Distance Hands-On Training Versus Video Instruction for Flexible Laryngeal Mask Airway Management: A Protocol for a Multicenter Randomized Controlled Trial.

BACKGROUND

Flexible laryngeal mask airway (fLMA) management is an important but technically demanding airway skill, particularly for novice physicians. Distance hands-on training may provide a scalable alternative when access to face-to-face simulation is limited, but evidence demonstrating transfer of such training to clinical performance in patients remains scarce. This trial aims to compare distance hands-on training with standardized video instruction for novice physicians learning fLMA management.

METHODS

This is a prospective, multicenter, parallel-group, rater-blinded, superiority randomized controlled trial conducted at three tertiary hospitals in China. Thirty novice physician participants will be randomized 1:1 to either distance hands-on training or video instruction. Both groups will receive identical standardized theoretical materials, a procedural demonstration video, and a written checklist. The distance hands-on training group will additionally receive remotely supervised deliberate practice using an airway task trainer with real-time instructor feedback. After training, each physician participant will perform fLMA management in two adult patient participants under direct supervision by experienced anesthesiologists. Clinical performance will be video-recorded and independently assessed by two blinded raters using the Flexible LMA Airway Management Global Rating Scale, for which validity evidence was established in a preceding study. Secondary outcomes include procedural success, insertion time, ventilation parameters, fLMA positioning, procedure-related complications, learning progression, and physician participant satisfaction.

DISCUSSION: This trial will evaluate whether structured distance hands-on training improves clinical procedural performance beyond standardized video instruction. By combining randomized educational intervention, multicenter clinical assessment, blinded video-based rating, and patient-based outcome evaluation, the study aims to provide evidence on the transfer of distance simulation training to clinical airway management.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR): ChiCTR2600121867.