Comparison of the Demonstration-Observation-Assistance-Performance Method and the Traditional Teaching Method for Endotracheal Intubation Skill Acquisition on a Simulator in Medical Students: An Educational Interventional Study

Abstract

Introduction: Endotracheal Intubation (ETI) is the insertion of a breathing tube into the trachea—a critical, life-saving skill in Cardiopulmonary Resuscitation (CPR), both inside and outside the hospital setting. Medical graduates often lack clinical skills such as ETI due to limited practical experience. Aim: To compare the methods of Demonstration-Observation-Assistance-Performance (DOAP) and Traditional Teaching (TT) for ETI skill acquisition, memory performance and skill retention in phase 3 part 1 MBBS students. Materials and Methods: This educational interventional crossover study was conducted at the Department of Anaesthesiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India from August 2023 to February 2024. The subjects (phase 3 part 1 MBBS students) were enrolled by universal sampling. They were given a pretest comprising Multiple Choice Questions (MCQs) followed by a lecture. Next, a post-test with the same MCQs was administered. Group I (DOAP) and Group II (TT) each comprised 22 students. ETI skills were taught using a simulator and assessed via Objective Structured Clinical Examinations (OSCE1 and OSCE2), with a recall test in between. On day 14, a crossover of the groups was conducted. Descriptive statistics, t-tests and Chi-square tests were used for statistical analysis. Results: The groups did not differ statistically significantly in terms of age, sex, or the number of attempts for the National Eligibility Entrance Test (NEET). The students’ post-test MCQ scores were significantly higher than pretest scores after the lecture (p-value=0.0001). The number of ETI attempts (1.77±0.685 for Group I and 1.82±1.006 for Group II) and intubation duration in seconds (62.50±20.061 for Group I and 59.55±19.576 for Group II) were comparable in OSCE1. In the recall test, Group I (8.77±0.428) and Group II (8.00±1.046) scores differed significantly (p-value=0.003). The number of ETI attempts (1.14±0.351 for Group I and 1.09±0.294 for Group II) and duration of intubations in seconds (65.23±12.626 for GroupI and 56.68±16.556 for Group II) were comparable in OSCE2. ETI attempts in independent groups decreased significantly, while ETI durations were comparable between OSCE1 and OSCE2. Conclusion: The DOAP and TT methods were equally effective for ETI skill acquisition and retention. However, the DOAP group demonstrated superior memory performance in the recall test.

Keywords

• checklist
• clinical competence
• crossover studies
• feedback
• intratracheal