Effect of Recent Refresher Training on in Situ Simulated Pediatric Tracheal Intubation Psychomotor Skill Performance

Abstract

Objective: Maintenance of competence in orotracheal intubation skills is challenging for nonanesthesiologists who do not practice intubation routinely. We hypothesized that discipline, recent training, and experience would affect immediate skill improvement during refresher training. Methods: Experienced pediatric providers refreshed intubation skills in six simulated infant trauma scenarios with cervical spine protection. Time (T) to successful intubation (in seconds) was used to calculate refresher training immediate effectiveness as a function of time to success at second vs. first session (T2/T1). Results: Twenty-six providers performed 156 intubations. Time to successful intubation (T1) was 33.8 ± 9.4 seconds (s) for the first scenario and for subsequent scenarios: (T2) 29 ± 6.4s, (T3) 27.4 ± 5.6s, (T4) 29.8 ± 9.2s, (T5) 28 ± 5.4s, and (T6) 25.6 ± 5.1s, with the largest improvement between T1 and T2. Immediate refresher training effectiveness (T2/T1) was associated with recent training ≤3 months (P = 0.025) but not with discipline (P = 0.40) or clinical experience >3 years (P = 0.93). Recent training remained significant (P = 0.017) in multivariable regression. The number of intubation attempts and the number of tracheal intubation-associated events were not different in recent training, discipline, or clinical experience. Conclusion: Recent tracheal intubation training, but not years of experience or discipline, is associated with immediate refresher training effectiveness. Introduction High-reliability organization theory supports a high number of operations, intensive training of personnel and teams, and intensive critiques of performance during operations and training in order to maintain a very low failure rate in high-hazard organizations. 2, 3 However, in busy clinical settings, the allocation of workforce and education resources faces significant challenges. For better allocation of resources to improve patient safety in organizations, it would be helpful to know which factors are associated with the learning effect of refresher training to maintain clinical competence. Many tasks required to maintain competence in clinical settings involve psychomotor skills with appropriate-level medical knowledge. Several studies have revealed that psychomotor skills