In a groundbreaking study published in the Christmas issue of The BMJ, researchers have found that giving inexperienced clinicians a quick coaching session with an expert just before they carry out a procedure can significantly boost their success rate and improve patient safety.
The study focused on the practice of “just-in-time” training, a concept borrowed from athletes and musicians who often warm up or practice just before performing. In the medical field, however, this practice is rare, despite the life-altering consequences of medical procedures.
The randomized clinical trial conducted by a team of US researchers aimed to assess whether coaching inexperienced clinicians just before intubating an infant could improve the quality of care. Intubating an infant, which involves inserting a breathing tube through the mouth and into the windpipe, can be challenging for trainees and is associated with complications such as low oxygen levels and cardiac arrest.
The trial involved 153 anesthesiology trainees from 10 regional training programs who were randomly assigned to either receive a 10-minute training session with an expert airway coach or usual on-the-job training before intubating an infant. The trainees then performed up to five infant intubations, with their cognitive workload measured after each attempt.
The results were promising, with the group that received just-in-time training showing a 10 percentage point improvement in first attempt success compared to the control group. The training was associated with improvements in the quality of care, including less time to intubation, improved views of the airway, and fewer technical difficulties.
Furthermore, the study found that just-in-time training reduced cognitive load and improved competency among trainees. While there were concerns about the training potentially slowing workflow, the researchers found that brief warm-up sessions were feasible and non-disruptive.
The researchers concluded that just-in-time training by an experienced coach before infant intubation could increase first attempt success rates, decrease mental workload, and improve competency metrics for inexperienced clinicians. This form of point-of-care continuing professional development has the potential to be widely adopted and could benefit both inexperienced and experienced clinicians.
In a linked editorial, Justine Naylor at the University of New South Wales praised the potential of just-in-time training to accelerate competency in inexperienced individuals while protecting their mental health. The study, although conducted at a single center, could have broader implications for improving the quality of high-stakes procedural care.
Overall, the findings of this study highlight the importance of providing support and training to clinicians just before they perform high-stakes procedures, ultimately improving patient safety and outcomes. Further research is warranted to explore the potential benefits of just-in-time training in other medical settings.
