• neonatology
• qualitative research

We read with interest the study by O’Shea et al,1 which provides useful trainee perspectives on videolaryngoscopy as a teaching aid and highlights the need for standardised training packages. We agree that the use of non-invasive respiratory support has lessened the opportunities for intubation training. In addition, European Working Time Directive regulations have significantly reduced training times, making the acquisition of all procedural skills more challenging for junior doctors.2

Most UK neonatal units use direct laryngoscopy to teach intubation. However, videolaryngoscopy use is gradually increasing. We performed a qualitative study using semistructured interviews of 22 consultants and trainees in a UK tertiary neonatal unit where videolaryngoscopy is commonly used. We aimed to see how videolaryngoscopy contributes to teaching and learning. Interviews were recorded and transcribed verbatim. Data were analysed using attribute and descriptive coding methods. Framework analysis was used to interpret the data obtained from interviews.

In our study, videolaryngoscopy was felt to have largely positive effects on facilitating safer training in an era where intubation opportunities are lacking. As with O’Shea et al,1 participants felt that videolaryngoscopy allowed considerably easier demonstration of intubation technique. Interviewees commented that looking at the monitor, combined with movements of the operator and coaching in real time, assisted eye–hand coordination and made it easier to correct technique.

In contrast to O’Shea et al,1 trainees in our study found that the team encouraging each other around the monitor gave rise to a supportive learning environment and enhanced positive feedback. This has not been previously described, and participants felt this contributed to a reduction in anxiety levels. We agree that non-technical skills are also important in achieving intubation. Interviewees felt that videolaryngosopy allowed group teaching and instilled confidence in the wider multidisciplinary clinical team watching. This ‘team learning’ aligns with social cognitive theory, where learning experiences are active and social, with regular interaction of colleagues in a real-life setting. This social interaction and kinaesthetic activity result in reflection, thus building on their previous knowledge of intubation as per situated learning theory.3

In our study, videolaryngoscopy was felt to improve patient safety while learning. Consultants commented that they felt confident giving trainees more time when they could be certain that they were at the point of intubation on the monitor. Participants expressed concerns that gaining proficiency in videolaryngoscopy might place the trainee at a disadvantage at another hospital where videolaryngoscopes were not in common use. Consultants said that to combat this, they have asked trainees to intubate as they would with direct laryngoscopy and not look at the monitor to aid translation of technique. However, we have found this is not always possible in extremely low birthweight babies due to the bulkiness of the blade.

We feel that videolaryngoscopy is a useful adjunct for intubation training but cannot completely replace direct laryngoscopy due to some differences in technique, equipment and the lack of availability across centres.