Background
An adaptive E-learning program in advanced airway management (AAM) was developed. The content consisted of 180 learning objectives (LOs) that were all covered by a learning resource (LR) and at least one probe (various question types).

If answering a probe incorrectly, a LR was offered, and a probe in the same LO was presented later. All LOs had to be answered correctly. The confidence in the answer was indicated for each probe using four categories of metacognition: "I know it", "I think so", "Unsure", "No idea". The answers were used by the adaptive part of the program to estimate individual learning needs for the following probes to address.

The goal of the study was to explore if adaptive E-learning in AAM could facilitate learning and reflection on personal educational needs.

Methods
Twenty-nine 2nd year residents completed the E-learning and a questionnaire exploring usability and satisfaction with the E-learning on a Likert scale from 1-7 (7=highest).
	
Results and Discussion
All 29 residents completed the E-learning and the questionnaire. The average experience in anaesthesiology was 2,5 years, and the average completion time for the E-learning was 4h18min (1h59min - 7h38min).

The E-learning results are summarised in Table 1. The metacognitive categories are simplified into two groups: "I know it" + "I think so" vs "Unsure" + "No idea". Results are termed "Aware" or "Unaware", respectively, depending on the correctness of the LO answer.

LOs were mostly answered Correct+Aware, reflecting the residents being mainly consciously competent. However, 12-16% of the LOs were answered Incorrect+Unaware, suggesting unconscious incompetence and therefore areas of important educational needs.

The E-learning was found very useful (5,3 of 7) and 97% would like to continue using the E-learning.

Conclusion
Adaptive E-learning in AAM was found very useful. The residents were consciously competent in AAM (75-76%), while the results from 12-16% of the LOs suggested that the residents were unconsciously incompetent. From a patient safety point of view, the latter LOs are areas of concern, and individualised training should focus on these.

05 / Development and Initial Results from Anaesthesiology Residents using Adaptive E-learning in Advanced Airway Management.