Elsevier

Academic Pediatrics

Volume 19, Issue 7, September–October 2019, Pages 822-827
Academic Pediatrics

Original Article
Self-Confidence in Endotracheal Intubation Among Pediatric Interns: Associations With Gender, Experience, and Performance

https://doi.org/10.1016/j.acap.2019.06.013Get rights and content

Abstract

Background and Objective

Supervisors’ decisions regarding procedural readiness are influenced by resident confidence. Confidence is a valuable metric if we understand how it correlates with trainee characteristics and procedural competence. Our objective was to evaluate the relationship between self-reported confidence in endotracheal intubation (ETI) and pediatric interns’ characteristics (gender, prior intubation experience) and performance (airway management knowledge, demonstrated skills on airway trainers).

Methods

This was a secondary analysis of a randomized, controlled trial of an airway management curriculum. Gender and prior intubation experience were reported on a preparticipation questionnaire. Interns’ performance was measured 1) using a 14-item knowledge-based assessment of airway management and 2) as time to successful intubation across 4 simulated intubation scenarios. After completing the curriculum and assessment, interns reported retrospective precurriculum and current postcurriculum confidence with ETI using a 10-point Likert scale.

Results

Forty-nine interns participated, of whom 16 (33%) were male. Eleven (22%) had ≥1 previous successful intubation. Median [interquartile range] pre- and postcurriculum confidence scores were 3 [2, 5] and 6 [5, 8], respectively. Male interns reported higher precurriculum confidence than females (median difference: 2.0; 95% confidence interval: 0.1, 3.9); postcurriculum confidence among males was also higher but not statistically significant. There was no correlation between self-reported precurriculum confidence and prior experience. There was no correlation between pre- or postcurriculum self-reported confidence and performance on the knowledge-based assessment or time to successful intubation on airway trainers.

Conclusions

Male pediatric interns self-report higher initial confidence in ETI compared to females. Self-reported confidence did not correlate with prior experience, airway management knowledge, or intubation performance on airway trainers.

Section snippets

Methods

This was a secondary analysis of a randomized, controlled educational trial of an airway management curriculum for pediatric interns. The primary study aimed to determine the effect of integrating prerecorded videos of patient endotracheal intubations on pediatric intubation performance.18 The study was conducted between January 2015 and June 2016. Baseline data were collected on age, gender and number of prior successful intubations. The control group received a standard didactic curriculum

Results

Characteristics of the 49 interns enrolled in the study are shown in Table 1. Sixteen of the 49 interns (33%) were male. Thirty eight of the 49 interns (78%) reported no prior successful intubations during clinical care, while 22% reported at least one prior successful intubation; 15% of females (5 of 33) and 38% of males (6 of 16) had ≥1 prior successful intubation (not a significant difference, P= .08). Across the full study sample, median retrospective precurriculum confidence was 3

Discussion

In the clinical setting, supervisors who lack an opportunity to directly assess trainee competency often seek to assess procedural readiness by asking trainees about their confidence in their procedural skills and their prior experience, as well as by utilizing questions posed to assess their medical knowledge surrounding the procedure. We found that pediatric interns’ self-reported confidence in endotracheal intubation does not correlate with prior experience, airway management knowledge or

Conclusions

When asked to self-report confidence in endotracheal intubation, pediatric interns’ responses do not correlate with prior experience, intubation performance on airway trainers, or airway management knowledge. However, male pediatric interns initially report higher confidence compared to their female colleagues prior to the curriculum—signaling a need for further exploration into gender influences on self-assessments, performance, and likelihood to request assistance. Further research into what

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    The authors have no conflicts of interest to disclose.

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