tracheal intubationInvestigators at the University of Arizona compared in person supervision of intubations to remote supervision using Facetime, finding that the virtual approach can be as effective as in-person supervision.

A total of forty eight first and second year medical students were recruited for the study. Each participant performed an intubation on an advanced airway simulation trainer with four supervision modalities.

Participants went through four rounds of intubation, using each supervision modality in random orders. FaceTime supervisors were located in another room in the facility. Of note, no participants had any prior intubation experience.

The four supervision modalities included:

  • In person supervision, using direct laryngoscopy
  • In person supervision, using video laryngoscopy
  • FaceTime supervision, using direct laryngoscopy
  • FaceTime supervision, using video laryngoscopy

They found that there was no statistically significant difference between the different methods of supervision. The main outcome, time to intubation, was stratified by the order in which each strategy fell in the sequence experienced by the participant. When looking at the fourth pass by each participant, the median times to intubation for FaceTime and in-person supervision were 37 sec vs 49 sec and 31 sec vs 20 sec for direct and video laryngoscopy respectively. The probability of first pass success for FaceTime and in-person supervision were 0.54 vs 0.38 and 0.83 vs 0.85 for direct and video laryngoscopy respectively.

It’s worth noting that the confidence intervals were fairly wide. So some seemingly impressive differences between endpoints, like 102 seconds for FaceTime video laryngoscopy vs 40 seconds for in person video laryngoscopy, didn’t end up being statistically significant. Therefore, saying that the supervision methods are totally equivalent, or one is better than the other is a bit of a stretch.

Rather, what this study demonstrates is that virtual supervision of procedures like intubation is feasible and is at least reasonably comparable to in person supervision. Others have explored virtual procedural supervision, such as using Google Glass in the cath lab.

This kind of supervision could be useful in many settings. For example, in academic hospitals staffed overnight by residents, virtual supervision could serve as both a backup for technically challenging procedures as well as for evaluation of performance competency. In remote settings where an infrequently performed procedure is urgently needed, virtual supervision could also be useful.

These findings should not however be taken to mean that in person supervision is readily exchangeable to in person training. In person supervision is critical, particularly in early stages of training. In some settings, however, in person supervision is simply not feasible; at those times in particular, perhaps we could improve training and patient safety with little more than a smartphone camera.