368 - Video-Based Study of the Progression of Pediatric Emergency Medicine Fellows’ Tracheal Intubation Performance during Training

Poster Number: 368
Publication Number: 368.211

Phillip M. Thomas, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Yin Zhang, Cincinnati Children's Hospital Medical Center, West Chester, OH, United States; Preston Dean, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Mary Frey, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Gary L. Geis, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Benjamin Kerrey, Cincinnati Children's Medical Center, Cincinnati, OH, United States; Stephanie Boyd, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: The lower clinical exposure of Pediatric Emergency Medicine (PEM) fellows to critical procedures may impede skill acquisition.

Objective: We sought to determine the tracheal intubation learning curve of PEM fellows during training and compared PEM fellow success against standards for tracheal intubation success.

Design/Methods: This was a retrospective, video-based study of a cohort of PEM fellows at a single academic Pediatric Emergency Department (PED). All forms of tracheal intubation were included (rapid sequence intubation and crash or no medication). The cohort consisted of 36 PEM fellows from 6 consecutive fellowship classes. Data were collected by structured review of both existing ceiling-mounted videos (Figure) and the electronic medical record. The main outcome was PEM fellows’ success on the first or second attempt. We used CUSUM to generate tracheal intubation learning curves. We specifically assessed the proportion of PEM fellows who reached one of 4 thresholds for procedural performance: 90% and 80% predicted success on the first and the first or second attempt.

Results: From July 2014 to June 2020, there were 610 patient encounters with at least one attempt at tracheal intubation. The 36 PEM fellows performed at least one attempt at tracheal intubation for 414 ED patient encounters (65%). Median patient age was 2.1 year (IQR 0.4, 8.1). PEM fellows were successful on the first attempt for 276 patients (67%) and on the first or second attempt for 337 (81%). None of the 36 PEM fellows reached the 90% threshold, for either 1st or 2nd attempt success. Four fellows (11%) met the 80% threshold for 1st attempt success, and 11 (31%) met the 80% threshold for 1st or 2nd attempt success.

Conclusion(s): Despite performing the majority of attempts, PEM fellows often failed to reach the standard thresholds for performance of tracheal intubation. Clinical exposure alone is too low to ensure acquisition of airway skills.