Well, add a few paragraph breaks and this is a really great post.
😀 Sorry, edited as reasonably requested😳
Outside of the crashing newborn intubations are rarely so emergent that it must be done by the best and the fastest. Remember, bagging is a more important, and, generally, more difficult- to-master skill than intubation and one that will buy the time to do the intubation properly (even with the crashing newborn on the DR back-table).
My observation of those who weren't good at intubation was that confidence (or lack thereof) played a significant role in their success (obviously hand-eye coordination and a reasonably steady hand played into it as well) or failure. Residency is a funny time for many reasons. One of those reasons is that you need to walk a balance between confidence in your abilities (yes, even as a know-nothing intern) and arrogance and this is especially true in the intensive care units where you are most likely to get to practice intubations. My observational experience was that NICU/PICU RTs and nurses, especially, will eat you alive if you are overly hesitant or milquetoast. But if you are respectfully assertive with a plan (by all means, double check with your senior resident/attending for any questions) and get the ancillary staff to give their input you'll see things go your way a lot including with procedures such as intubations.
You're also going to have to develop the willingness to speak up and say "Hey, I'd like this this one [intubation]" to get your practice regardless if your "the best one to do it". Like I said, most intubations-being nonemergent- afford ample opportunity for the ones who need the most practice to do them.
Another thing that might help is to see if you can get some time with anesthesia on some days just to do intubations. See what days the ENTs are doing T&As because they are real turn'n'burn cases with intubated kids. That controlled environment may help a lot with your confidence. I was really good at tubes from ~1/4 through my intern year. One of the things that helped me, believe it or not, was a week doing intubations with anesthesia on my third year surgery rotation (and this was all adults). A year and a half later it still helped me have a feel for passing the tube through the cords. Just some thoughts.
I'd only add that changes in the way both patients are cared for and in residency training have led to a decrease in the opportunities for new residents to do procedures, including intubations. We don't intubate almost any meconiums in the delivery room and we have more folks in the units who intubate than in the past. Residents uncommonly do transports, etc.
This seems to be the conundrum of training at a program with a fellowship or not. I look at the procedures and patient-care leadership that the fellows do/partake in vs. the residents where I am now and am impressed with how much of what the fellows do is what I did in residency. Plenty of intubations and umbilical lines and, in the middle of the night, I was the first line decision maker with NNPs there to help and the Neo available by phone. The residents seem to do much less here than I did. However, they get to see all the quarternary care that I didn't see in residency (ex. ECMO)
An intern who is comfortable intubating is almost always someone who did an anesthesia elective somewhere along the way.
The decision to do critical care medicine of any stripe is based on your interest in caring for patients with complex multi-organ problems. It has extremely little to do with procedural skills and nothing to do with procedural skills you have as an intern.
I totally agree. If it wasn't clear in my post, I don't think that intubation is an end-all, be-all procedure to learn. The side notes were mostly to emphasize that confidence is important for learning and getting good at procedures and is self-perpetuating and is desirable to do well in residency and fellowship (esp. in the critical care fields).
