Age Before Beauty: Physician Training and Its Effects on First-Pass Intubation

Sunday, March 22, 2026

11:00 AM - 12:00 PM Central Time

Location: Connections Central - RST 12

Caitlyn Johnson-Bryant, MD (she/her/hers)

Virginia

Disclosure(s): No relevant financial relationship(s) to disclose.
Peter Sweetser, MD (he/him/his)

District of Columbia

Disclosure(s): No relevant financial relationship(s) to disclose.
JL

Jenny Libov, MD

Resident
George Washington University

Disclosure information not submitted.
Dami Fakunle, MD (she/her/hers)

Virginia

Disclosure(s): No relevant financial relationship(s) to disclose.
KP

Kirra Paulus, MD

Resident
George Washington University

Disclosure information not submitted.
Ayal Pierce, MD

George Washington University Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.
DY

David Yamane, MD

Associate Professor
George Washington University

Disclosure information not submitted.
Amelia Bryan, MD

George Washington University Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Endotracheal intubations in the Emergency Department are most often performed on patients with high risk of decompensation. First pass success is crucial to their outcomes, therefore the most senior provider is preferred. Data is limited on comparisons of senior and junior providers in intubation outside of the simulation space. This study aimed to assess the relation of intubator training level with time to acquired view of vocal cords and endotracheal tube placement.

Methods: This retrospective study was performed at a single urban academic emergency department with automated recording of intubations utilizing video laryngoscope. Videos were independently analyzed by two reviewers for blade placement, grade of view, time to endotracheal tube (ETT) placement, and use of airway adjuncts. Following analysis, recordings were then matched to electronic medical records to identify training level of the intubator.

Results: Among the 113 videos reviewed for this study, 59 were matched to patients EHR. 11 were excluded due to unknown training level of the intubating provider. Training level and time to view as well as ETT placement were inversely related to Post graduate year (PGY) level. PGY-1 physicians taking on average 9 secs (4.5 - 12 sec) to achieve intubation view and 26.5 secs (15.25 - 50.5 sec) for ETT placement in comparison to PGY-3 taking 7 secs (6 - 8 sec) and 23 secs (20-30 sec) respectively. Further analysis of errors during intubation, such as posterior tube delivery, inappropriate blade placement, or resultant airway trauma demonstrate decreasing number of errors with increased training level, PGY-1 with an average of 1.1 errors and PGY-3 with 0.67. On evaluation of grade of view, with acceptable view of Grade 1 or 2a, PGY-2 physicians were lowest at 93.3% (compared to PGY-1 and PGY-3, 100%).

Conclusions: Though underpowered, preliminary results support the previously hypothesized positive correlation between training level and efficient intubations using video laryngoscopy. Ongoing and future studies, should focus on increasing sample size and expanding demographics to include more levels of training such as fellows and attendings.