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Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 26-27

Video review with sports performance software improves trainee endotracheal intubation time, posture, and confidence

Medical Simulation Center, Loma Linda University School of Medicine Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, California, USA

Date of Submission31-Oct-2017
Date of Decision28-Jan-2020
Date of Acceptance29-Jun-2020
Date of Web Publication25-Aug-2020

Correspondence Address:
Timothy P Young
11234 Anderson Street, A108 Loma Linda, California 92354
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/efh.EfH_290_17

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How to cite this article:
Fierro L, Kuntz HM, Guptill M, Reibling ET, Kiemeney M, Smith DD, Young TP. Video review with sports performance software improves trainee endotracheal intubation time, posture, and confidence. Educ Health 2020;33:26-7

How to cite this URL:
Fierro L, Kuntz HM, Guptill M, Reibling ET, Kiemeney M, Smith DD, Young TP. Video review with sports performance software improves trainee endotracheal intubation time, posture, and confidence. Educ Health [serial online] 2020 [cited 2023 Feb 3];33:26-7. Available from:

Dear Editor,

Medical educators in acute care specialties are tasked with teaching time-sensitive technical skills to novice learners. Expert-novice differences can help teachers understand how to guide trainees to competence in these skills. One example is endotracheal intubation. Studies comparing intubators of varying skill levels find differences in body posture between experienced and inexperienced practitioners. Experienced intubators use a straighter arm, with a mean elbow angle of 108°.[1] Experienced intubators lever less, intubating with a lower laryngoscope handle angle (mean 37°) and with a steeper line of sight angle (mean 41°).[2] Experienced intubators also stand with their faces further from the patient.[1],[3] It is recommended that trainees be taught to intubate with a straight back to accomplish this positioning.[2]

Video analysis has been used by coaches in competitive athletics to enhance skill practice.[4] For medical procedure teaching, video analysis might be well-suited for skills that are affected by posture and positioning, such as endotracheal intubation.

We created a direct laryngoscopy teaching session with residents in their first month of training. We aimed to determine if reviewing a trainee's performance with them using a sports analysis application would improve intubation posture and time to successful tube passage during a simulated manikin intubation session and whether any improvement would be retained.

We positioned an Apple iPad 2 running Dartfish Express software ($6.99, Dartfish, Fribourg, Switzerland) on the right side of a Gaumard HAL Adult Airway Trainer (Gaumard Scientific, Miami, Florida). Dartfish Express allows for video recording, playback at various speeds, and measuring of angles and time.

Thirteen residents participated. Before beginning, each resident rated confidence with direct laryngoscopy on a 100-mm Visual Analog Scale (VAS). We asked the resident to intubate and recorded timed video. We immediately reviewed the video footage with the resident, providing feedback measuring 4 posture angles [Figure 1]. The resident then completed another intubation session, and the video was again reviewed. Finally, the resident was again asked to rate self-confidence with direct laryngoscopy on a 100-mm VAS. Participants returned to complete the same session 2 months later.
Figure 1: Angles measured during the feedback session. (a) Line of sight angle; (b) laryngoscope angle; (c) back angle; (d) elbow angle

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Median intubation times immediately following the video analysis instruction session and 2 months later were both shorter than before the session (median time before, 51 s; time after, 17 s [P = 0.002]; time at 2 months, 23 s [P = 0.02]). Back angle was significantly closer to ideal both immediately after the session and at 2 months (difference from ideal before, 31°; after teaching, 3° [P = 0.002]; at 2 months, 18° [P = 0.02]). The remaining posture angles (line of sight, laryngoscope handle, and elbow) were not significantly different after the session. The median VAS level of confidence with intubation was higher after the teaching session than before (51.5 mm versus 32 mm, P = 0.005).

We have since incorporated this technology-enhanced coaching session into our curriculum as a yearly training for incoming residents. We believe coaching shows promise for skill enhancement in medical training and should follow the lead of competitive athletics.[5]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Matthews AJ, Johnson CJ, Goodman NW. Body posture during simulated tracheal intubation. Anaesthesia 1998;53:331-4.  Back to cited text no. 1
Walker JD. Posture used by anaesthetists during laryngoscopy. Br J Anaesth 2002;89:772-4.  Back to cited text no. 2
Lee HC, Yun MJ, Hwang JW, Na HS, Kim DH, Park JY. Higher operating tables provide better laryngeal views for tracheal intubation. Br J Anaesth 2014;112:749-55.  Back to cited text no. 3
Melchiorri G, Viero V, Triossi T, De Sanctis D, Padua E, Salvati A, et al. Water polo throwing velocity and kinematics: Differences between competitive levels in male players. J Sports Med Phys Fitness 2015;55:1265-71.  Back to cited text no. 4
Gawande A. Annals of Medicine: Personal Best. Top athletes and singers have coaches. Should you? The New Yorker. Published September 26, 2011. Accessed July 9, 2020.  Back to cited text no. 5


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