Abstract
AIM: To evaluate the effectiveness of AvTrach(®) wearable artificial airway simulators (AWAS) compared to high-fidelity manikins (HFM) in enhancing tracheostomy suctioning competency, managing physiological stress, and improving engagement through dimensions of physical, conceptual, and psychological fidelity. DESIGN: A multi-institutional, randomized controlled trial (RCT) was conducted to compare AWAS with HFM training modalities for tracheostomy suctioning among healthcare professionals and students. METHODS: Participants (n = 69) from two institutions were randomized into experimental (AWAS) and control (HFM) groups. Competency was assessed using an Objective Structured Clinical Examination tool, and stress responses were measured through salivary cortisol levels. The study encompassed four sessions: recruitment, baseline competency levels and training, simulation, and clinical demonstrations. Quantitative data were analyzed using descriptive statistics, Wilcoxon rank-sum tests, and mixed-effects regression models. RESULTS: Both groups demonstrated improved competency post-training (p < 0.001). However, the AWAS group achieved higher clinical competency scores (p < 0.001) and exhibited stable cortisol levels during clinical demonstrations, indicating better stress adaptation. Participants in the AWAS group also reported higher engagement, attributed to dynamic feedback and enhanced emotional immersion. CONCLUSION: AWAS training, integrating physical, conceptual, and psychological fidelity, significantly enhances tracheostomy care competency and stress management compared to HFM. This approach supports technical skill development, emotional preparedness, and interprofessional collaboration, essential for high-stakes clinical environments.