BACKGROUND: Several simulation-based possibilities for training flexible optical intubation have been developed, ranging from non-anatomical phantoms to high-fidelity virtual reality simulators. These teaching devices might also be used to assess the competence of trainees before allowing them to practice on patients.

OBJECTIVES: To evaluate the validity of airway simulation as an assessment tool for the acquisition of the preclinical basic skills in flexible optical intubation and to investigate anaesthetists' opinion on airway simulation.

DESIGN: Observational study.

SETTING: International airway course.

PARTICIPANTS: Thirty-six consultants and residents in anaesthesiology.

MAIN OUTCOME MEASURES: All participants performed one single procedure on each of the three different simulators. Their video-filmed performances were assessed by two independent, blinded experts and their opinions of simulation were surveyed.

RESULTS: The mean score increased 0.33 points after each attempt (P = 0.021). The attitude towards simulation-based training was always more than 4 on a scale from 1 to 5. Only 25% of the procedures were performed to satisfaction with a learning-by-testing effect (P = 0.021). Generalisability coefficient was 0.55, and there was no correlation between the number of clinical procedures performed beforehand and test scores (P = 0.93).

CONCLUSION: The increase in mean score is a learning effect indicating that simulator training allows for entry of the learning curve at a higher level. The anaesthetists in our study agreed completely that simulation-based training was useful regardless of the fidelity of the simulator. Local, practical issues such as cost and portability should decide available simulation modalities in each teaching hospital.