Faculty Evaluations Correlate Poorly with Medical Student Examination Performance in a Fourth-Year Emergency Medicine Clerkship

Background

Clerkship directors routinely evaluate medical students using multiple modalities, including faculty assessment of clinical performance and written examinations. Both forms of evaluation often play a prominent role in final clerkship grade. The degree to which these modalities correlate in an emergency medicine (EM) clerkship is unclear.

Creation and Implementation of a National Emergency Medicine Fourth-Year Student Examination

Background

A National Board of Medical Examiners examination does not exist for Emergency Medicine (EM) students. To fill this void, the Clerkship Directors in Emergency Medicine tasked a committee with development of an examination for 4th-year (M4) EM students, based on a published syllabus, and consisting of questions written according to published question-writing guidelines.

Study Objectives

Describe examination development and statistics at 9 months.

Methods

The committee reviewed an existing EM student question database at www.saemtests.org for statistical performance, compliance with item-writing guidelines, and topic inclusion within the published EM M4 syllabus. For syllabus topics without existing questions, committee members wrote new items. LXR 6.0 software (Applied Measurement Professionals, Inc., Georgetown, SC) was used for examination administration. Data gathered included numbers of examinations completed, mean scores with SD, and point biserial correlation (rpb).

Results

Of the 553 questions assessed, 157 questions met the stated criteria, and 37 were included in the examination. Thirteen new questions were written by committee members to cover all curriculum topics. The National EM M4 Examination was released online August 1, 2011. Nine months later, the examination had been completed 1642 times by students from 27 clerkships. Mean score was 79.69% (SD 3.89). Individual question difficulties ranged from 26% to 99%. Question rpbs ranged from 0.067 to 0.353, mean 0.213 (SD 0.066).

Conclusions

A national group of EM educators developed an examination to assess a published clerkship syllabus. The examination contains questions written according to published item-writing guidelines, and exhibits content validity, appropriate difficulty levels, and adequate question discriminatory ability.     

Medical Student Education in Emergency Medicine: Do Students Meet the National Standards for Clinical Encounters of Selected Core Conditions?

Background

Establishing a core curriculum for undergraduate Emergency Medicine (EM) education is crucial to development of the specialty. The Clerkship Directors in Emergency Medicine (CDEM) National Curriculum Task Force recommended that all students in a 4^th-year EM clerkship be exposed to 10 emergent clinical conditions.

Objectives

To evaluate the feasibility of encountering recommended core conditions in a clinical setting during a 4^th-year EM clerkship.

Methods

Students from three institutions participated in this ongoing, prospective observation study. Students' patient logs were collected during 4-week EM clerkships between July 2011 and June 2012. De-identified logs were reviewed and the number of patient encounters for each of the CDEM-identified emergent conditions was recorded. The percentage of students who saw each of the core complaints was calculated, as was the average number of core complaints seen by each.

Results

Data from 130 students at three institutions were captured; 15.4% of students saw all 10 conditions during their rotation, and 76.9% saw at least eight. The average number of conditions seen per student was 8.4 (range of 7.0–8.6). The percentage of students who saw each condition varied, ranging from 100% (chest pain and abdominal pain) to 31% (cardiac arrest).

Conclusions

Most students do not encounter all 10 conditions during patient encounters throughout a 4-week EM rotation, although most have exposure to at least eight. Certain conditions are far less likely than others to be encountered, and may need to be taught in a nonclinical setting.     

The Multiple Mini-Interview for Emergency Medicine Resident Selection

Background

The Multiple Mini-Interview (MMI) uses multiple, short-structured contacts to evaluate communication and professionalism. It predicts medical school success better than the traditional interview and application. Its acceptability and utility in emergency medicine (EM) residency selection are unknown.

Objective

We theorized that participants would judge the MMI equal to a traditional unstructured interview and it would provide new information for candidate assessment.

Methods

Seventy-one interns from 3 programs in the first month of training completed an eight-station MMI focused on EM topics. Pre- and post-surveys assessed reactions. MMI scores were compared with application data.

Results

EM grades correlated with MMI performance (F_{[1, 66]} = 4.18; p < 0.05) with honors students having higher scores. Higher third-year clerkship grades were associated with higher MMI performance, although this was not statistically significant. MMI performance did not correlate with match desirability and did not predict most other components of an application. There was a correlation between lower MMI scores and lower global ranking on the Standardized Letter of Recommendation. Participants preferred a traditional interview (mean difference = 1.36; p < 0.01). A mixed format (traditional interview and MMI) was preferred over a MMI alone (mean difference = 1.1; p < 0.01). MMI performance did not significantly correlate with preference for the MMI.

