CAN J ANESTH 55: 2 www.cja-jca.org Februar y, 2008 Purpose: Simulation centres, where trainees can practise technical procedures on models of varying fidelity, provide a training option that allows them to acquire skills in a controlled environment prior to clinical performance. It has been proposed that the time to complete a simulator task may translate to proficiency in the clinical setting. The objective of this study was to determine whether time to complete a simulator task translates to clinical fibreoptic manipulation (FOM) performance.Methods: Thirty registered respiratory therapists at a teaching hospital were recruited as subjects for a single-blinded randomized trial. Subjects were randomized to training on either a low fidelity (n = 15) or high fidelity (n = 15) model. After training, each subject was tested for the time required to complete a specific task on his/her respective model. Subjects then performed a fibreoptic orotracheal intubation (FOI) on healthy, consenting, and anesthetised patients requiring intubation for elective surgery. Performance was measured independently by blinded examiners using a checklist and global rating scale (GRS); and time was measured from insertion of the fibreoptic scope to visualization of the carina. Data were analyzed using Spearman rank order correlation coefficients.Results: There was no correlation between the time to complete a task on either the high or low fidelity simulators, and the clinical FOI performance as assessed by a checklist, GRS, and time to complete the FOM (all P = NS). Conclusion: These results suggest that simulator-based, taskorientated time measurement may not be a good indicator of FOI performance in the clinical setting.

There was no added benefit from training on a costly virtual reality model with respect to transfer of FOI skills to intraoperative patient care. Second attempts in both groups were significantly better than first attempts. Low-fidelity models for FOI training outside the operating room are an alternative for programs with budgetary constraints.

anesthesia trainees because of their experience with FOI equipment and techniques but lack of actual bronchoscopic experience. Subjects were randomized to training on a low-fidelity (n=14) or high-fidelity (n=14) model. The low-fidelity group was trained by experts on a simple non-anatomic box model designed to refine FOI skills. The high-fidelity group practiced on a virtual reality (VR) bronchoscopy simulator. Following training, subjects performed two consecutive FOIs on healthy, consenting, anesthetized patients undergoing intubation for elective surgery. Two blinded examiners evaluated each subject's FOI performance using a validated checklist and global rating scale (GRS). Success at achieving intubation was also measured. Checklist and GRS scores were analyzed using a two-way mixed ANOVA with "fidelity of training model" as a between-subject variable and "first vs. second attempt" as a within-subject variable. Success was analyzed using Fisher's Exact Test. RESULTS: There was no significant difference between the low-fidelity and high-fidelity model groups when evaluated with the checklist and GRS (p=NS). There was also no significant difference in success at achieving tracheal intubation between groups (p=NS). Interestingly, second attempts in both groups were significantly better than first attempts (p<0.001) and there was no interaction between "fidelity of training model" and "first vs. second attempt" scores. Inter-rater reliability was strong (checklist: r=0.90; GRS: r=0.85). DISCUSSION: These results suggest that there is no added benefit from training on a costly virtual reality model with respect to transfer of FOI skills to intraoperative patient care. The lowfidelity model costs $20.00 CAD to produce, while the high-fidelity VR trainer retails at $100,000.00 CAD. In an attempt to justify the increased cost of the VR trainer, this study was adequately powered to demonstrate the potential presence of a large effect of model fidelity on FOI training outside of the OR. Second attempts in both groups were significantly better than first attempts; thus reinforcing the importance of clinical experience. Low-fidelity models for FOI training outside the OR are an alternative for programs with budgetary constraints.