Endotracheal intubation exposure obtained by Emergency Care students in Cape Town during work-integrated learning

Abstract

BACKGROUND: Endotracheal intubation (ETI) is a critical, life-saving procedure in emergency medical care, requiring a combination of technical proficiency and the ability to manage cognitive load in stressful circumstances. Despite its importance, the training and clinical exposure necessary to achieve ETI competency vary between individual students, particularly in prehospital and emergency settings. In South Africa, Emergency Care Practitioner (ECP) students undergo Work Integrated Learning (WIL) placements to acquire the necessary knowledge, skills, and attributes for ETI. However, the variability in exposure to diverse clinical contexts and patients may impact the adequacy of graduate preparation for independent practice. This study examines ETI exposure among ECP students in Cape Town, Western Cape, South Africa, focusing on the frequency, diversity, and clinical characteristics of ECP student ETI exposures during WIL. METHODOLOGY: A retrospective, quantitative, cross-sectional study design was used to analyse clinical data from the FISDAP™ database, capturing ETI experiences of ECP students during WIL placements from 2012 to 2016. Although the dataset reflects historical clinical practices, it remains valuable for understanding foundational airway management training trends during a period of curriculum stability. Key variables assessed included the number of ETI procedures performed or observed, success rates, patient characteristics, and exposure to advanced airway interventions, such as Rapid Sequence Intubation (RSI). Statistical analyses were performed using SPSS Version 29, with descriptive and inferential tests (Chi Square, Fisher’s Exact, Z-tests, and t-tests) used to explore relationships between variables. FINDINGS: Analysis of 850 ETI events revealed variation in student exposure by setting, showing limited exposure to prehospital ETI. Intubations were most frequently performed in operating rooms (30.6%), followed by emergency centres (16.9%), prehospital settings (15.2%), and simulation laboratories (37.2%). In the prehospital clinical setting, students recorded a limited degree of individual exposure (range: 2 to 15). RSI exposure accounted for 21.4% of clinical ETI events. Students with greater overall exposure, including skills laboratory procedures (>60 intubations), achieved first-attempt success rates exceeding 88%. CONCLUSION: The study highlights limited clinical exposure, particularly in the prehospital setting and in the diversity of patients. The study also highlights the role played by simulated ETI exposure to expand learning opportunities and focus on particular patient subgroups less frequently observed in the clinical setting. Strengthening preceptor support and structuring post-graduation internships are recommended to improve readiness for independent airway management. These findings contribute new, context-specific evidence to the body of knowledge on emergency medical education and suggest pathways for refining ECP airway management training strategies in South Africa.