• Robert Greif, Lars Egger, Reto M Basciani, Andrew Lockey, and Andreas Vogt.
• Department of Anaesthesiology and Pain Therapy, University Hospital Bern and University of Bern, Switzerland.
• Resuscitation. 2010 Dec 1;81(12):1692-7.

IntroductionThe "4-stage approach" has been widely accepted for practical skill training replacing the traditional 2 stages ("see one, do one"). However, the superior effectiveness of the 4-stage approach was never proved.ObjectivesTo evaluate whether skill training with the 4-stage approach results in shorter performance time needed for a successful percutaneous needle-puncture cricothyroidotomy, and consequently in a reduced number of attempts needed to perform the skill in <60s compared to traditional teaching.Trial DesignRandomized controlled single-blinded parallel group study at the University Hospital Bern.MethodsWith IRB approval and informed consent 128 undergraduate medical students were randomized in four groups: traditional teaching, no stage 2, no stage 3, and 4-stage approach for the training of cricothyroidotomy. Everyone watched a video of the cricothyroidotomy as stage 1 followed by skill training in the respective teaching group. Participants had to perform the cricothyroidotomy 10 times on skin-covered pig larynxes. Performance time was measured from skin palpation to trachea ventilation. Study participants filled out a self-rating on competency during the training.ResultsPerformance time for each attempt was comparable in all groups and improved similarly to reach a performance time of <60 s. Self-rating revealed that all groups felt equally competent throughout.ConclusionsEven if the 4-stage approach is widely accepted and used as a didactic method for skill teaching we could not find evidence that its use or omitting stage 2 or 3 results in superior learning of an emergency skill compared to traditional teaching.Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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