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October 14, 2007
3:30 PM - 5:00 PM
Room Room 123
Teaching without a Teacher: Competence at Bullard Laryngoscopy Using Only a PowerPoint Presentation
Dale A. Santrock, M.D., Leonard M. Pott, M.B.B.Ch. F.C.A.(SA)
Department of Anesthesiology, Penn State Hershey Medical Center, Hershey, Pennsylvania
Teaching without a Teacher: developing competence with a Bullard laryngoscope using only a PowerPoint presentation.

Background: The traditional model of clinical instruction requires the presence of an experienced instructor who is skilled at the task to be taught. Typically, the instructor demonstrates the skill then allows the learner progressively more autonomy in performing the task in the clinical environment. This process is obviously time consuming, expensive, and is difficult to achieve with large groups of learners. The current study examines a novel method to facilitate the acquisition of intubating skills using the Bullard laryngoscope without direct expert instruction.

Methods: The authors developed a PowerPoint presentation containing still pictures and text describing the essential steps for proper use of the Bullard laryngoscope. Anesthesia residents, fellows, medical student allocated to the department, and attending faculty with no, or minimal, experience using the Bullard laryngoscope were included. Subjects were provided the PowerPoint presentation, a Bullard laryngoscope, and an intubating mannequin. They were allowed unlimited time to view the presentation and practice independently. The investigators assessed the subjects once the subjects felt they were competent at this motor skill. Competence was evaluated using a standardized checklist containing the essential steps for preparation and intubation using the Bullard laryngoscope. A mannequin head different from the one used for practice was used for assessment. Subjects had no access to human instruction or advice at any point during this study. End-points were successful intubation; time taken for preparation and successful mannequin intubation; and time taken to complete the entire course.

Results: A total of 28 subjects, primarily first year anesthesia residents, completed the study. All participants completed the entire course in 21 minutes or less (mean = 14.1 min. SD = 3.1 min. Range = 9.2 – 21.0 min). During the assessment period all participants assembled and successfully intubated the mannequin in 4.5 minutes or less (mean = 2.7 min. SD = 0.6 min. Range = 1.8 – 4.5 min). Each participant properly followed the essential steps for use of the Bullard and all had first time success at intubation. All subjects felt that they would be able to intubate a patient satisfactorily in a clinical situation, although this was not tested.

Conclusions: This study shows that novice Bullard users could successfully and efficiently learn to intubate a mannequin without direct instruction. Development of this type of tool requires considerable time to prepare and test. However, once produced, innumerable students can successfully learn the basics of a complex motor skill with no further investment of faculty time. This instructional methodology is an efficient use of scarce attending faculty time.

Anesthesiology 2007; 107: A993