Perceived Decline in Straight Blade Direct Laryngoscopy Skills in the Era of Video Laryngoscopy: An Exploratory Pilot Survey Study

Background Video laryngoscopy is increasingly used for airway management and is often chosen for both routine and complex intubations. While video laryngoscopy offers clear advantages, direct laryngoscopy remains an important fallback technique when visualization is impaired or equipment fails. As video laryngoscopy becomes more common, questions have been raised about whether reliance on this technology may reduce opportunities for trainees to practice and maintain direct laryngoscopy skills. Methods We conducted a cross-sectional survey of anesthesiology residents and attending anesthesiologists at a single academic institution. The survey assessed self-reported confidence using the Miller blade, frequency of use, perceived importance of maintaining this skill, and beliefs about the effectiveness of current teaching practices. Responses were recorded using a 1-5 Likert scale. Descriptive statistics and Spearman correlation coefficients were calculated. Results Twenty-three clinicians completed the survey (12 residents, 11 attendings). Residents reported low confidence (mean 2.5) and infrequent use (mean 2.2) of the Miller blade but rated its importance as relatively high (mean 3.75). Confidence correlated strongly with frequency of use (ρ=0.77, p=0.0031). Attendings reported limited teaching (mean 1.8), acknowledged the importance of maintaining direct laryngoscopy (DL) (mean 3.8), and expressed moderate agreement that these skills are at risk of becoming a "lost art" (mean 3.36). Conclusions This exploratory pilot study suggests that anesthesiology residents and attendings perceive direct laryngoscopy skills as important yet underemphasized in training. Given its small, single-center design, these findings are not generalizable but highlight the need for multi-center studies to further evaluate how reliance on video laryngoscopy may influence preservation of foundational airway techniques.