Development of a low-cost fiberoptic intubation task trainer using an intended-use-driven V-model framework

Abstract Fiberoptic intubation is an essential airway management skill requiring precise bronchoscope manipulation, visuospatial orientation, and coordinated hand–eye control. Simulation can support deliberate practice before clinical performance; however, commercially available airway simulators are often costly, difficult to procure, and poorly accessible in low- and middle-income countries. We describe the development of Intu-box, a low-cost fiberoptic intubation task trainer designed and fabricated at the Center for Innovation in Medical Education, Aga Khan University, Pakistan. Applying an intended-use-driven approach informed by the V-model of simulator development, we linked user requirements to design specifications, component verification, integrated testing, and pilot user acceptance testing. Intu-box was designed to prioritize functional task alignment over detailed anatomical resemblance, focusing on scope tip steering, spatial orientation, controlled advancement and withdrawal, and hand–eye coordination. The final prototype consisted of a rectangular training box with transparent acrylic walls and interchangeable acrylic navigation plates with progressively challenging hole configurations. Digital modeling, expert review, and iterative testing informed refinements to plate spacing, hole geometry, fabrication method, and usability. During a pilot workshop involving six anesthesia residents, participants provided favorable ratings of perceived procedural resemblance, hand–eye coordination training, and overall experience. With a direct manufacturing cost of US$80, inclusive of fabrication and technician labor, Intu-box offers a reproducible, locally manufacturable model for accessible, purpose-driven procedural simulation. These preliminary findings support the feasibility and perceived usability of Intu-box, although its effects on skill acquisition and clinical performance remain to be established.