DOI: 10.1002/oto2.93 ISSN: 2473-974X

Teaching Tracheostomy Tube Changes: Comparison of Operant Learning Versus Traditional Demonstration

Elliot Schiff, Anthony Ma, Tracy Cheung, Marc‐Mina Tawfik, Ryan S. Ference, Michael S. Weinstock, I. Martin Levy, Christina J. Yang
  • Otorhinolaryngology
  • Surgery



Tracheostomy tube change is a multistep skill that must be performed rapidly and precisely. Despite the critical importance of this skill, there is wide variation in teaching protocols.


An innovative operant conditioning teaching methodology was employed and compared to traditional educational techniques. Medical student volunteers at a tertiary care academic institution (Albert Einstein College of Medicine) were recruited and randomly distributed into 2 groups: operant vs traditional (control). Following the educational session, each group was provided with practice time and then asked to perform 10 tracheostomy tube changes. Performance was recorded and scored by blinded raters using deidentified video recordings.


The operant learning group (OLG) demonstrated greater accuracy in performing a tracheostomy tube change than the traditional demonstration group. Twelve of 13 operant learners performed the skill accurately each time compared to 3 of 13 in the traditional group (P = 0.002). The median lesson time was longer for the OLG (535 seconds) than for the traditional group, (200 seconds P < 0.001). The average time per tracheostomy change was not significantly different between the 2 groups (operant learners mean 7.1 seconds, traditional learners mean 7.5 seconds, P = 0.427).


Although the operant conditioning methodology necessarily requires a greater time to teach, the results support this methodology over traditional learning modalities as it enhances accuracy in the acquired skill. Operant learning methodology is under consideration for other skills and education sessions in our program. Future steps include the application and adaptation of this education model to students and residents in other settings and fields.

Implications for Practice

Operant learning is effective for teaching multistep skills such as tracheostomy tube changes with decreased error rates.

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