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Risk orientation predicts hypoxic time during difficult airway simulation: a mixed-methods pilot study
  1. Jake Hayward1,
  2. Niresha Velmurugiah1,
  3. Jonathan Duff2
  1. 1 Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Jake Hayward, Emergency Medicine, University of Alberta, Edmonton, Alberta T6G 2B7, Canada; jhayward{at}


Personality factors may explain some of the practice variation observed in medicine. In this pilot study, we used simulation to investigate the relationship between risk orientation and airway management. We hypothesised that higher risk tolerance would predict earlier intervention.

Ten emergency medicine residents from the University of Alberta participated in a standardised difficult airway simulation. There was a constant rate of oxygen desaturation necessitating eventual airway intervention. A debriefing interview and a risk orientation questionnaire followed. Time of hypoxia prior to intervention was the outcome measure. Audio interview transcripts underwent thematic analysis.

Nine participants were included; one did not complete the simulation as instructed. Higher risk tolerance predicted longer hypoxic time prior to intubation (r=0.72, p=0.03). Theme analysis revealed consistent fears regarding patient instability and chances of a failed airway intervention. Patient instability was emphasised more so by those who intervened earlier.

We show that personality characteristics influence resuscitation decision-making at an early stage of training. Trainees may therefore be susceptible to certain types of medical error based on their risk aversion. Implications for resident training, care quality and patient safety are discussed.

  • simulation
  • risk aversion
  • risk tolerance
  • difficult airway
  • personality

Statistics from


  • Contributors JH and NV conceived the idea. JH conducted statistical analysis and wrote the first draft of manuscript. NV created the frequency table for the theme analysis. JD provided project oversight and guidance for experimental design and data analysis. All authors edited and revised manuscript, and approved of the final manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Research ethics board approval was obtained from the University of Alberta.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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