- “Just-in-time” training refers to structured training that occurs right before the performance of a task. While this approach is common in other fields (for example, musicians warming up before a performance), it is rarely used in medicine.
- In this non-blinded randomized clinical trial, the authors sought to investigate whether providing trainees with “just-in-time” training before performing a high-stakes medical procedure – in this case, intubating an infant in the OR – could improve outcomes.
- 153 trainees, including anesthesiology fellows, anesthesiology residents, and student registered nurse anesthetists (SRNAs), were included in this study. Overall, these trainees performed 515 intubations that were analyzed in the study.
- Trainees were randomized to receive either approximately 10 minutes of “just-in-time” preoperative training on an infant mannequin immediately prior to the intubation, or standard training, i.e. unstructured intraoperative instruction on intubation by an attending anesthesiologist.
- Primary outcome: “just-in-time” training increased the likelihood of successful intubation on the first attempt. In the group that received just-in-time training, the first attempt success rate was 91.4%, while in the standard training group the first attempt success rate was 81.6% (odds ratio 2.42 (95% confidence interval 1.45 to 4.04), p = 0.001).
- Secondary outcomes favored “just-in-time” training with evidence of decreased cognitive load and improved competency. While complications were lower in the “just-in-time” training group, the difference was not significant.
- The authors conclude that providing “just-in-time” training to inexperienced clinicians is an effective approach to teaching infant intubation skills that may improve patient safety. They further suggest that these results may be more broadly applicable to the teaching of other high-stakes clinical procedures.
- Further studies are warranted to elaborate on specific coaching elements that may improve the success of trainees, and to investigate whether a similar approach could also be beneficial to experienced clinicians.
Summary of "Coaching inexperienced clinicians before a high stakes medical procedure: randomized clinical trial"
Summary published March 3, 2025
