Resident comfort teaching and performing pediatric airway procedures after instruction using the Peyton method, standard simulation, or digital platforms

Introduction: Many learners use the internet or other independent means as a primary way to master procedures. There are also numerous described methods to teach procedures using simulation. The optimal method for teaching procedures is unknown. We compare residents' confidence and performance of pediatric airway skills (bag valve mask [BVM] and endotracheal intubation [ETI]) and their confidence in teaching these skills to others after training using (1) standard simulation (SS), (2) the Peyton method, or (3) self-directed learning. Materials and Methods: In 2019–2020, emergency medicine (EM) residents at a single program were randomized to one of three training groups. Prior to training, residents underwent standard airway simulation skill assessment sessions with two blinded observers. Residents in the SS group then underwent training using SS with postprocedure debriefing. Residents in the Peyton method group underwent simulation through a structured technique described elsewhere. The residents in the independent learning group were encouraged to master the skills through any means they saw fit. Residents were surveyed regarding prior experience, knowledge base, and confidence in performing and teaching procedures. Results: Thirty-three residents were randomized. After training, there were no differences between groups in comfort performing procedures. Residents randomized to independent learning were less comfortable teaching ETI than other groups. In 4–6 month follow-up, all residents showed improvement in procedural performance, regardless of assigned learner group. Conclusions: Residents using self-directed learning to master airway skills are less comfortable teaching ETI than those taught using simulation. Their skill performance is equivalent regardless of teaching method. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, Systems-based practice.