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Research ArticleOriginal Research

Mental Practice as an Additional Step Before Simulation Practice Facilitates Training in Bronchoscopic Intubation

Martin Urner, Gema De Lama and Briseida Mema
Respiratory Care August 2021, 66 (8) 1299-1305; DOI: https://doi.org/10.4187/respcare.08793
Martin Urner
Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
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Gema De Lama
Department of Pediatric Critical Care Medicine, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
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Briseida Mema
Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada and also with the Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
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Abstract

BACKGROUND: Learning bronchoscopy is challenging for novices, as it requires navigation in a 3-dimensional space under 2-dimensional viewing conditions and execution of complex motor skills with an unfamiliar instrument. Mental practice exercises are based on repeated visualization of motor actions without physically performing them, thereby promoting the learning of skills. We aimed to evaluate whether a teaching intervention including mental practice exercise modules for the acquisition of bronchoscopy skills improves fiberoptic intubation performance of novice learners.

METHODS: In this prospective cohort study, 24 pediatric intensive care trainees and respiratory therapists participating in a bronchoscopy learning curriculum in 2016–2017 attended a theoretical lecture followed by self-guided learning. Subsequently, the learners were randomly assigned to either participating in a teaching intervention including mental practice exercises or not (control group). The primary outcome was time to complete their first bronchoscopic intubation using a virtual reality simulator. Secondary outcomes were the occurrence of “red outs” (ie, the anatomy could no longer be visualized) or collisions with the airway wall. Bayesian Poisson Mixture models were used to estimate the effect of the intervention on outcomes. Furthermore, participation in the teaching intervention was examined in short interviews and with descriptive thematic analysis.

RESULTS: Subjects in the intervention group completed the bronchoscopy on average 1.2 times faster (rate ratio 1.2 [95% credible intervals 1.1–1.3]). The posterior probability that the teaching intervention reduced the occurrence of “red outs” by more than half was 86%. No differences were found regarding the odds of colliding with the airway wall. Everyone except 1 trainee in the mental practice group engaged with and found the mental practice modules helpful.

CONCLUSIONS: A teaching intervention including mental practice exercises represents a valuable additional learning strategy promoting the performance and complex skill acquisition of novice learners in the initial stages of learning bronchoscopy procedures.

  • mental practice
  • bronchoscopy simulation
  • fiberoptic intubation

Footnotes

  • Correspondence: Briseida Mema MD, Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. E-mail: briseida.mema{at}sickkids.ca
  • Dr Mema presented at the International Association for Medical Education (AMEE) 2017 meeting, held August 26–30, 2017, in Helsinki, Finland.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • The work was supported by the Peri-operative Services Innovation Grant, The Hospital for Sick Children, Toronto, Canada (BM) and (MU) is supported by a Vanier Canada Graduate Scholarship, Canadian Institutes of Health Research (CIHR). The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (8)
Respiratory Care
Vol. 66, Issue 8
1 Aug 2021
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Mental Practice as an Additional Step Before Simulation Practice Facilitates Training in Bronchoscopic Intubation
Martin Urner, Gema De Lama, Briseida Mema
Respiratory Care Aug 2021, 66 (8) 1299-1305; DOI: 10.4187/respcare.08793

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Mental Practice as an Additional Step Before Simulation Practice Facilitates Training in Bronchoscopic Intubation
Martin Urner, Gema De Lama, Briseida Mema
Respiratory Care Aug 2021, 66 (8) 1299-1305; DOI: 10.4187/respcare.08793
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Keywords

  • mental practice
  • bronchoscopy simulation
  • fiberoptic intubation

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