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Giving inexperienced clinicians a brief coaching session just before they perform a medical procedure can significantly improve their success rates and potentially enhance patient safety, according to a new study published in The BMJ Christmas issue.
While athletes and musicians commonly warm up or rehearse before performances, such “just-in-time” training is rarely practiced in the medical field, despite the life-altering consequences that procedures can have. To explore the potential benefits of pre-procedure coaching, a team of U.S. researchers conducted a randomized clinical trial at Boston Children’s Hospital. The aim was to determine whether coaching inexperienced clinicians just before performing infant intubations—an intricate procedure involving the insertion of a breathing tube into the windpipe—could improve the quality of care.
Intubating an infant can be especially challenging for trainees, who often require multiple attempts to correctly insert the tube. This increases the risk of complications such as hypoxia (low oxygen levels), bradycardia (slow heart rate), and even cardiac arrest, as well as creating added mental stress for the clinician.
The trial, conducted between August 2020 and April 2022, involved 153 anesthesiology trainees from 10 regional programs, all of whom had varying levels of experience in infant intubation. Each participant completed a survey on their prior experience before being randomly assigned to one of two groups: the treatment group, which received a 10-minute coaching session on an infant manikin with an expert airway coach, or the control group, which underwent standard on-the-job training.
The results were striking. Trainees who received coaching on the manikin showed a significant improvement in their first-attempt success rate—91.4% compared to 81.6% in the control group. This 10 percentage point difference was deemed clinically meaningful. In addition to a higher success rate, the coaching group exhibited improvements in several key metrics, including reduced time to intubation, improved visualization of the airway, fewer attempts to insert the tube, and fewer technical difficulties.
Perhaps most notably, trainees who received the just-in-time training experienced a significantly lower cognitive load, as measured by a NASA-developed survey assessing mental workload during the procedure. Lower cognitive load is linked to fewer task-specific errors. Complication rates in the treatment group were also lower, though the difference was not statistically significant, with complication rates of 2.75% in the treatment group compared to 4.71% in the control group.
A common concern regarding such training is whether it would disrupt workflow or place an undue burden on staff. However, the researchers found that these brief warm-up sessions were feasible and did not disrupt hospital operations. This suggests that the model could be implemented in various healthcare settings without creating significant workflow challenges.
While the study was conducted at a single center, the findings suggest that this approach could be beneficial in other contexts and might even improve performance in more experienced clinicians. Further studies are needed to validate these results and explore the broader applicability of just-in-time training.
The authors conclude that “just-in-time training by an experienced coach before infant intubation increases the first attempt success rate, decreases the mental workload, and improves competency metrics for inexperienced clinicians.” They suggest that this method of training could have broader applications in improving high-stakes procedural care.
In an accompanying editorial, Justine Naylor from the University of New South Wales highlighted the potential for just-in-time coaching to become a widespread practice in medical education. She noted that such training could accelerate the development of competency in less experienced practitioners while having minimal impact on existing resources. Additionally, Naylor pointed out that the approach may help protect the mental health of clinicians by reducing stress and cognitive overload.
The study, “Coaching inexperienced clinicians before a high-stakes medical procedure: randomized clinical trial,” was published in The BMJ on December 17, 2024. DOI: 10.1136/bmj-2024-080924.
