# Perceived Decline in Straight Blade Direct Laryngoscopy Skills in the Era of Video Laryngoscopy: An Exploratory Pilot Survey Study

## TL;DR

This study explores how the increasing use of video laryngoscopy may be reducing opportunities to practice direct laryngoscopy skills among anesthesiologists.

## Contribution

It is the first exploratory pilot study to assess perceived skill decline in direct laryngoscopy due to video laryngoscopy reliance.

## Key findings

- Residents reported low confidence and infrequent use of the Miller blade for direct laryngoscopy.
- Confidence in direct laryngoscopy strongly correlated with frequency of use.
- Attendings acknowledged the importance of direct laryngoscopy but noted limited teaching and a risk of it becoming a 'lost art.'

## Abstract

Background

Video laryngoscopy is increasingly used for airway management and is often chosen for both routine and complex intubations. While video laryngoscopy offers clear advantages, direct laryngoscopy remains an important fallback technique when visualization is impaired or equipment fails. As video laryngoscopy becomes more common, questions have been raised about whether reliance on this technology may reduce opportunities for trainees to practice and maintain direct laryngoscopy skills.

Methods

We conducted a cross-sectional survey of anesthesiology residents and attending anesthesiologists at a single academic institution. The survey assessed self-reported confidence using the Miller blade, frequency of use, perceived importance of maintaining this skill, and beliefs about the effectiveness of current teaching practices. Responses were recorded using a 1-5 Likert scale. Descriptive statistics and Spearman correlation coefficients were calculated.

Results

Twenty-three clinicians completed the survey (12 residents, 11 attendings). Residents reported low confidence (mean 2.5) and infrequent use (mean 2.2) of the Miller blade but rated its importance as relatively high (mean 3.75). Confidence correlated strongly with frequency of use (ρ=0.77, p=0.0031). Attendings reported limited teaching (mean 1.8), acknowledged the importance of maintaining direct laryngoscopy (DL) (mean 3.8), and expressed moderate agreement that these skills are at risk of becoming a "lost art" (mean 3.36).

Conclusions

This exploratory pilot study suggests that anesthesiology residents and attendings perceive direct laryngoscopy skills as important yet underemphasized in training. Given its small, single-center design, these findings are not generalizable but highlight the need for multi-center studies to further evaluate how reliance on video laryngoscopy may influence preservation of foundational airway techniques.