Conclusions

Although the MMI alone was viewed less favorably than a traditional interview, participants were receptive to a mixed-methods interview. The MMI does correlate with performance on the EM clerkship and therefore can measure important abilities for EM success. Future work will determine whether MMI performance predicts residency performance.     

Indian and United States paramedic students: comparison of examination performance for the American Heart Association Advanced Cardiovascular Life Support (ACLS) training

Background

The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course is taught worldwide. The ACLS course is designed for consistency, regardless of location; to our knowledge, no previous study has compared the cognitive performance of international ACLS students to those in the United States (US).

Study Objectives

As international health educational initiatives continue to expand, an assessment of their efficacy is essential. This study assesses the AHA ACLS curriculum in an international setting by comparing performance of a cohort of US and Indian paramedic students.

Methods

First-year paramedic students at the Emergency Management and Research Institute, Hyderabad, India, and a cohort of first-year paramedic students from the United States comprised the study population. All study participants had successfully completed the standard 2-day ACLS course, taught in English. Each student was given a 40-question standardized AHA multiple-choice examination. Examination performance was calculated and compared for statistical significance.

Results

There were 117 Indian paramedic students and 43 US paramedic students enrolled in the study. The average score was 86% (± 11%) for the Indian students and 87% (± 6%) for the US students. The difference between the average examination scores was not statistically significant in an independent means t-test (p = 0.508) and a Wilcoxon test (p = 0.242).

Conclusion

Indian paramedic students demonstrated excellent ACLS cognitive comprehension and performed at a level equivalent to their US counterparts on an AHA ACLS written examination. Based on the study results, the AHA ACLS course proved effective in an international setting despite being taught in a non-native language.     

A two-year experience of an integrated simulation residency curriculum

Background

Human Patient Simulation (HPS) is increasingly used in medical education, but its role in Emergency Medicine (EM) residency education is uncertain.

Study Objectives

The objective of this study was to evaluate the perceived effectiveness of HPS when fully integrated into an EM residency didactic curriculum.

Methods

The study design was a cross-sectional survey performed in 2006, 2 years after the implementation of an integrated simulation curriculum. Fifty-four residents (postgraduate year [PGY] 1–4) of a 4-year EM residency were surveyed with demographic and curricular questions on the perceived value of simulation relative to other teaching formats. Survey items were rated on a bipolar linear numeric scale of 1 (strongly disagree) to 9 (strongly agree), with 5 being neutral. Data were analyzed using Student t-tests.

Results

Forty residents responded to the survey (74% response rate). The perceived effectiveness of HPS was higher for junior residents than senior residents (8.0 vs. 6.2, respectively, p < 0.001). There were no differences in perceived effectiveness of lectures (7.8 vs. 7.9, respectively, p = 0.1), morbidity and mortality conference (8.5 vs. 8.7, respectively, p = 0.3), and trauma conference (8.4 vs. 8.8, respectively, p = 0.2) between junior and senior residents. Scores for perceptions of improvement in residency training (knowledge acquisition and clinical decision-making) after the integration of HPS into the curriculum were positive for all residents.

Conclusion

Residents’ perceptions of HPS integration into an EM residency curriculum are positive for both improving knowledge acquisition and learning clinical decision-making. HPS was rated as more effective during junior years than senior years, while the perceived efficacy of more traditional educational modalities remained constant throughout residency training.     

The development and assessment of an evaluation tool for pediatric resident competence in leading simulated pediatric resuscitations

Introduction

It is critical that competency in pediatric resuscitation is achieved and assessed during residency or post graduate medical training. The purpose of this study was to create and evaluate a tool to measure all elements of pediatric resuscitation team leadership competence.

Methods

An initial set of items, derived from a literature review and a brainstorming session, were refined to a 26 item assessment tool through the use of Delphi methodology. The tool was tested using videos of standardized resuscitations. A psychometric assessment of the evidence for instrument validity and reliability was undertaken.

