Evaluating the Impact of Direct, Direct Video, and Indirect Video Laryngoscopy Training on the Proficiency of Medical Students in Performing Direct Laryngoscopy: A High-Fidelity Manikin-Based Assessment

Endotracheal intubation (ETI), a potentially lifesaving intervention employed frequently in the emergent setting, is a manual skill that improves with repetitive practice and high-quality feedback. Classically, ETI centered around Direct Laryngoscopy (DL); however, with the advent and recent availability of Indirect Video Laryngoscopy (IVL) and Direct Video Laryngoscopy (DVL), studies have demonstrated varying results on the benefit of Video Laryngoscopy (VL) in training. We hypothesize that a training program centered on DVL, allowing students to visualize the anatomy and simultaneously receive instructor feedback via a real-time video feed, will practically improve student performance in DL. Our study of first-year medical students from the Edward Via College of Osteopathic Medicine (n = 21) randomized participants to one of three cohorts: DL, IVL, and DVL in a manikin-based simulation laboratory evaluated on successful intubation, time to successful intubation, dental injury, Numeric Rating Scale (NRS) to assess the trainee's perception of their performance and confidence level of performing intubation in a real-life scenario. Our results did not demonstrate a statistically significant difference between the three training modalities based on the outcomes assessed. Although IVL and DVL cohorts achieved 100% success following training, compared to 71% in the DL cohort, the results were not statistically significant. This is potentially due to our limited sample size, as our sample did not meet the calculated 162 participants for 80% power. These findings suggest that a larger sample size may be required to determine if there is a significant difference in outcomes for these training modalities.