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Br J Anaesth. 2003 Sep;91(3):312-8.

Failure of simulation training to change residents' management of oesophageal intubation.

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Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.



There are few scientific reports documenting the effects of simulation training on learning. Issues of scientific validity challenge investigators who measure such outcomes. We perceived a failure of residents to change their technical management of oesophageal intubation after simulation training and sought clarification of this observation.


Twenty-one residents were randomly exposed to two deliberate oesophageal intubation scenarios, first as a junior assistant (JS group) or as a senior managing resident (SS group), and secondly as a senior managing resident. After the first episode, residents were given an explanation and demonstration of the suggested technical management strategy, including: (i) confirmation of oesophageal intubation with a second direct laryngoscopy; and (ii) concurrent insertion of a second tube into the trachea. After the second episode, we retrospectively sought to confirm improvement in technical management within the SS group by measuring videotaped performances. Questionnaires were sent to the residents before and after reporting their performance results.


There were 14 SS and seven JS subjects. Within SS, there was no improvement in "confirmation of oesophageal intubation with direct laryngoscopy" (8/14 vs 9/14) or any improvement in "concurrent insertion of a second ETT (tracheal) tube" (1/14 vs 2/14). Questionnaire responses offered considerable insight into these negative results.


This failure to change may have been secondary to a lack of criterion validity, lack of repetition or a long duration between episodes. The expectations for management were not regarded as being advantageous in simulation, but they were successfully adopted in actual clinical emergencies.

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