Results

The performance of 30 residents on two videotaped scenarios was assessed by 4 pediatricians using the tool, with 12 items assessing ‘leadership and communication skills’ (LCS) and 14 items assessing ‘knowledge and clinical skills’ (KCS). The instrument showed evidence of reliability; the Cronbach's alpha and generalizability co-efficients for the overall instrument were α = 0.818 and Ep² = 0.76, for LCS were α = 0.827 and Ep² = 0.844, and for KCS were α = 0.673 and Ep² = 0.482. While validity was initially established through literature review and brainstorming by the panel of experts, it was further built through the high strength of correlation between global scores and scores for overall performance (r = 0.733), LCS (r = 0.718) and KCS (r = 0.662) as well as the factor analysis which accounted for 40.2% of the variance.

Conclusion

The results of the study demonstrate that the instrument is a valid and reliable tool to evaluate pediatric resuscitation team leader competence.     

Dedicated emergency department ultrasound rotation improves residents' ultrasound knowledge and interpretation skills

Background

Graduates of Emergency Medicine (EM) residency training programs are expected to be proficient in ultrasound. However, best practices for teaching residents ultrasonography has yet to be determined.

Study Objectives

To determine if a dedicated Emergency Department (ED) ultrasound rotation objectively improves residents’ EM ultrasound knowledge, interpretation accuracy, and clinical decision-making based on ultrasound findings.

Methods

EM residents completing a required ED-based ultrasound rotation were prospectively studied. Before the start of the rotation, each resident completed a 20-question pre-test. At the end of the rotation, residents completed a 20-question post-test. Both tests covered physics, trauma (focused assessment with sonography for trauma), first-trimester pregnancy, aorta, biliary, echocardiography, and vascular sonography, using a multiple-choice format. In both tests, ultrasound images were included in 11 of the 20 questions. The questions were divided into three categories: knowledge-based (8 questions), interpretation (9 questions), and clinical decision-making (3 questions), for both tests. Scores on pre-tests and post-tests were compared using a Wilcoxon signed-rank test.

Results

During the 2-year study period, 21 residents completed the rotation. The median pre-test score was 16 (interquartile range [IQR] 14.5–17), compared to a median post-test score of 19 (IQR 18–20), p < 0.001.

Conclusions

A dedicated ED ultrasound rotation improves residents’ EM ultrasound knowledge and interpretation accuracy based on ultrasound findings, as measured by improvement on ultrasound test scores.     

Tendon fixation in arthroscopic latissimus dorsi transfer for irreparable posterosuperior cuff tears: an in vitro biomechanical comparison of interference screw and suture anchors

Background

The fixation of the tendon to the bone remains a challenging problem in the latissimus dorsi tendon transfer for irreparable cuff tears and can lead to unsatisfactory results. A new arthroscopic method of tendon to bone fixation using an interference screw has been developed and the purpose of this study was to compare its biomechanical properties to the ones of a standard fixation technique with anchors.

Methods

Six paired fresh frozen cadaveric human humeri were used. The freed latissimus dorsi tendon was randomly fixed to the humeral head with anchors or with interference screw after a tubularization procedure. Testing consisted to apply 200 cycles of tensile load on the latissimus dorsi tendon with maximal loads of 30 N and 60 N, followed by a load to failure test. The stiffness, displacements after cyclic loadings, ultimate load to failure, and site of failure were analysed.

Findings

The stiffness was statistically higher for the tendons fixed with interference screws than for the ones fixed with anchors for both 30 N and 60 N loadings. Likewise, the relative bone/tendon displacements after cyclic loadings were lower with interference screws compared to anchors. Load to failure revealed no statistical difference between the two techniques.

Interpretation

Compared to the standard anchor fixation, the interference screw fixation technique presents higher or similar biomechanical performance. These results should be completed by further biomechanical and clinical trials to confirm the interest of this new technique as an alternative in clinical use.     

Comparison of air-Q(®) and Soft Seal(®) laryngeal mask for airway management by novice doctors during infant chest compression: a manikin study

Background

Recent resuscitation guidelines for infant cardiopulmonary resuscitation (CPR) emphasise that rescuers should minimise the interruption of chest compressions. To that end, supraglottic devices such as laryngeal mask airways (LMAs) are suggested as a backup for airway management during infant CPR. We therefore compared the utility of the air-Q^® LMA (air-Q) with that of the Soft Seal^® LMA (Soft Seal) for infant CPR in an infant manikin.

Methods

Twenty-four novice doctors in the anaesthesia department performed insertion and ventilation with air-Q and Soft Seal on an infant manikin with or without chest compression.

