Mental Rehearsal in Emergency Cricothyroidotomy Training (MERIT)

Effect of Mental Rehearsal Training on the Effectiveness of Emergency Cricothyroidotomy Training Among Medical Personnel.

Medical staff at the clinic will participate in standard cricothyroidotomy training supplemented with structured mental rehearsal exercises in order to evaluate the usefulness and effectiveness of this approach as a training tool.

Study Overview

• Status: Not yet recruiting
• Conditions: Airway Management; Difficult Airway; Cricothyroidotomy; Medical Training
• Intervention / Treatment: Other: Mental Training

Detailed Description

Mental rehearsal (MR) is a training method widely used to improve manual skills, psychomotor coordination, and performance under stressful conditions. It has been successfully applied in fields such as sports, music, military training, rehabilitation, and surgery. MR involves mentally visualizing and rehearsing the sequence of movements required to perform a specific task, which may contribute to the development of procedural automatization and "muscle memory." Neurophysiological studies suggest that imagined movements activate neural pathways similar to those engaged during actual motor performance.

Emergency cricothyroidotomy (eFONA - Emergency Front of Neck Access) is a rare but life-saving procedure performed when airway management cannot be achieved using less invasive methods such as endotracheal intubation. The procedure requires rapid identification of anatomical landmarks, technical precision, and efficient execution under significant time pressure and stress. Because opportunities for real-life performance are limited, regular and effective training of medical personnel is essential.

Aim: Evaluation whether the integration of structured mental rehearsal (MR) into routine emergency cricothyroidotomy training can improve procedural preparedness, technical performance, and confidence among medical personnel, as well as to assess the usefulness of MR as a supplementary training tool for emergency airway management.

Methodological information: This prospective, randomized educational study will include up to 60 medical personnel from the UCK WUM anaesthesiology and intensive care. Participants will be randomized 1:1 to either structured mental rehearsal plus standard emergency cricothyroidotomy training or standard training alone.

Randomization will be computer-generated and stratified by professional subgroup to ensure balanced allocation of specialist physicians, resident physicians, and nurses. The planned sample includes 30 participants per group: 20 specialists, 20 residents, and 20 nurses in total.

Sample size was estimated a priori using G*Power. Assuming an effect size of 0.80, alpha of 0.05, and power of 0.80, at least 26 participants per group are required; therefore, 30 per group will be recruited to account for potential incomplete data.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Agata Stężewska, MD; Phone Number: +48 882068582; Email: agata.stezewska@uckwum.pl

Study Locations

• Poland
  • Warsaw, Poland, 02-091
    • Medical University of Warsaw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Medical personnel, including anesthesiology and intensive care specialists, residents, and nursing staff employed within Anesthesiology and Intensive Care Departments of the Medical University of Warsaw network.
• No prior experience with the use of Mental Rehearsal techniques in performing emergency cricothyroidotomy.
• Informed consent.

Exclusion Criteria:

• Medical personnel involved in the training process of study participants in emergency cricothyroidotomy, including instructors, assisting staff, and examiners.
• Previous experience with the use of Mental Rehearsal techniques for acquiring competencies in performing emergency cricothyroidotomy.
• Lack of informed consent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Routine Training + Mental Rehearsal; Participants will undergo standard emergency cricothyrotomy training supplemented with structured mental rehearsal exercises integrated into the routine educational program	Other: Mental Training; Structured mental rehearsal exercises integrated into the routine educational program.
No Intervention: Routine Training; Participants will undergo standard emergency cricothyrotomy training without additional mental rehearsal exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective Structured Clinical Examination (OSCE)	Participants' procedural performance will be assessed using a standardized Objective Structured Clinical Examination (OSCE). The total score will be expressed as the percentage of correctly performed procedural steps. Scores range from 0% to 100%, with higher scores indicating better procedural performance.	6 months after enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Procedure completion time	Time required to complete the cricothyrotomy procedure during the practical examination. Time will be recorded in seconds from initiation to completion of the procedure.	6 months after entrollment
Self-assessed procedural competencies and perceived stress during cricothyroidotomy (individual questionnaire items).	Participants will complete an author-developed questionnaire following completion of the training program. The questionnaire consists of individual items assessing perceived procedural competence and stress related to performing cricothyrotomy. Selected items are rated on a 10-point Likert-type scale (1-10). For competence-related items, higher scores indicate better perceived competence (10 = highest competence). For stress-related items, higher scores indicate greater perceived stress (10 = highest stress level). Each item will be analyzed and reported individually. No composite score will be calculated.	6 months after enrollment

Collaborators and Investigators

• Sponsor: Medical University of Warsaw
• Investigators: Principal Investigator: Agata Stężewska, MD, Medical University of Warsaw

Study record dates

Study Major Dates

• Study Start (Estimated): June 8, 2026
• Primary Completion (Estimated): May 1, 2028
• Study Completion (Estimated): May 1, 2028

Study Registration Dates

• First Submitted: May 19, 2026
• First Submitted That Met QC Criteria: June 1, 2026
• First Posted (Actual): June 4, 2026

Study Record Updates

• Last Update Posted (Actual): June 4, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Critical care; Airway Management; Cricothyroidotomy; Mental Training; Mental Rehearsal; eFONA (Emergency Front of Neck Airway)
• Other Study ID Numbers: KB/68/2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No