Tracheal intubation is a critical but technically demanding procedure in emergency airway management. Junior emergency medicine residents often struggle to achieve proficiency, leading to increased risks of complications. This study evaluates the effectiveness of a Plan-Do-Check-Act (PDCA) cycle-based training program in improving intubation skills. The study was conducted in the emergency department of a tertiary teaching hospital. Residents performing intubations in 2023 with conventional training served as the control group, while those trained with the PDCA model in 2024 formed the intervention group. The PDCA program included structured lectures, high-fidelity simulation, supervised clinical practice, and iterative feedback. Primary outcomes were first-attempt success rate and intubation completion time. Secondary outcomes included incidence of local airway trauma, extubation failure due to airway injury within 72 hours, and resident satisfaction. This study aims to provide evidence that PDCA-based training can enhance procedural competency, safety, and learner satisfaction in emergency airway management.
Tracheal intubation is a high-risk, time-sensitive procedure that is fundamental to emergency airway management. Despite its lifesaving role, it remains one of the most technically challenging skills for junior emergency medicine residents. Failed or delayed intubation is associated with serious complications, including airway trauma, hypoxemia, aspiration, and cardiac arrest. Traditional didactic training often lacks the iterative practice and structured feedback required for durable skill acquisition. The Plan-Do-Check-Act (PDCA) cycle is an educational quality improvement framework that emphasizes continuous evaluation, feedback, and refinement. This study was designed to investigate whether a PDCA-based training model could improve intubation competency among emergency medicine residents in a tertiary teaching hospital. This prospective observational study compared intubation performance before and after PDCA cycle implementation. The control group included residents performing intubations in 2023 with conventional training, while the intervention group included residents trained with the PDCA model in 2024. The PDCA program consisted of structured didactic sessions, high-fidelity simulation, supervised clinical practice, and iterative debriefing with continuous feedback loops. Primary outcomes were first-attempt success rate and intubation completion time, as these are widely recognized benchmarks of procedural safety and efficiency. Secondary outcomes included the incidence of local airway trauma, extubation failure due to airway injury within 72 hours, and resident satisfaction with training. We hypothesized that PDCA-based training would significantly improve first-pass success, shorten intubation time, reduce airway-related complications, and enhance trainee satisfaction. The findings may provide evidence for adopting structured, feedback-oriented frameworks in emergency and critical care training, with broader implications for competency-based medical education.
Study Type
OBSERVATIONAL
Enrollment
100
A structured training program for emergency medicine residents based on the Plan-Do-Check-Act (PDCA) cycle. The intervention includes didactic teaching, simulation-based airway management practice, supervised clinical intubation, iterative performance assessment, and feedback-driven improvement.
The Affiliated Panyu Central Hospital, Guangzhou Medical University
Guangzhou, Guangdong, China
First-Attempt Success Rate of Tracheal Intubation
The proportion of tracheal intubation attempts by emergency medicine residents successfully completed on the first attempt, as verified by standard clinical confirmation (e.g., chest rise, end-tidal CO₂, auscultation, chest X-ray).
Time frame: Within procedure (immediately at time of intubation)
Intubation Completion Time
Time in seconds from insertion of the laryngoscope to confirmation of successful tube placement.
Time frame: Periprocedural (measured once during each intubation attempt, from laryngoscope insertion to confirmed tracheal tube placement, using a stopwatch
Incidence of Local Airway Trauma
Presence of fresh blood in the airway post-intubation, excluding bleeding from preexisting conditions (e.g, subglottic mass, pulmonary hemorrhage).
Time frame: Assessment was performed immediately after completion of intubation and within 5 minutes post-procedure, by direct laryngoscopic visualization or suction catheter inspection
Extubation Failure Due to Airway Injury
Reintubation within 72 h despite meeting extubation criteria, confirmed by laryngoscopy (e.g., edema, vocal cord paralysis, granulation, or subglottic stenosis).
Time frame: Assessment was performed within 72 hours following planned extubation. Patients were monitored for the need of reintubation, and airway injury was confirmed by laryngoscopy when extubation failure occurred.
Mean Questionnaire Score on Learning Experience and Perceived Training Value
Assessed via anonymous questionnaire administered immediately after training。Scores are reported on a 5-point Likert scale (1 = very poor, 5 = excellent), with higher scores indicating a better learning experience and greater perceived training value.
Time frame: Immediately after completion of the training session (within 24 hours).
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