A Qualitative Exploration of Neonatal Fellows' and Attendings' Perceptions of Intubation (Neo-POPPINS: Neonatal Providers' Perceptions of Intubation Study)

Decreased incidence of neonatal intubation combined with an increase in advanced practice providers performing the skill limits intubation opportunities for neonatal fellows. Fellows must now achieve intubation competency in an environment of increased competition for intubations. Little is known about the impact of this new environment on neonatal fellows' and attending neonatologists' perceptions of intubation. The objective of this study is to qualitatively explore neonatal fellows' and attending neonatologists' unique perceptions of and experiences with intubation. A qualitative study of neonatal fellows and attending neonatologists recruited from a single neonatal division that covers a level III and a level IV neonatal intensive care unit (NICU). Participants completed one-on-one semistructured interviews exploring their perceptions of and experiences with neonatal intubation. A qualitative researcher analyzed interview transcripts using coding and analytical memos in ATLAS.ti V7. We generated salient themes using the constant comparative method. Interviews continued until thematic saturation was achieved. A total of 15 neonatal fellows (5 from each year) and 11 attending neonatologists completed interviews. Qualitative analysis revealed four major topics with 12 themes. Perceived importance of neonatal intubation differed significantly between fellows and attendings, with fellows placing immense emphasis on the skill. Attendings both empathized with and were frustrated by fellows' preoccupation with intubation. Provider relationships with intubation failure varied greatly by training level. Third-year fellows expressed more difficulty recovering from unsuccessful intubations and fear of future failures as attendings. This qualitative study highlights differences in fellow perceptions of intubation by training level and suggests that this relationship evolves throughout fellowship and into attendinghood. With fewer intubation opportunities during fellowship training, neonatal educators should incorporate these distinct perceptions to develop training-level-specific intubation curricula.