High-fidelity simulation in airway management training: results from the AIR-MASTER-SIM randomised study.

Introduction: Airway management is a key competency in emergency medicine and critical care, and effective training in endotracheal intubation is essential during undergraduate medical education. Direct laryngoscopy has traditionally been considered the standard technique for airway access, although it can present technical difficulties for inexperienced operators. Videolaryngoscopy provides indirect visualisation of the glottis and may facilitate airway management during the early stages of training. This study compared the acquisition of airway management skills among medical students trained using direct laryngoscopy or videolaryngoscopy in a simulation-based educational environment. Methods: A prospective, randomised, comparative simulation-based study was conducted among fourth-year medical students at the University of Granada (Spain). Participants were assigned to direct laryngoscopy or videolaryngoscopy training. Training and assessment were conducted in a high-fidelity clinical simulation environment using standardised scenarios designed to assess cognitive, procedural and attitudinal competencies related to airway management. The main outcomes included the intubation success rate, the time required to achieve airway access, the number of attempts required to achieve successful intubation and the occurrence of procedure-related complications. Perceived stress and perceived control of procedure time during the simulation scenario were also recorded. Results: A total of 305 medical students participated in the study, including 152 in the direct laryngoscopy group and 153 in the videolaryngoscopy group. Airway access was achieved in 98.0% of students trained with videolaryngoscopy compared to 7.9% of those trained with direct laryngoscopy. Videolaryngoscopy was associated with fewer attempts required to achieve successful intubation, shorter procedure time and fewer procedure-related complications. Trainees trained with videolaryngoscopy also reported greater perceived control of procedure time and lower levels of stress during the simulation scenario. Conclusion: Videolaryngoscopy facilitated the acquisition of airway management skills during the early stages of medical training. The improved view of airway structures and the possibility of shared visualisation between instructors and trainees may partly explain the better procedural performance observed in the simulation setting.