Effective Nonanatomical Endoscopy Training Produces Clinical Airway Endoscopy Proficiency

In Brief We studied the effectiveness of two nonanatomical endoscopic dexterity training models: “Choose the Hole” and Dexter™. Effectiveness was assessed in terms of time spent training, subjective rating, performance on an anatomical manikin, and clinical performance on fellow participants who acted as awake subjects. Forty-three anesthesia specialists, trainees, and technicians volunteered. Performances were videotaped, timed, and scored with a Global Rating Scale (GRS) from 1 (very poor) to 5 (clearly superior). The Dexter™ group spent more time training than the Choose the Hole group (median time [range], 152 min [70–510 min] versus 75 min [17–281 min]; P < 0.01). Subjective ratings were better in the Dexter™ group. In clinical bronchoscopy, the Dexter™ group was faster (30.7 s [17.1–43.5 s] versus 36.6 s [22.8–105.1 s]; P = 0.02) and had higher GRS scores (mean [SD]: 3.0 [0.4] versus 2.6 [0.6]; P = 0.04), indicating superior performance. Clinical and manikin performance (GRS scores) were significantly correlated (ρ = 0.62; P = 0.0001). Benchmark levels of clinical bronchoscopic performance can be anticipated from bench model performance without a clinical learning curve. Dexter™ is a more effective model for learning endoscopic dexterity than the Choose the Hole model. Airway topicalization with lidocaine in a dose range consistent with published series (490–980 mg or 7.14–14.77 mg/kg) resulted in a frequent incidence of side effects. No major adverse events occurred. IMPLICATIONS: Endoscopic skills can be developed and measured on models with the expectation that good model performance will result in good clinical performance. Benchmark levels of endoscopic dexterity can be achieved clinically without a novice learning curve. Dexter™ is a more effective model than “Choose the Hole” for learning endoscopic dexterity. Caution is warranted in the use of topical lidocaine in amounts approaching the upper limits of published dose ranges.