Learning curves of novice anesthesiology residents performing simulated fibreoptic upper airway endoscopy

Background: In various medical and surgical specialties, it is essential to acquire fibreoptic upper airway endoscopy skills for successful endotracheal intubation, especially when faced with a difficult airway. The aim of our study was to evaluate the learning curves of residents performing fibreoptic upper airway endoscopy in the simulation environment. Methods: Following a standardized video and practice session, 16 residents newly enrolled in the anesthesiology program performed nasal fibreoptic endoscopy of the upper airway (endpoint being the carina) on a high fidelity simulator. Weekly 20-min sessions continued for a period of one month. Each attempt was designated as either a "success" or a "failure" based on the study participant's ability or inability to visualize the carina in ≤60 sec and with ≤five collisions with the simulated mucosal wall. Proficiency was attained when the downward graphical trend of the cumulative sum (CUSUM) analysis crossed two adjacent boundary lines, i.e., an acceptable failure rate was reached. Results: The residents' mean number of attempts at fibreoptic airway endoscopy was 47 (9) with a range of 32-64. Time to visualization of the carina was 51 (36) sec. Three classical patterns of CUSUM trends were observed: proficient (n = 7); not proficient with a downward (improvement) trend (n = 3); and not proficient with an upward (worsening) trend (n = 6). The number of attempts at which proficiency was achieved varied from 27 to 58. Conclusion: There is a large variation in the learning curves of residents performing fibreoptic upper airway endoscopy. The training for fibreoptic airway endoscopy should be tailored to the needs of each individual.