Pediatr Emerg Care. 2024 Nov 1;40(11):761-765. doi: 10.1097/PEC.0000000000003204. Epub 2024 Aug 23.
The lower clinical exposure of Pediatric Emergency Medicine (PEM) fellows to critical procedures may impede skill acquisition. We sought to determine the tracheal intubation learning curve of PEM fellows during training and compared PEM fellow success against standards for tracheal intubation success.
This was a retrospective, video-based study of a cohort of PEM fellows at a single academic pediatric emergency department (PED). All forms of tracheal intubation were included (rapid sequence intubation and crash or no medication). The cohort consisted of 36 PEM fellows from all or part of 5 consecutive fellowship classes. Data were collected by structured review of both existing ceiling-mounted videos and the electronic medical record. The main outcome was PEM fellows' success on the first or second attempt. We used cumulative summation to generate tracheal intubation learning curves. We specifically assessed the proportion of PEM fellows who reached 1 of 4 thresholds for procedural performance: 90% and 80% predicted success on the first and the first or second attempt.
From July 2014 to June 2020, there were 610 patient encounters with at least 1 attempt at tracheal intubation. The 36 PEM fellows performed at least 1 attempt at tracheal intubation for 414 ED patient encounters (65%). Median patient age was 2.1 years (interquartile range, 0.4-8.1). The PEM fellows were successful on the first attempt for 276 patients (67%) and on the first or second attempt for 337 (81%). None of the 36 PEM fellows reached the 90% threshold for either first or second attempt success. Four fellows (11%) met the 80% threshold for first attempt success and 11 (31%) met the 80% threshold for first or second attempt success.
Despite performing the majority of attempts, PEM fellows often failed to reach the standard thresholds for performance of tracheal intubation. Clinical exposure alone is too low to ensure acquisition of airway skills.
儿科急诊医学（PEM）住院医师在关键程序方面的临床经验较少，可能会阻碍技能的掌握。我们旨在确定在培训期间 PEM 住院医师的气管插管学习曲线，并将 PEM 住院医师的成功率与气管插管成功率的标准进行比较。
这是一项对单家学术儿科急诊部（PED）的一组 PEM 住院医师进行的回顾性、基于视频的研究。所有形式的气管插管（快速顺序插管和紧急或无药物插管）均包括在内。该队列由来自 5 个连续的 fellowship 班的全部或部分 36 名 PEM 住院医师组成。数据通过对现有的天花板安装视频和电子病历进行结构化审查收集。主要结果是 PEM 住院医师首次或第二次尝试的成功率。我们使用累积总和生成气管插管学习曲线。我们专门评估了以下 4 个程序性能阈值中，有多少比例的 PEM 住院医师达到了其中之一：首次和首次或第二次尝试的预测成功率为 90%和 80%。
从 2014 年 7 月至 2020 年 6 月，共有 610 名患者至少进行了 1 次尝试进行气管插管。36 名 PEM 住院医师对 414 名 ED 患者进行了至少 1 次尝试进行气管插管（65%）。中位患者年龄为 2.1 岁（四分位距，0.4-8.1）。276 名患者（67%）首次尝试成功，337 名患者（81%）首次或第二次尝试成功。没有一名 PEM 住院医师达到首次或第二次尝试成功率 90%的阈值。4 名住院医师（11%）达到首次尝试成功率 80%的阈值，11 名住院医师（31%）达到首次或第二次尝试成功率 80%的阈值。
尽管进行了大多数尝试，但 PEM 住院医师通常未能达到气管插管表现的标准阈值。单独的临床经验太低，无法确保获得气道技能。
