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A Randomized Controlled Trial of a Video-Enhanced Advanced Airway Curriculum for Pediatric Residents

Miller, Kelsey A., MD; Monuteaux, Michael C., ScD; Aftab, Saima, MD; Lynn, Alex; Hillier, Debra, MD; Nagler, Joshua, MD, MHPEd

doi: 10.1097/ACM.0000000000002392
Research Reports

Purpose Pediatric advanced airway management is a low-frequency but critical procedure, making it challenging for trainees to learn. This study examined the impact of a curriculum integrating prerecorded videos of patient endotracheal intubations on performance related to simulated pediatric intubation.

Method The authors conducted a randomized controlled educational trial for pediatric residents between January 2015 and June 2016 at Boston Children’s Hospital. Investigators collecting data were blinded to the intervention. The control group received a standard didactic curriculum including still images, followed by simulation on airway trainers. The intervention group received a video-enhanced didactic curriculum including deidentified intubation clips recorded using a videolaryngoscope, followed by simulation. The study assessed intubation skills on simulated infant and pediatric airway scenarios of varying difficulty immediately after instruction and at three months.

Results Forty-nine trainees completed the curriculum: 23 received the video-enhanced curriculum and 26 received the standard curriculum. Median time to successful intubation was 18.5 and 22 seconds in the video-enhanced and standard groups, respectively. Controlling for mannequin age and difficulty, residents receiving the video-enhanced curriculum successfully intubated faster (hazard ratio [95% confidence interval]: 1.65 [1.25, 2.19]). Video-enhanced curriculum participants also demonstrated decreased odds of requiring multiple attempts and of esophageal intubation. At three-month follow-up, residents who received the video-enhanced curriculum remained faster at intubation (hazard ratio [95% confidence interval]: 1.93 [1.23, 3.02]).

Conclusions Integrating videos of patient intubations into an airway management curriculum improved participating pediatric residents’ intubation performance on airway trainers with sustained improvement at three months.

K.A. Miller is a fellow, Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts.

M.C. Monuteaux is senior epidemiologist and biostatistician, Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts.

S. Aftab is director, Fetal Care Center, Nicklaus Children’s Hospital, Miami, Florida.

A. Lynn is a medical student, Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona.

D. Hillier is staff physician, Intermediate Care Program, Boston Children’s Hospital, Boston, Massachusetts.

J. Nagler is associate physician, Division of Emergency Medicine, and director, Pediatric Emergency Medicine Fellowship, Boston Children’s Hospital, Boston, Massachusetts.

Funding/Support: This study was supported by a Boston Children’s Hospital Lovejoy Research Award for Trainees.

Other disclosures: None reported.

Ethical approval: Boston Children’s Hospital Institutional Review Board approved this study on November 20, 2014 (protocol number IRB-A00013772-1).

Supplemental digital content for this article is available at

Correspondence should be addressed to Kelsey Miller, Division of Emergency Medicine, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115; telephone: (617) 355-6624; e-mail:

© 2018 by the Association of American Medical Colleges