Results

Two doctors failed to insert the Soft Seal without chest compression, while nine failed during chest compression (P < 0.05). However, only one doctor failed to insert the air-Q without chest compression, and two doctors failed during chest compression. Insertion time was not significantly increased with chest compression using either device. Insertion time during chest compression was significantly shorter for the air-Q than for the Soft Seal (P < 0.05). The visual analogue scale (VAS) was used to evaluate difficulty of use (0 mm (extremely easy) to 100 mm (extremely difficult)). VAS scores did not change significantly by the addition of chest compression with either device; however, VAS scores during chest compression were significantly higher with Soft Seal than with the air-Q device.

Conclusion

We conclude that novice doctors find the air-Q easier to use than Soft Seal for emergency airway management during chest compression in infants, in an infant manikin.     

Ultrasound Exposure During Gross Anatomy

Background

As medical schools seek to standardize ultrasound training and incorporate clinical correlations into the basic science years, we proposed that ultrasonography should have a greater role in the anatomy curriculum.

Objectives

To describe the introduction of ultrasound into the curriculum of a first-year medical student anatomy course and evaluate the utility of this introduction.

Methods

First-year medical students attended two ultrasound lectures and three small-group hands-on sessions that focused on selected aspects of musculoskeletal, thoracic, abdominal, and neck anatomy. Pre and post surveys were administered to assess student perception of their ability to obtain and interpret ultrasound images and the utility of ultrasound in the anatomy course. Understanding of basic ultrasound techniques and imaging was tested in the practical examinations.

Results

Of the 269 first-year medical students who completed the course, 144 students completed both surveys entirely, with a response rate of 53%. Students' interest and self-perceived experience, comfort, and confidence in ultrasound skills significantly increased (p < 0.001) as a result of this early introduction to ultrasonography. Objective evidence, provided by practical examination scores on ultrasound images, is consistent with this self-perceived confidence reported by students.

Conclusions

Ultrasound can be effectively incorporated into an anatomy course for first-year medical students by utilizing didactics and hands-on exposure. Medical students found the addition of ultrasound training to be valuable, not only in enhancing their understanding of anatomy, but also in increasing their interest and experience in ultrasound imaging.     

Correlations between strength and quantitative computed tomography measurement of callus mineralization in experimental tibial fractures

Background

The evaluation of fracture healing in the clinic has not changed significantly during the past few decades, despite the development of modern tissue-imaging tools. Recent publications have reported significant and interesting associations between biomechanical properties and quantitative computed tomography data of fractures and grafts. We therefore studied the correlations between the strength and segmented quantitative computed tomography data of tibial diaphyseal fractures.

Methods

Forty male rats received a tibial-shaft osteotomy that was initially stabilized with either intramedullary nailing or external fixation. Evaluation at 30 and 60 days post-osteotomy included X-ray, quantitative computed tomography and bending testing. Quantitative computed tomography data were segmented by voxel density into soft callus (171–539 mg/cm³), hard callus (540–1199 mg/cm³) and cortical bone (≥ 1200 mg/cm³), and volumetric bone mineral density was calculated.

Findings

All fractures demonstrated pronounced formation of soft and hard callus tissues at 30 days post-osteotomy, and at 60 days the cortical bone volume was significantly increased with callus resorption. Bending strength correlated significantly and positively with fracture-site cortical bone volume and volumetric bone mineral density in the intramedullary nailed group in the early phase of healing.

Interpretation

Quantitative computed tomography was used to quantify characteristic secondary healing. The observed correlations indicate that biomechanically important mineralization can be measured by quantitative computed tomography in the early phase of healing in flexibly fixed fractures.     

Comparative sensitivity of computed tomography vs. magnetic resonance imaging for detecting acute posterior fossa infarct

Background

Posterior fossa strokes, particularly those related to basilar occlusion, pose a high risk for progression and poor neurological outcomes. The clinical history and examination are often not adequately sensitive or specific for detection.

Study Objectives

Because this population stands to benefit from acute interventions such as intravenous and intra-arterial tissue plasminogen activator, mechanical thrombectomy, and intensive monitoring for neurologic deterioration, this study examined the sensitivity of non-contrast head computed tomography (NCCT) for diagnosing posterior fossa strokes in the emergency department.

Methods

This study analyzed a prospectively collected database of acute ischemic stroke patients who underwent head NCCT within 30 h of symptom onset and who were subsequently found to have a posterior fossa infarct on brain magnetic resonance imaging (MRI) performed within 6 h of the NCCT.

