Video laryngoscopy as a teaching tool in direct intubation in undergraduate medical education – a randomized controlled trial

Direct laryngoscopy (DL) is a crucial skill and continues to be indispensable. While the superiority of video laryngoscopy (VL) has been demonstrated regarding the rate of first attempt successful intubations, its application as a teaching tool for DL remains largely unexplored. We hypothesised a higher first-pass success and shorter durations of conventional intubation after video laryngoscopy supported training (VLF = video-laryngoscopy based feedback) compared to students trained without VL (DLF = direct-laryngoscopy based feedback). All 211 medical students (DLF: 92/ VLF:119) trained conventional intubation, using a manikin in an airway course during their anaesthesiology rotation in fourth year of medical school. The study period was October 2023 to August 2024. In the DLF group, the tutor could only provide feedback via an intermittent direct view of the larynx during intubation whereas in the VLF group, the tutor had a continuous view via the monitor. Students of the VLF group did not get a view of the monitor and performed laryngoscopy via direct view. The main outcome measures were the first-pass success, time for intubation, Cormack-Lehane Score, occurrence of tooth damage, a difficulty score and a self-confidence score. Both groups achieved a high rate of first-pass success (DLF 97,8% vs. VLF 100%, p = 0.081). Nevertheless, we found a significant difference concerning duration of intubation (DLF 21,49s ± 7,421 vs. VLF 24,75s ± 10,371, p = 0.008). DLF group demonstrated a higher reduction in a subjective difficulty score (p = 0.018). Both groups demonstrated enhanced confidence regarding airway management following training favouring DLF group (difference between the groups: p = 0.039). Teaching direct laryngoscopy by using the video laryngoscope monitor as a teaching tool for the tutor seems to give students more detailed feedback and a more realistic rating of the difficulty level, which is reflected in the students spending more time on the task, a smaller decrease in the difficulty value and a more realistic self-assessment. Furthermore, a higher first-pass success in our assessment with direct laryngoscopy is reached after video-laryngoscopy based feedback training. We assume that this method holds great chances for teaching practice. DRKS00032815 https://drks.de/search/de/trial/DRKS00032815.