Fellow Physician UC San Diego/Rady Children's Hospital San Diego, California, United States
Background: Pediatric intubation is a high-risk, low-frequency procedure in pediatric emergency departments. Given its low-frequency, opportunities for pediatric emergency medicine (PEM) fellows and faculty are rare. Breaking down a procedural skill into micro-skills can help develop mastery in that skill as a whole. However, there is sparse literature that defines the micro-skills that encompass pediatric direct laryngoscopy and endotracheal tube delivery, and therefore, identifying these component micro-skills can help to inform the future development of a formal airway curriculum for PEM physicians. Objective: Our project aims to define airway micro-skills utilized in pediatric direct laryngoscopy and endotracheal tube delivery through a Delphi technique. Design/Methods: We have recruited twelve interdisciplinary airway experts from PEM, Pediatric Critical Care, and Pediatric Anesthesiology with seven institutions across the United States represented. Through multiple rounds of the Delphi method, our airway experts have been tasked with reaching consensus on a complete list that defines the airway micro-skills utilized in pediatric direct laryngoscopy and tracheal intubation. During each round, experts score each step on a 7-point scale, where 1, 2, and 3 represent not important; 4, 5, and 6 represent somewhat important; and 7 represents mandatory. Participants are able to suggest additional steps as needed, propose wording changes, suggest removal of steps that sound similar, change the order of existing steps, and add free text comments to further qualify their rankings. The study coordinator calculates the mean for each step and steps with a mean ≤3.0 are removed for subsequent rounds. List consolidation is also performed after each round. For subsequent rounds, each expert is provided the revised consolidated micro-skills list and an abstract of panel members’ comments from the previous round. This Delphi process will be continued until the checklist is finalized by reaching ≥80% airway expert consensus that the airway micro-skill list is comprehensive.
