Introduction Airway management is a fundamental skill of emergency medicine (EM) practice, and suboptimal management leads to poor outcomes. Endotracheal intubation (ETI) is a procedure that is specifically taught in residency, but little is known how best to maintain proficiency in this skill throughout the practitioner’s career. The goal of this study was to identify how the frequency of intubation correlated with measured performance. Methods We assessed 44 emergency physicians for proficiency at ETI by direct laryngoscopy on a simulator. The electronic health record was then queried to obtain their average number of annual ETIs and the time since their last ETI, supervised and individually performed, over a two-year period. We evaluated the strength of correlation between these factors and assessment scores, and then conducted a receiver operator characteristic (ROC) curve analysis to identify factors that predicted proficient performance. Results The mean score was 81% (95% confidence interval, 76% – 86%). Scores correlated well with the mean number of ETIs performed annually and with the mean number supervised annually (r = 0.6, p = 0.001 for both). ROC curve analysis identified that physicians would obtain a proficient score if they had performed an average of at least three ETIs annually (sensitivity = 90%, specificity = 64%, AUC = 0.87, p = 0.001) or supervised an average of at least five ETIs annually (sensitivity = 90%, specificity = 59%, AUC = 0.81, p = 0.006) over the previous two years. Conclusion Performing at least three or supervising at least five ETIs annually, averaged over a two-year period, predicted proficient performance on a simulation-based skills assessment. We advocate for proactive maintenance and enhancement of skills, particularly for those who infrequently perform this procedure.

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Background: Communication and interpersonal skills are important for effective patient care but are difficult to measure. Unannounced standardized patient encounters (USPEs) have the benefit of providing a standardized situation and provide a representation of usual care rather than best behavior, while also allowing for video recording without violating patient privacy. We conducted a feasibility pilot study to examine the use of videotaped USPEs in resident education of interpersonal and communication skills and specifically empathy. Methods: This was a pilot study conducted at an urban community teaching hospital. About 16 first-year emergency medicine engaged in four videotaped USPEs during their normal clinical shifts during 1 academic year. All visible recording equipment was concealed from the residents. The standardized patients completed two assessment forms after each encounter to measure empathy. Results: All 16 residents engaged in four videotaped USPEs for a total of 64 encounters. Conclusions: We were able to successfully demonstrate the feasibility of using USPEs for assessment of resident interpersonal and communication skills. E ffective communication is integral to the physician-patient relationship. Studies have shown that empathy in particular improves patient outcomes, results in a decreased rate of litigation, and increases patient and family satisfaction. 1-4 Unfortunately, communication and interpersonal skills are often overshadowed by medical knowledge and procedural skills during medical school and residency. One study found that 26% of interns failed to perform at entry-level milestones related to professionalism and patient-From

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