Objective To explore the minimum number of practice attempts required for undergraduate medical interns to master endotracheal extubation skills under the ″sandwich″ teaching method. Methods Fifteen fifth-year undergraduate clinical students from the Class of 2019 at Jiaxing University medical college, who completed a rotation in the Department of Anesthesiology at the Affiliated Hospital of Jiaxing University between June and September 2023, were enrolled in the study. The ″Sandwich″ teaching method was employed for training in tracheal extubation procedures. All bedside extubation practices were independently supervised and assessed by the same two senior attending physician. Each intern independently completed 30 cases of tracheal extubation (a total of 450 cases), The quality score of the operation was recorded using a scale validated by the Delphi method, and a learning curve was constructed using the Cumulative Sum (CUSUM) method. They fitted quadratic and cubic polynomial functions and compared the goodness of fit (R2). The derivative analysis method was used to analyze the slope of the fitted curve and determine the skill turning point. Results The cubic polynomial function has the best fitting effect on the learning curve (R2=0.914). Using polynomial fitting derivative analysis method, the 18th operation is the inflection point of the learning curve slope, indicating a significant slowdown in skill improvement speed and entering a stable plateau period. Conclusions The ″sandwich″ teaching method can serve as an effective approach for training interns in endotracheal extubation skills. Learning curve analysis indicated that the minimum number of practice attempts required to achieve skill mastery was 18, providing evidence-based support for setting teaching objectives and optimizing resource allocation.
Liu Mingjuan
,
Dong yuanyuan
,
Cao Jin
,
Yu Danhong
,
Yang Rui
,
Liu Ke
,
Ni Huadong
. Learning curve analysis of tracheal extubation skills in undergraduate medical interns under the ″Sandwich″ teaching method[J]. Chinese Journal of Medical Education, 2026
, 46(4)
: 259
-263
.
DOI: 10.3760/cma.j.cn115259-20240625-00652
[1] Zhang C, Wang S, Li H, et al. Anaesthesiology in China: a cross-sectional survey of the current status of anaesthesiology departments[J]. Lancet Reg Health West Pac, 2021, 12: 100166. DOI:10.1016/j.lanwpc.2021.100166.
[2] Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. Part 1: anaesthesia[J]. Br J Anaesth, 2011, 106(5): 617-631. DOI:10.1093/bja/aer058.
[3] Katsioudi G, Kostareli E. A Sandwich-model experiment with personal response systems on epigenetics: insights into learning gain, student engagement and satisfaction[J]. FEBS Open Bio, 2021, 11(5): 1282-1298. DOI:10.1002/2211-5463.13135.
[4] Cai X, Peng M, Qin J, et al. Sandwich teaching improved students′ critical thinking, self-learning ability, and course experience in the community nursing course: a quasi-experimental study[J]. Front Psychol, 2022, 13: 957652. DOI:10.3389/fpsyg.2022.957652.
[5] Bock A, Thomas C, Heitzer M, et al. Transferring the sandwich principle to instructional videos: is it worth the effort?[J]. BMC Med Educ, 2021, 21(1): 1-7. DOI:10.1186/s12909-021-02967-3.
[6] Pernar LIM, Robertson FC, Tavakkoli A, et al. An appraisal of the learning curve in robotic general surgery[J]. Surg Endosc, 2017, 31(11): 4583-4596. DOI:10.1007/s00464-017-5520-2.
[7] Cai X, Yue M, Liu X, et al. Learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents: a cumulative sum analysis[J]. PLoS One, 2023, 18(7): e0288617. DOI:10.1371/journal.pone.0288617.
[8] Scorzoni M, Gonnella GL, Capogna E, et al. Achieving lumbar epidural block competency in inexperienced trainees after a structured epidural teaching model: a randomized, single blind, prospective comparison of CUSUM learning curves[J]. Anesthesiol Res Pract, 2022: 1738783. DOI:10.1155/2022/1738783.
[9] 王荣, 盛晗, 姚明, 等. 全麻患者气管拔管质量评价体系的构建:基于零缺陷管理理论[J]. 中华麻醉学杂志, 2022, 42(11): 1348-1352. DOI:10.3760/cma.j.cn131073.20220704.01116.
[10] Langeron O, Bourgain JL, Francon D, et al. Difficult intubation and extubation in adult anaesthesia[J]. Anaesth Crit Care Pain Med, 2018, 37(6): 639-651. DOI:10.1016/j.accpm.2018.03.013.
[11] Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists task force on management of the difficult airway[J]. Anesthesiology, 2013, 118(2): 251-270. DOI:10.1097/ALN.0b013e31827773b2.
