Remote Hands-on Training versus On-site Hands-on Training for Flexible Optical Intubation: A Noninferiority Randomized Controlled Trial

BACKGROUND: Simulation-based training for flexible optical intubation (FOI) is effective but costly and often unavailable in remote areas. Online, hands-on training using affordable, shippable models could be a feasible alternative. METHODS: In this noninferiority randomized controlled trial, 30 participants with fewer than 5 FOI experiences were assigned randomly to either remote or on-site hands-on training groups at a 1:1 ratio. The remote group received online theoretical teaching and supervised training and hands-on practice using a modified “Choose-the-Hole” model and a three-dimensional (3D)-printed airway manikin shipped to them. The on-site group received theoretical teaching and hands-on FOI practice in the Eye & ENT Hospital Training Center. Within 1 week after training, all participants performed the FOIs on anesthetized patients with normal airway anatomy. The performances were video recorded and evaluated. The primary outcome was the global rating scale (GRS) scores of the FOI performance on the patient. Secondary outcomes included the checklist scores of FOI performance, first attempt and total success rate, mean intubation time, self-assessment, and training satisfaction. RESULTS: From July 2022 to December 2022, 30 participants were randomly assigned to receive either remote training (n = 15) or on-site training (n = 15), of whom 28 participants were included in the analyses (17 females, 11 males, average age of 30.0 years). The baseline characteristics of the participants were comparable between 2 groups. No significant difference was found in GRS scores (14.2 ± 3.95 vs. 12.0 ± 3.60, P = .146, mean difference, 2.14, 95% confidence interval [CI], −0.79 – 5.08) between the remote and on-site groups. Statistically similar mean checklist scores (9.32 ± 0.78 vs. 8.89 ± 1.08, P = .238) and intubation time (123 ± 68 vs. 117 ± 54 seconds, P = .780) were noted, respectively, in the remote and on-site groups. The total success rate was 100% in both groups. No significant difference was found in the remote and on-site groups regarding self-assessment and training satisfaction scores. CONCLUSIONS: Remote FOI hands-on training using shippable models was as effective as on-site training, with similar performance, checklist scores, success rate, and intubation time. This suggests that remote training can serve as a viable, cost-effective alternative to traditional on-site methods.