Mental Rehearsal in Emergency Cricothyroidotomy Training

Mental rehearsal (MR) is a training method widely used to improve manual skills, psychomotor coordination, and performance under stressful conditions. It has been successfully applied in fields such as sports, music, military training, rehabilitation, and surgery. MR involves mentally visualizing and rehearsing the sequence of movements required to perform a specific task, which may contribute to the development of procedural automatization and "muscle memory." Neurophysiological studies suggest that imagined movements activate neural pathways similar to those engaged during actual motor performance.

Emergency cricothyroidotomy (eFONA - Emergency Front of Neck Access) is a rare but life-saving procedure performed when airway management cannot be achieved using less invasive methods such as endotracheal intubation. The procedure requires rapid identification of anatomical landmarks, technical precision, and efficient execution under significant time pressure and stress. Because opportunities for real-life performance are limited, regular and effective training of medical personnel is essential.

Aim: Evaluation whether the integration of structured mental rehearsal (MR) into routine emergency cricothyroidotomy training can improve procedural preparedness, technical performance, and confidence among medical personnel, as well as to assess the usefulness of MR as a supplementary training tool for emergency airway management.

Methodological information: This prospective, randomized educational study will include up to 60 medical personnel from the UCK WUM anaesthesiology and intensive care. Participants will be randomized 1:1 to either structured mental rehearsal plus standard emergency cricothyroidotomy training or standard training alone.

Randomization will be computer-generated and stratified by professional subgroup to ensure balanced allocation of specialist physicians, resident physicians, and nurses. The planned sample includes 30 participants per group: 20 specialists, 20 residents, and 20 nurses in total.

Sample size was estimated a priori using G*Power. Assuming an effect size of 0.80, alpha of 0.05, and power of 0.80, at least 26 participants per group are required; therefore, 30 per group will be recruited to account for potential incomplete data.

Inclusion criteria

• Medical personnel, including anesthesiology and intensive care specialists, residents, and nursing staff employed within Anesthesiology and Intensive Care Departments of the Medical University of Warsaw network.
• No prior experience with the use of Mental Rehearsal techniques in performing emergency cricothyroidotomy.
• Informed consent.

Exclusion criteria

• Medical personnel involved in the training process of study participants in emergency cricothyroidotomy, including instructors, assisting staff, and examiners.
• Previous experience with the use of Mental Rehearsal techniques for acquiring competencies in performing emergency cricothyroidotomy.
• Lack of informed consent.