98 - Simulation-based Just-in-time Training for Teaching Neonatal Endotracheal Intubation : A Randomized Controlled Trial.

Poster Number: 98
Publication Number: 98.438

Ewa Gizicki, Royal Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada; Michael-Andrew Assaad, CHU Sainte-Justine, Montreal, PQ, Canada; Édith Massé, Université de Sherbrooke Faculty of Medicine, Sherbrooke, PQ, Canada; Sylvie Bélanger, CMES du CHU de Québec, Université Laval, Quebec city, PQ, Canada; François Olivier, Montreal Children Hospital, Montréal, PQ, Canada; Christian Lachance, Universite de Montreal Faculty of Medicine, Montréal, PQ, Canada; Ahmed Moussa, Universite de Montreal Faculty of Medicine, Westmount, PQ, Canada

Background: For pediatric trainees, acquiring the skill of neonatal endotracheal intubation (ETI) is difficult because of particularities in the neonate's airway. Just-in-time training (JITT) allows recall of procedural skills that have been previously acquired through teaching (didactic or simulation) or clinical experience, immediately prior to initiating the procedure. No human study has assessed the impact of the use of simulation-based JITT on acquisition of the skill of neonatal ETI by pediatric residents.

Objective: Assess if simulation-based JITT is superior to video training in acquiring the ETI skill as a pediatric resident.

Design/Methods: A multicenter randomized controlled trial was held in four general pediatrics training programs in Quebec, Canada (July 2017-June 2021). Primary outcome: Success rate and learning curve (Intention to treat analysis: Generalized estimating equations corrected for type of laryngoscope and use of succinylcholine). Secondary outcome: a) Duration of attempts, number of attempts and ETI related complications (Mann-Whitney Test and Chi-square); b) residents’ confidence level survey (Chi-square).

Results: We randomized 74 pediatric residents to simulation-based JITT (37 residents) or video training (37 residents) prior to performing 188 ETI. Patient characteristics, success rate, ETI characteristics and ETI related complications are presented in table 1. Although not statistically significant, the learning curve of residents randomized to video training shows increased success rate (figure 1). Table 2 presents the results of the residents’ confidence level survey. Residents in both groups reported similar confidence level in performing ETI (p=0.15). Residents in the video training group felt more ready to proceed to ETI without further training (p < 0.001) and residents in the simulation-based JITT group preferred to complete simulation-based JITT before their next ETI (p < 0.001).Conclusion(s): In the NICU, while learning ETI, success rate is similar whether trainees are exposed to simulation-based JITT or video training. Number of attempts, duration of attempt and ETI related complications are all similar in both groups except for mucosal trauma which is higher in the simulation-based JITT group. Residents in both groups reported similar level of confidence in performing ETI. Residents felt that video training was sufficient before proceeding to ETI and those exposed to simulation-based JITT felt it necessary for their next ETI.
Table 1Patient and endotracheal intubation characteristics. Primary and secondary outcomes.
Table 2Residents’ confidence level survey