Arduino-Based Real-Time Feedback for Manikin Endotracheal Intubation Training in Medical Students

Single-center, two-arm, cluster-randomized controlled pretest-posttest study conducted during the 2022-2023 academic year at Tri-Service General Hospital, Taipei, Taiwan. The unit of allocation was the small teaching group (three to four students), assigned before each session by a physical chance-based procedure (lot drawing or coin toss).

Both arms received the same curriculum: a concept map of airway management, direct teaching and demonstration of airway adjuncts, bag-mask ventilation, and endotracheal intubation, followed by coached manikin practice with reflection and reattempts.

In the experimental arm, a pressure-sensing element at the tooth end of a standard laryngoscope blade transmitted signals to an Arduino-based display that showed a unitless upper-incisor pressure score and elapsed intubation time after each attempt, with an audible alarm above a preset pressure threshold. The control arm practiced on a standard manikin with usual instructor observation and verbal feedback.

The study was registered retrospectively after completion.

Structured airway-management course with coached manikin practice using the Arduino-based real-time pressure and time feedback laryngoscope (40 students).

Device: Arduino-based real-time feedback laryngoscope · Behavioral: Structured airway-management course

Same structured airway-management course with coached practice on a standard manikin and usual instructor observation and verbal feedback, without device-generated scores (40 students).

Behavioral: Structured airway-management course

Standard laryngoscope blade fitted with a pressure-sensing element at the tooth end, connected to an Arduino-based display that shows a unitless upper-incisor pressure score and elapsed intubation time after each manikin intubation attempt, with an audible alarm when sensed pressure exceeds a preset threshold. Used during coached manikin practice within the structured airway-management course.

Course-opening concept map of airway management, direct teaching and demonstration of oral and nasal airways, bag-mask ventilation, and endotracheal intubation, followed by coached practice on an airway manikin with instructor feedback, reflection, and reattempts. Delivered identically to both arms.

Time frame: Before training (pretest) and immediately after training (posttest), within the same teaching session

Unitless score generated by the pressure-sensing laryngoscope during a manikin intubation attempt; higher scores indicate less loading of the upper incisors. The posttest score is compared between arms with adjustment for the pretest score.

Time frame: Before training (pretest) and immediately after training (posttest), within the same teaching session

Four-item learner-reported scale with 5-point responses (1, strongly disagree, to 5, strongly agree); total score range 4-20, higher scores indicate greater perceived autonomy.

Time frame: Before training (pretest) and immediately after training (posttest), within the same teaching session

Four-item learner-reported scale with 5-point responses; total score range 4-20, higher scores indicate greater perceived competence.

Time frame: Before training (pretest) and immediately after training (posttest), within the same teaching session

Seven-item learner-reported scale with 5-point responses; total score range 7-35, higher scores indicate greater intubation self-efficacy.

Time frame: Immediately after training

Mean score of three postcourse items with 5-point responses; range 1-5, higher scores indicate greater satisfaction.

Time frame: During the clinical anesthesiology rotation following training

Proportion of successful endotracheal intubation attempts on patients in the operating room, with two to four scored attempts (success or failure) per student.

Effects of an Arduino-Based Real-Time Feedback Device on Manikin-Based Endotracheal Intubation Training in Medical Students: A Cluster-Randomized Controlled Pretest-Posttest Study