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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Prospectively registered

Titles & IDs
Public title
Can we identify junior doctors with low visuospatial and psychomotor ability and provide extra skills training to allow them to perform fibreoptic bronchoscopy
Scientific title
Targeting educational intervention in fibreoptic bronchoscopy skills training based on visuospatial and psychomotor testing of junior doctors
Secondary ID [1] 289566 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Junior doctors with low visuospatial and low psychomotor ability 299296 0
Condition category
Condition code
Public Health 299291 299291 0 0
Health service research

Study type
Description of intervention(s) / exposure
In this non-drug trial, we will perform psychometric testing on junior doctors recruited into the study. The testing is paper based and is a battery of norm based, standardised neuro-cognitive tests of innate visuospatial and psychomotor ability and administered by a trained neuropsychologist. Tests include the Mental Rotations A, Block Design, Matrix Reasoning, Zig-Zag, and Trail Making Tests A and B. All tests will take 45-60minutes.
Participants will then be stratified into low ability cohorts (defined as > 1 standard deviation below population mean). The low ability cohort will receive mental imagery training, which is a textually and graphically rich written script with step by step descriptions of the fibreoptic bronchoscopy procedure. Participants will be asked to read through and mentally rehearse each of the steps for 1 week. Training is via a paper booklet sent to participants. Each participant will be asked to perform mental imagery training daily for the 1 week, and should take approximately 15 minutes per rehearsal. Compliance will be audited by researchers at the end of the training week. This week of training will occur 3 weeks after psychometric baseline assessment; ie. 1 week prior to bronchoscopy testing.
All participants will then be asked to perform a fibreoptic bronchoscopy procedure on an anatomically correct bench top manikin. This performance will be timed and a video recorded of the performance for scoring by blinded experts using a validated global rating scale
Intervention code [1] 295162 0
Treatment: Other
Intervention code [2] 295163 0
Comparator / control treatment
The control group are junior doctors performing the same fibreoptic bronchoscopy task, but stratified as high ability on psychometric testing. The control group will not receive the additional mental imagery training
Control group

Primary outcome [1] 298783 0
Time taken to complete the fibreoptic bronchoscopy task, recorded on stopwatch by a research assistant from picking up the bronchoscope to reaching the endpoint (successful intubation of the right and left main bronchus)
Timepoint [1] 298783 0
immediately after psychometric testing (baseline), and at 1 month post baseline
Secondary outcome [1] 325188 0
proficiency score of bronchoscopy performance, based on global rating scale
Timepoint [1] 325188 0
at baseline, and at 1 month post baseline

Key inclusion criteria
All junior doctors rotating into critical care terms at Liverpool Hospital, including rotations into anaesthesia, intensive care, and emergency medicine.
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Has had previous training, workshops or actual performance of video fibreoptic bronchoscopy. Has had psychometric testing or neurocognitive testing in the past 12 months.

Study design
Purpose of the study
Educational / counselling / training
Allocation to intervention
Non-randomised trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s

The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Other design features
Not Applicable
Type of endpoint(s)
Statistical methods / analysis
Based on individual scores in the psychometric tests, participants will be stratified by population norms into ‘low’ and ‘high’ ability cohorts. Sample size is based on population norms of psychometric tests used, which are normally distributed. We expect 12-15 participants in each low and high ability cohorts. No formal power calculation has been performed.
The time taken to successfully complete the task, and Global rating scale numerical scores, will be analysed against cohort by t tests or the Mann-Whitney U tests. Dichotomous satisfactory and unsatisfactory performance item in the global rating scale will be analysed against cohort by Fisher's exact test. Rate of improvement from baseline to 1-month performance for each cohort will be analysed by repeated measures ANOVA. Correlation between psychometric scores, time taken to complete the task, and GRS scores, will be analysed by Pearson or Spearman rank correlation. A two tailed, P value < 0.05 will be deemed significant.

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 6035 0
Liverpool Hospital - Liverpool
Recruitment postcode(s) [1] 13484 0
2170 - Liverpool

Funding & Sponsors
Funding source category [1] 293942 0
Name [1] 293942 0
Liverpool Hospital Department of Anaesthesia
Address [1] 293942 0
Level 1, New Clinical Building,
Liverpool Hospital
Elizabeth Street
NSW 2170
Country [1] 293942 0
Primary sponsor type
Liverpool Hospital
Elizabeth Street
NSW 2170
Secondary sponsor category [1] 292765 0
Name [1] 292765 0
Address [1] 292765 0
Country [1] 292765 0

Ethics approval
Ethics application status
Ethics committee name [1] 295355 0
South West Sydney HREC
Ethics committee address [1] 295355 0
‘Research and Ethics Office’
Locked Bag 7103
Ethics committee country [1] 295355 0
Date submitted for ethics approval [1] 295355 0
Approval date [1] 295355 0
Ethics approval number [1] 295355 0

Brief summary
Flexible video fibreoptic bronchoscopy (FOB) is an important component of the airway skills required by doctors in the area of critical care, including anaesthetists, intensive care physicians, and in emergency medicine. Speed and accuracy of performance, as well as causing no trauma to the patient's airway, is essential to secure the airway for adequate oxygenation and ventilation. However, FOB skills are often learnt in an unstructured format by trainees, and clinical exposure is limited by their relative rarity, causing skills decay after initial training.
In this study, we are examining if training in FOB skills can be improved based on the innate visuospatial and psychomotor abilities of doctors. Other procedural tasks in medicine, similar in complexity to FOB, have previously been shown to be associated with these cognitive abilities as they influence hand-eye dexterity and motor skills.
An educational intervention will be provided to those novices identified with lower visuospatial and psychomotor abilities, to determine if these novices can be brought up to the same level of FOB performance as their higher ability colleagues. This training is based on mental rehearsal of the procedure, which has been used by professional athletes, musicians, and by surgeons where they "practice" the performance in their heads before they actually perform it in real life.
This study will recruit doctors rotating into critical care areas where FOB skill is necessary (anaesthesia, intensive care, emergency medicine). Visuospatial and psychomotor ability will be assessed by a standardised test battery. For doctors stratified into the low ability cohort of visuospatial and psychomotor ability, mental imagery training will be provided. FOB performance is measured using an anatomically correct, benchtop manikin of the human airway. Primary endpoint of performance is time taken to successfully perform a FOB task, and secondary endpoint is proficiency as evaluated by blinded assessors using a validated global rating scale.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 67006 0
Dr Alwin Chuan
Address 67006 0
Department of Anaesthesia
Room 124, Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
NSW 2170
Country 67006 0
Phone 67006 0
+61 407743668
Fax 67006 0
Email 67006 0
Contact person for public queries
Name 67007 0
Dr Alwin Chuan
Address 67007 0
Department of Anaesthesia
Room 124, Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
NSW 2170
Country 67007 0
Phone 67007 0
+61 2 9828 3173
Fax 67007 0
Email 67007 0
Contact person for scientific queries
Name 67008 0
Dr Alwin Chuan
Address 67008 0
Department of Anaesthesia
Room 124, Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
NSW 2170
Country 67008 0
Phone 67008 0
+61 407743668
Fax 67008 0
Email 67008 0

No information has been provided regarding IPD availability
Summary results
Have study results been published in a peer-reviewed journal?
Other publications
Have study results been made publicly available in another format?
Results – basic reporting
Results – plain English summary