IDEA | Airway Series: Reviewing Intubation Footage in Conference to Improve Airway Mastery

Airway management is one of the most critical skills learned by emergency medicine (EM) residents and can be difficult to teach in traditional lectures. Increasingly, video laryngoscopy has been utilized by emergency departments partially due to its increasing first-pass success in certain situations [1]. Additionally from a training perspective, video laryngoscopy has proven to be beneficial as attendings can have the same view as residents and provide real time feedback [2]. However, this valuable real-time feedback and anatomy visualization ability has not always been utilized in other situations such as resident conferences. In this post, we highlight how to use videos from the GlideScope (or any video laryngoscopy tool) of actual airway attempts to teach airway skills and anatomy recognition at resident educational conferences.

The Innovation

Using Video Laryngoscopy Recordings to Improve Identification of Airway Anatomy

This innovation utilizes the recording function on certain GlideScope machines to capture videos of intubations. The videos can be used during conference didactics to quiz learners on airway anatomy. They also allow learners to see a variety of difficult intubations and the different troubleshooting techniques employed.

The Learners

Although this innovation targets PGY1 EM residents, it can be beneficial to medical students or any residents struggling with intubation. It can also serve as a refresher of airway anatomy and aid in advanced troubleshooting techniques for senior residents.

Equipment

• GlideScope machine (or any other video laryngoscopy unit) with a video record function
• Lecture slides for material review

Description of the Innovation

During the resident didactic conference, residents, students, and attendings were presented with a series of pictures and videos recorded on a GlideScope machine, showcasing intubations performed in our ED. They then completed a timed quiz, assessing the following areas:

• Anatomy identification
• Airway grading
• Identification of difficulties
• Critique of the techniques used
• Methods for improving the intubation

Subsequently, a brief lecture reviewing airway anatomy and intubation techniques. Finally, learners were presented with the same series of images and quizzed again.

Figure 1. Example of quiz question featuring a difficult airway image assessment question

Figure 2. Example of a match-format quiz question assessing airway anatomy

Lessons Learned

Our GlideScope machine automatically records all intubation procedures, which made putting this together easier. For institutions unable to record videos, several blogs have collections of airway footage that could be utilized, such as AirwayCam.

Quizzes were performed before and after the airway lecture. Automated grading showed significant improvement in learner performance after the lecture.
Audience feedback was overwhelmingly positive with 96% of the participants stating that the innovation would help them with real-time airway evaluation. Sample audience comments:

• “Love this. Very educational and entertaining”
• “Excellent session and informative”
• “Please continue providing videos for us to learn.”

Educational Theory

This project is based on visual and applied learning. Additionally it utilizes a “learning from errors” framework which Tulis proposes can trigger emotional and motivational self regulatory learning processes [3].

Closing Thoughts

The innovation is logistically simple, is easy to replicate, received overwhelmingly positive feedback, and markedly improved scores post-lecture. Even considering the high volume of intubation experiences in the emergency department, there is always room for improvement in the learning process for this high-stakes procedure. Often we do not take the take the time to stop and critique our technique in real-time to reflect and improve. The applied and visual learning concepts serve to reinforce skills of advanced learners and build the skills of novice learners. The hope and expectation is that with serial utilization of recordings, learners will have improved recognition of difficult airways and anatomy. This in turn will hopefully lead to improving our first-pass intubation success rates.

The authors and ALiEM do not have any financial affiliations with GlideScope or any other video laryngoscopy companies.

References

1. Brown CA 3rd, Kaji AH, Fantegrossi A, et al. Video Laryngoscopy Compared to Augmented Direct Laryngoscopy in Adult Emergency Department Tracheal Intubations: A National Emergency Airway Registry (NEAR) Study. Acad Emerg Med. 2020;27(2):100-108. PMID 31957174
2. Monette DL, Brown CA 3rd, Benoit JL, et al. The Impact of Video Laryngoscopy on the Clinical Learning Environment of Emergency Medicine Residents: A Report of 14,313 Intubations. AEM Educ Train. 2019;3(2):156-162. Published 2019 Jan 15. PMID 31008427
3. Tulis M, Steuer G, Dresel M. Learning from errors: A model of individual processes. Frontline Learning Research; 2016. https://doi.org/10.14786/flr.v4i2.168