Coaching inexperienced clinicians before a high stakes medical procedure: randomized clinical trial (17 December 2024)

Summary

Giving inexperienced clinicians a quick coaching session with an expert just before they carry out a procedure boosts their success rate and could improve patient safety, finds a study in the BMJ.

Content

Athletes and musicians often rehearse, warm up, or practice just before they are about to perform. Yet in medicine, where performing a procedure can have life-altering consequences, warm-up, or “just-in-time” training is rare to non-existent.

To fill this knowledge gap, a team of US researchers conducted a randomised clinical trial to assess whether coaching inexperienced clinicians just before intubating an infant (inserting a breathing tube through the mouth and into the windpipe) could improve the quality of care.

The trial took place at Boston Children’s Hospital and involved 153 anaesthesiology trainees (residents, fellows, or student resident nurses) from 10 regional training programs who completed a questionnaire about their knowledge and previous experience of intubating infants.

Participants were then randomly assigned to either a 10 minute training session on an infant manikin with an expert airway coach (treatment group) or usual on-the-job training (control group) within one hour of intubating an infant.

Just-in-time training was associated with significant improvements in quality of care, including less time to intubation, improved views of the airway while intubating, fewer manoeuvres by the trainee in trying to place the breathing tube in the airway, and fewer technical difficulties.

Just-in-time training was also associated with significantly lower cognitive load scores and improved competency.

A concern by hospital systems may be that just-in-time training could slow workflow. However, the researchers found brief warm-up sessions feasible and non-disruptive to workflow without becoming a burden to the coaching team.