Evidence map›Paper›PMID 39681397›Full record

Trial reportBMJ (Clinical research ed.)2024

Coaching inexperienced clinicians before a high stakes medical procedure: randomized clinical trial.

Stephen G Flynn, Raymond S Park, Anupam B Jena, Steven J Staffa, Samuel Y Kim, Julia D Clarke, Ivy V Pham, Karina E Lukovits, Sheng Xiang Huang, Georgios D Sideridis and 6 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04472195 (Just-In-Time Rapid Cycle Deliberate Practice Simulation Intubation Training Among Novice Pediatric Anesthesia Trainees), which is not on this map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04472195 nacompletednot on this map

Just-In-Time Rapid Cycle Deliberate Practice Simulation Intubation Training Among Novice Pediatric Anesthesia Trainees: A Randomized Control Study

TypeinterventionalSponsorBoston Children's HospitalRan2020 to 2022Enrolled182ConditionsAnesthesiaArmsSimulation Airway Coaching
3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Trial
  2. Article
  3. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Stephen G FlynnDepartment of Anesthesia, Harvard Medical School, Boston, MA 02115, USA stephen.flynn@childrens.harvard.edu.ORCID 0000-0002-1348-2307
Raymond S ParkDepartment of Anesthesia, Harvard Medical School, Boston, MA 02115, USA.
Anupam B JenaDepartment of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Steven J StaffaDepartment of Anesthesia, Harvard Medical School, Boston, MA 02115, USA.
Samuel Y KimDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Julia D ClarkeDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Ivy V PhamDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Karina E LukovitsDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Sheng Xiang HuangDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Georgios D SideridisDepartment of Pediatrics, Harvard Medical School, Boston, MA, USA.
Rachel S BernierDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
John E FiadjoeDepartment of Anesthesia, Harvard Medical School, Boston, MA 02115, USA.
Peter H WeinstockDepartment of Anesthesia, Harvard Medical School, Boston, MA 02115, USA.
James M PeytonDepartment of Anesthesia, Harvard Medical School, Boston, MA 02115, USA.
Mary Lyn SteinDepartment of Anesthesia, Harvard Medical School, Boston, MA 02115, USA.
Pete G KovatsisDepartment of Anesthesia, Harvard Medical School, Boston, MA 02115, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess whether training provided to an inexperienced clinician just before performing a high stakes procedure can improve procedural care quality, measuring the first attempt success rate of trainees performing infant orotracheal intubation.

designRandomized clinical trial.

settingSingle center, quaternary children's hospital in Boston, MA, USA.

participantsA non-crossover, prospective, parallel group, non-blinded, trial design was used. Volunteer trainees comprised pediatric anesthesia fellows, residents, and student registered nurse anesthetists from 10 regional training programs during their pediatric anesthesiology rotation. Trainees were block randomized by training roles. Inclusion criteria were trainees intubating infants aged ≤12 months with an American Society of Anesthesiology physical status classification of I-III. Exclusion criteria were trainees intubating infants with cyanotic congenital heart disease, known or suspected difficult or critical airways, pre-existing abnormal baseline oxygen saturation <96% on room air, endotracheal or tracheostomy tubes in situ, emergency cases, or covid-19 infection.

interventionsTrainee treatment group received preoperative just-in-time expert intubation coaching on a manikin within one hour of infant intubation; control group carried out standard practice (receiving unstructured intraoperative instruction by attending pediatric anesthesiologists).

main outcome measuresPrimary outcome was the first attempt success rate of intraoperative infant intubation. Modified intention-to-treat analysis used generalized estimating equations to account for multiple intubations per trainee participant. Secondary outcomes were complication rates, cognitive load of intubation, and competency metrics.

results250 trainees were assessed for eligibility; 78 were excluded, 172 were randomized, and 153 were subsequently analyzed. Between 1 August 2020 and 30 April 2022, 153 trainees (83 control, 70 treatment) did 515 intubations (283 control, 232 treatment). In modified intention-to-treat analysis, first attempt success was 91.4% (212/232) in the trainee treatment group and 81.6% (231/283) in the control group (odds ratio 2.42 (95% confidence interval 1.45 to 4.04), P=0.001). Secondary outcomes favored the intervention, showing significance for decreased cognitive load and improved competency. Complications were lower for the intervention than for the control group but the difference was not significant.

conclusionsJust-in-time training among inexperienced clinicians led to increased first attempt success of infant intubation. Integration of a just-in-time approach into airway management could improve patient safety, and these findings could help to improve high stakes procedures more broadly. Randomized evaluation in other settings is warranted.

trial registrationClinicalTrials.gov NCT04472195.

Indexed as

Clinical CompetenceIntubation, IntratrachealAdultAnesthesiologyCOVID-19FemaleHumansInfantMaleManikinsMentoringPediatricsProspective StudiesAirway managementCognitive loaddeliberate practicehuman capital depreciationInfantIntubationjust-in-timeNASA-TLXNeonateSimulationvolume-outcome

Identifiers

PMID39681397
PMCPMC11648086

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.