Application of PDCA Cycle in Tracheal Intubation Training for Emergency Medicine Residents

Tracheal intubation is a high-risk, time-sensitive procedure that is fundamental to emergency airway management. Despite its lifesaving role, it remains one of the most technically challenging skills for junior emergency medicine residents. Failed or delayed intubation is associated with serious complications, including airway trauma, hypoxemia, aspiration, and cardiac arrest. Traditional didactic training often lacks the iterative practice and structured feedback required for durable skill acquisition.

The Plan-Do-Check-Act (PDCA) cycle is an educational quality improvement framework that emphasizes continuous evaluation, feedback, and refinement. This study was designed to investigate whether a PDCA-based training model could improve intubation competency among emergency medicine residents in a tertiary teaching hospital.

This prospective observational study compared intubation performance before and after PDCA cycle implementation. The control group included residents performing intubations in 2023 with conventional training, while the intervention group included residents trained with the PDCA model in 2024. The PDCA program consisted of structured didactic sessions, high-fidelity simulation, supervised clinical practice, and iterative debriefing with continuous feedback loops.

Primary outcomes were first-attempt success rate and intubation completion time, as these are widely recognized benchmarks of procedural safety and efficiency. Secondary outcomes included the incidence of local airway trauma, extubation failure due to airway injury within 72 hours, and resident satisfaction with training.

We hypothesized that PDCA-based training would significantly improve first-pass success, shorten intubation time, reduce airway-related complications, and enhance trainee satisfaction. The findings may provide evidence for adopting structured, feedback-oriented frameworks in emergency and critical care training, with broader implications for competency-based medical education.

Inclusion criteria

• Emergency medicine residents rotating in the emergency department during the study period.
• Residents who are required to perform tracheal intubation as part of clinical training.
• Residents who have completed baseline theoretical and simulation-based airway management training.
• Voluntary participation with written informed consent.

Exclusion criteria

• • Residents who refuse to participate or withdraw consent.

• Residents with prior advanced airway fellowship training or extensive intubation experience (>50 independent intubations).
• Residents who are unable to complete the full PDCA-based training program due to absence or rotation schedule.
• Any medical condition or circumstance deemed by investigators to interfere with participation or data integrity.