Resident competency lacking in neonatal intubation

1. Only 23% of pediatric and medicine-pediatric residents studied achieved competency in neonatal intubation during their residency years.

2. Using Bayesian statistics, competency was defined as 75% likelihood of achieving successful intubation on next attempt, and translated into 4 previous cumulative successful intubations.

Evidence Rating Level: 1 (Excellent)    

Study Rundown: Neonatal intubation is a vital skill for pediatricians whose careers require delivery room presence. Given changing work hour limitations and an increase in non-physician providers (ex: nurse practitioners) in neonatal care, residents are now less frequently exposed to neonatal intubation. In light of the growing use of competency-based framework in trainee assessment, this study evaluated the trajectory towards resident competency in neonatal intubation. Utilizing Bayesian statistics, researchers found that the significant majority of residents do not achieve competency, defined as 4 cumulative prior successes, in neonatal intubation by the end of residency. Residents with greater trial opportunities and those with success in earlier attempts were more likely to achieve competence. This study is limited by its inability to define the time duration between trial attempts, postulating that residents with greater opportunities in a shorter timeframe may have been more likely to achieve competence. Nevertheless, it suggests Bayesian statistics as a modality to help define competence and highlights an important gap in trainee skills.

Click to read the study, published today in Pediatrics

Relevant Reading: The lost art of intubation: assessing opportunities for residents to perform neonatal intubation

Study Author, Dr. Stephen D. DeMeo, DO, talks to 2 Minute Medicine: Division of Neonatology, Duke University Medical Center, Durham, North Carolina.

“In a graduate medical education environment moving towards competency based education, we need to start building better definitions of what competency means for our trainees, whether that be in cognitive, affective, or in this case, procedural outcomes. Without having a proper definition of competency for neonatal intubation, it remains difficult to assess novel educational interventions to improve procedural training in residency programs. We hope this study can play a small part in forming that foundation.”

In-Depth [retrospective observational study]: This study involved the analysis of neonatal intubation attempts by 105 pediatric and medicine-pediatrics residents as each resident completed 3 full academic years of pediatric residency. Bayesian statistics were applied, allowing for likelihood of future successful intubations to be predicted based upon previous distributions. Successful intubation was defined as appropriate endotracheal tube placement confirmed via chest radiograph; appropriate placement in any of multiple attempts during one event was included as a successful intubation. Competency was defined as the 75% likelihood that the resident would achieve successful intubation on his or her next attempt; this translated into a Bayesian score of 80, or 4 prior cumulative successful attempts. Only 24 of 105 residents (23%) achieved competence by end of residency; these residents had a median 7 opportunities, while the overall cohort had a median 3 opportunities. As such, the overall cohort had a lower median number of opportunities (3) than even the number of successful attempts (4) required to define competency. Residents with success during their first 2 attempts were more likely to achieve competency during residency.

Image: PD

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