Use of a virtual procedure app improves intubation success rate

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There are an abundance of apps available for medical education. They range from learning basic anatomy to the most nuanced details of cardiac pressure-volume loops.

We’ve also highlighted a number of apps that help teach procedural skills using, in general, text and video.

Unique among them, one group has taken the additional step of attempting to validate their app as effective in improving actual procedural skills.

Background

A team from Northwestern University developed an app, iLarynx, to help teach fiberoptic intubation skills. Unlike other procedure apps, iLarynx uses the accelerometer of the iPad to help trainees understand the actual motions necessary with an aim to improve dexterity when doing the real thing. By twisting and turning the iPad, users navigate through a 3D virtual airway on their screen. There are several variations on anatomy available to help mix things up a bit.

We actually named iLarynx one of the most innovative medical apps of 2012.

Methods

Twenty senior medical students without prior endoscopy experience were randomly divided into a control group that received a lecture in intubation techniques and an experimental group that additionally received up to 30 minutes of training with iLarynx. Each participant was then tested using a simulation mannequin with instructions to perform 10 sequential intubations. The primary outcome was the time required to view the carina; participants were also observed and examined on their technique by a blind observation evaluation.

Results and Discussion

The control group had significantly more failed attempts (24 vs. 4, p<0.005). In addition, the group that received the additional virtual training were shown to have more rapid improvement in their global assessments. They were able to achieve the pre-specified “acceptable” speed of 25 seconds to carina visualization.

Despite this, intubation times were better in the experimental group only in about half of the attempts. This seems a bit puzzling given the above findings, though it could be explained by the study simply not being adequately powered to detect differences at individual attempt points. While many, including those of us at iMedicalApps, have speculated that apps can help improve medical education, this study is one of the few that suggests not only improved information retention but also potential real world implications.

There are some limitations to consider here. The most obvious is that the testing was on mannequins – it would be really interesting to see the same trend say with new anesthesia residents or students on an anesthesia rotation. The second is that this is a pretty niche technique –the same method of teaching may not be as successful with procedures dependent on fine motor skills (surgery, cardiac catheterization for example).

However, if a free app can confer a slight improvement in intubation performance by trainees, that could still have a number of implications for patient care. It also suggests that skills which require manipulating an instrument that the user cannot see based on images on a screen (e.g. GI endoscopy, echo, laproscopic surgery) may be particularly amenable to this approach.

iTunes Link

Reference: G. S. De Oliveira et al. Virtual airway simulation to improve dexterity among novices performing fiberoptic intubation. Anaesthesia. 2013. 68, 1053-1058.

Discussion ( 1 comment ) Post a Comment
  • Instead of using med students you might consider a test bed of new paramedics since there is more churn and opportunity for intubation. I’d like new EMS staff to become proficient as quickly as possible before I need their services.

    Ed Tyler Subscriber

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