well as number of times the scope hit the mucosa. The criteria for attaining competence were achieving a minimum score of 3 out of 5 on all the items of the checklist and being deemed competent by the evaluator. Results: A total of 105 flexible laryngoscopies were performed by 15 medical students. A mean of six attempts (range, 2-17) were necessary for a medical student to become competent in performing flexible laryngoscopy. An 80% probability of becoming competent was achieved with the 14th attempt. An inverse relationship was noted between the number of times the scope hit the mucosa and the probability of being competent. The time taken to perform the procedure decreased with increasing number of attempts. Conclusions: Our results suggest that it takes six attempts on average for a novice to become competent in performing flexible laryngoscopy. This finding has implications for residency programs because it indicates the learning curve can be overcome in the laboratory rather than with patients.