Learning curve and proficiency attainment in preterm airway endoscopy: a simulation-based study comparing neonatologists and medical students

Abstract Background Flexible airway endoscopy is a valuable adjunct for neonatal airway assessment and confirmation of endotracheal tube placement. However, patient vulnerability and the low frequency of these procedures in routine care restrict opportunities for clinical training. Simulation offers a safe environment for skill acquisition. This study aimed to characterize the learning curve of preterm airway endoscopy and compare procedural proficiency attainment between experienced neonatologists and novice medical students. Methods We conducted a prospective, simulation-based observational study involving 39 participants (13 neonatologists and 26 medical students). Participants performed a standardized airway visualization task on a neonatal airway simulator using a flexible micro-endoscope. Following standardized training based on Peyton’s four-step approach, participants performed two unassessed practice attempts before completing 12 assessed trials and a retention session 7–14 days later. Success was defined as stable visualization of the vocal folds within 180 s without critical errors; task success was defined as three consecutive successful attempts. We measured time-to-task completion for visualization of the aryepiglottic folds (TTS1) and vocal folds (TTS2). Learning curves were analyzed using the Learning Curve-Cumulative Sum (LC-CUSUM) method ( p 0 =0.20, p 1 =0.50). Results All participants completed the study protocol. Inter-rater reliability was high for procedural success ( kappa = 0.80) and task success attainment ( kappa ≈ 1.00). Time measurements demonstrated excellent reliability (ICC single measures 0.94; 95% CI 0.93–0.95). LC-CUSUM analysis indicated progressive skill acquisition, with participants in both groups achieving procedural proficiency after repeated attempts. The incidence of critical errors was negligible in both groups (experts 0 [IQR 0–0] vs. students 0 [IQR 0–1], p = 0.074). Procedure duration did not differ significantly between groups (TTS1: 20 s vs. 18 s, p = 0.15; TTS2: 31 s vs. 33 s, p = 0.27). Participants reported similar perceived procedural ease and maintained performance levels at the retention session. Conclusions Preterm airway endoscopy is a learnable skill that can be effectively acquired through simulation training. Despite differing levels of prior clinical experience, medical students achieved similar task performance to neonatologists. These findings support the integration of simulation-based training to introduce minimally invasive airway techniques into neonatal care.