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Open Access Open Badges Original research article

Use of a Low-fidelity simulator to improve trans-nasal fibre-optic flexible laryngoscopy in the clinical setting: a randomized, single-blinded, prospective study

Michael W Deutschmann1, Warren K Yunker12, John J Cho1, Meri Andreassen3, Shari Beveridge3 and John Douglas Bosch1*

Author Affiliations

1 Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of Calgary, 262-1632 14th Avenue NW, Calgary, Canada

2 Division of Paediatric Surgery, Department of Surgery, University of Calgary, Calgary, Canada

3 Department of Rehabilitation Services, Alberta Health Services, Calgary Zone, Calgary, Canada

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Journal of Otolaryngology - Head and Neck Surgery 2013, 42:35  doi:10.1186/1916-0216-42-35

Published: 21 May 2013



Trans-nasal flexible fibre-optic laryngoscopy (TFFL) is an essential skill for otolaryngologists. There is evidence to suggest that simulators help residents acquire procedural skills. The objective of this study was to examine the effect of simulation on endoscopy skill acquistion.


A randomized controlled trial was conducted utilizing medical students and junior residents with limited experience in TFFL. Learners all performed a baseline endoscopy and were then randomized to receive either 45 minutes of simulation training or not. Following this, a second endoscopy was performed. Time to adequate visualization of the glottis, the percentage of time adequate visualization of the airway was maintained, and the number of collisions with mucosa were analyzed. Qualitative assessments were also obtained from the learner, patient, and staff laryngologist.


Time to adequate visualization of the glottis and the number of mucosal collisions were significantly less during the second endoscopy, irrespective of the use of simulation (84.8 sec vs. 68 sec, pā€‰<ā€‰0.01; 5.0 vs. 3.2, pā€‰<ā€‰0.01, respectively). Analysis using a two-way ANOVA with interaction established that none of the quantitative measures analyzed in this study improved with the addition of simulation.


Improvements in time to visualization of the glottis and number of mucosal contacts were seen between the first and second endoscopy irrespective of simulator use. No additional benefit was conferred with the use of a low-fidelity simulator.

Endoscopy; Education; Simulation; Larynx