Results

There were 67 patients identified who had restricted diffusion on MRI in the posterior fossa. The National Institutes of Health Stroke Scale (NIHSS) scores ranged from 0 to 36, median 3. Only 28 patients had evidence of infarction on the initial NCCT scan. The timing of NCCT scans ranged from 1.2 to 28.9 h after symptom onset. The sensitivity of NCCT was 41.8% (95% confidence interval 30.1–54.4). The longest period of time between symptom onset and a negative NCCT with a subsequent positive diffusion-weighted imaging MRI was 26.7 h.

Conclusions

Head NCCT imaging is frequently insensitive for detecting posterior fossa infarction. Temporal evolution of strokes in this distribution, coupled with beam-hardening artifact, may contribute to this limitation. When a posterior fossa stroke is suspected and the NCCT is non-diagnostic, MRI is the preferred imaging modality to exclude posterior fossa infarction.     

Cerebrolysin and morphine decrease glutathione and 5-hydroxyindole acetic acid levels in fasted rat brain

Purpose

The aim was to evaluate if morphine sulphate combined with cerebrolysin enhances the risk of oxidative damage in the presence of moderate hypoglycaemia.

Methods

Wistar rats under starvation for 48 h received a single dose of 215 mg/kg cerebrolysin or 4 mg/kg morphine sulphate. Glutathione (GSH) and 5-hydroxyindoleacetic acid (5-HIAA) levels were measured in brain tissue, as well as lipid peroxidation, Na⁺–K⁺ ATPase and total ATPase enzymatic activities, by fluorescence and spectrophotometric methods.

Results

GSH and 5-HIAA levels decreased significantly (p < 0.05) in animals which received cerebrolysin and morphine alone or combined. TBARS levels increased in all groups, but the values were statistically significant only in those animals that received cerebrolysin combined with morphine (p < 0.05). Na⁺–K⁺ ATPase and total ATPase activities decreased significantly in rats treated only with morphine, but the cerebrolysin and morphine groups showed a significant increase in these enzymatic activities.

Conclusions

Results suggest that cerebrolysin as well as morphine induced changes in cellular regulation and biochemical responses to oxidative stress induced by moderate hypoglycaemia in brain.     

Admission interview scores are associated with clinical performance in an undergraduate physiotherapy course: an observational study

Objective

The purpose of this study was to determine if there is an association between admission interview score and subsequent academic and clinical performance, in a four-year undergraduate physiotherapy course.

Design

Retrospective observational study.

Participants

141 physiotherapy students enrolled in two entry year groups.

Outcome measures

Individual student performance in all course units, practical examinations, clinical placements as well as year level and overall Grade Point Average. Predictor variables included admission interview scores, admission academic scores and demographic data (gender, age and entry level).

Results

Interview score demonstrated a significant association with performance in three of six clinical placements through the course. This association was stronger than for any other admission criterion although effect sizes were small to moderate. Further, it was the only admission score to have a significant association with overall Clinical Grade Point Average for the two year groups analysed (r = 0.322). By contrast, academic scores on entry showed significant associations with all year level Grade Point Averages except Year 4, the clinical year.

Conclusions

This is the first study to review the predictive validity of an admission interview for entry into a physiotherapy course in Australia. The results show that performance in this admission interview is associated with overall performance in clinical placements through the course, while academic admission scoring is not. These findings suggest that there is a role for both academic and non-academic selection processes for entry into physiotherapy.     

Foot placement variability as a walking balance mechanism post-spinal cord injury

Background

Spinal cord injury affects walking balance control, which necessitates methods to quantify balance ability. The purposes of this study were to 1) examine walking balance through foot placement variability post-injury; 2) assess the relationship between measures of variability and clinical balance assessments; and 3) determine if spatial parameter variability might be used as a clinical correlate for more complex balance measurements.

Methods

Ten persons with spinal cord injury walked without devices on a split-belt treadmill at self-selected speeds. Ten healthy controls walked at 0.3 and 0.6 m/s for comparison. Variability of step width and length, anteroposterior and mediolateral foot placements relative to center-of-mass, and margin-of-stability were calculated. Clinical assessments included Berg Balance Scale and Dynamic Gait Index.

Findings

Participants with spinal cord injury demonstrated significantly different variability in all biomechanical measures compared to controls (P ≤ 0.007). Berg Balance Scale scores were significantly inversely associated with step length as well as anteroposterior and mediolateral foot placement variability (P ≤ 0.05). Dynamic Gait Index scores were significantly inversely associated with mediolateral foot placement variability (P ≤ 0.05). Participants with spinal cord injury showed significant correlations between spatial parameter variability and all other measures (P ≤ 0.005), except between step length and margin-of-stability (P = 0.068); controls revealed fewer correlations.

