Comparison of training in department of anesthesiology for flexible fibreoptic intubation with application of virtual reality simulator and high-fidelity manikin

Abstract

Objective To compare the efficacy and efficiency of simulation-based training of flexible fibreoptic intubation in novices with virtual reality simulator. Methods A total of 46 anaesthesia residents in their first stage of training in anaesthesiology with no experience in flexible fibreoptic intubation at Peking University People' s Hospital were enrolled in the study, and were divided into 2 groups randomly, which were virtual reality simulator group(group S, n=23)and manikin group(group M, n=23). The group S was then trained for 25 times on simulator, while the group M did the same processes on manikin. After training, participants in both groups had their performance assessed with the fibrescope evaluated through the oral route using a simulation manikin, who were instructed to attempt to advance the fibrescope 5 consecutive times to view the carina in the shortest amount of time. The time required to view the carina of each practice during training in both groups were recorded as pooled data to construct group learning curves with the application of SPSS 20.0. By using repeated measures analysis of variance and T-test, the procedure time and global rating scale(GRS)of fibreoptic bronchoscope manipulation ability were compared between groups, so did the participant’s confidence between before and after the training both within-subjects and between-subjects. Results The plateaus in the learning curves were achieved after 19(15, 26)practice sessions in group S and 24(19, 31)in group M, respectively. There was no significant difference in the procedure time[(13.7±6.6)s and(11.9±4.1)s]and GRS [(3.9±0.4)vs.(3.7±0.3)]between groups. There were significant increases in participant’s confidences in both groups after training [group S:(1.8±0.5)vs.(3.9±0.6), t=10.928, P=0.000; group M:(2.0±0.7)vs.(3.9±0.5), t=15.306, P=0.000], but there was no significant difference between groups. Conclusion The simulation-based training of flexible fibreoptic intubation in novices with virtual reality simulator is more efficient than the one with manikin, but the similar effects can be achieved in both modalities, after adequate trainings. In the related training a balance between time cost and economic cost should be considered and the appropriate teaching methods and forms should be taken. Key words: Standardized training for medicine residents; Simulation-based training; Flexible fibreoptic intubation; Virtual reality simulators; Learning curves