691: VISUALIZING PEDIATRIC CRITICAL CARE FELLOW TRACHEAL INTUBATION LEARNING CURVES

Abstract

Introduction: Tracheal intubation (TI) is a life-saving procedure for pediatric intensivists. Developing proficiency in TI is one of the goals in the PCCM fellowship. We aim to develop a dashboard for PCCM fellows to visualize their own learning curves and proactively identify educational needs. We hypothesize majority of the fellows will achieve TI competence during first 12 months of training. Methods: Using the local airway management quality improvement database (a part of National Emergency Airway Registry for Children: NEAR4KIDS), we built a data field for each fellow’s training ID. Using REDCap and R, we developed a cumulative sum (CUSUM) learning curve visualization to achievement of competence level. We piloted the data visualization in a cohort of first year PCCM fellows starting in one of academic year 2019-2021 for their TIs in the PICU for first 12 months. Two levels of TI competence thresholds were a priori defined: 80% success for the first attempt, and 80% success for the course (course is defined as one approach to secure an airway) with both alpha and beta at 0.1. Results: Seventy-one TI courses were performed by six first year fellows (mean 22 TIs, range 14-30 per fellow) with 87 intubation attempts. First attempt success rate was mean 73% (range 57-85%), course success rate was 85% (range 79-93%). CUSUM curves were successfully plotted from the database. Three of six fellows (50%) achieved the competence threshold for the first attempt (80% first attempt success) after 12, 15, and 18 TIs. Five fellows (83%) achieved the competence threshold for the TI course (80% overall success) after 8, 8, 12, 12, 12 TIs. One fellow who did not achieve competence had the lowest number of intubations (n=14). When an alternative competence threshold at 70% for first attempt success is used, five fellows achieved the first attempt competence after 4,4,4,4,7 TIs. Conclusions: The number of tracheal intubations needed to achieve procedural competence amongst first year pediatric critical care fellows is likely variable. Only half of the first year PCCM fellows met the criteria for competence level (80% first attempt success). While repeated procedural attempts may lead to competency for some fellows, individualized educational strategies may be necessary for others.