Interpretation

Persons post-spinal cord injury exhibit an abnormal amount of stepping variability when challenged to walk without devices, yet preserve the ability to avoid falling. When complex laboratory measures of variability are unavailable clinically, spatial parameter variability or standardized balance assessments may be plausible indicators of walking balance control.     

Cyclic loading of fractured cadaveric femurs after elastomer femoroplasty: An in vitro biomechanical study

Background

Elastomer femoroplasty is a novel and experimental approach in the prevention of hip fracture surgery. Previously, we published the results of an in vitro cadaveric experiment in which we showed a significant reduction of fracture displacement in treated femurs. The aim of the present study was to establish the failure loads and inter‐fragmentary movement of fractured, elastomer femoroplasty treated femurs during cyclic loading.

Methods

16 cadaveric femurs were treated with elastomer femoroplasty and fractured in a simulated fall configuration. Each specimen underwent 10 cycles with a preload of 50 N, starting with a peak load of 250 N followed by 10 cycles of 500 N and continued with 500 N increments. The crosshead speed was 2 mm/s. The failure load, the number of completed cycles, and crosshead extensions were recorded.

Findings

The mean failure load was 2709 N (SD 1094). The number of completed cycles until failure was 60 (SD 22). The mean translation during maximum loading was 5.25 mm (SD 0.9). At 1500 N (two times the bodyweight of a 75 kg individual) the extension was 3.16 mm.

Interpretation

Preventive elastomer femoroplasty leads to the stabilization of the proximal femur after fracture. In a single leg stance configuration, cyclic loading with mean failure loads that well exceed the peak loads during normal gait is feasible.     

Utilization of Behavioral Therapy Services Long-Term After Traumatic Brain Injury in Young Children

Objective

To examine associations of clinical need, defined by elevated parent ratings of child behavior problems and utilization of behavioral health services in young children with traumatic brain injury (TBI) and an orthopedic injury (OI) comparison group.

Design

Parents completed outcome measures 18 months after injury and at an extended follow-up conducted an average of 38 months postinjury.

Setting

Children's hospitals and a general hospital.

Participants

Participants included parents of 3 groups of children injured between 3 and 7 years of age (N=139): 47 children with complicated mild to moderate TBI, 18 with severe TBI, and 74 with OI.

Interventions

Not applicable.

Main Outcome Measures

Parents completed ratings of child behavior, mental health symptomology, and family functioning at both visits; at the extended follow-up, they reported utilization of behavior therapy or counseling services since the 18-month follow-up visit.

Results

Children with TBI had more behavior problems than those with OI. Although clinical need at both follow-ups was associated with greater service utilization at the extended follow-up, all groups had unmet needs as defined by a clinical need in the absence of services. Lower socioeconomic status was associated with higher rates of unmet need across groups.

Conclusions

The results document unmet long-term behavioral health needs after both TBI and OI in children and underscore the importance of monitoring and treatment of postinjury behavior problems.     

Comparison of GlideScope(®) versus Macintosh laryngoscope for the removal of a hypopharyngeal foreign body: A randomized cross-over cadaver study

Objective

This study aimed to evaluate whether GlideScope^® is an effective and acceptable method for the removal of a hypopharyngeal foreign body.

Methods

This was a prospective study conducted in 28 first year emergency residents with little prior airway management experience. Participants extracted hypopharyngeal foreign bodies using a Macintosh laryngoscope and GlideScope^® with Magill and Sponge forceps. The primary endpoints were extraction time and success rate with each device. Participant preferences were also assessed.

Results

The cumulative success rate in relation to time to extraction was significantly higher with the Macintosh laryngoscope than with the GlideScope^® (p < 0.001) regardless of the extraction device. Significantly fewer attempts were required for the first successful extraction with the Macintosh laryngoscope versus GlideScope^® with Magill forceps (p = <0.001) and Sponge forceps (p = <0.001). The time for successful foreign body extraction using GlideScope^® was significantly lower when using Magill (median 46 s, IQR 28–75 s) forceps than Sponge forceps (median 79 s, IQR 41–88 s).

Conclusions

In this cadaver model, the Macintosh laryngoscope appeared to be more efficient and preferred than GlideScope^® for extracting hypopharyngeal airway foreign bodies that are associated with fatal asphyxiation.