I've had the opportunity this past summer to teach some residents and medical students this procedure and have discovered that I have some pretty strong opinions about it.

Aside from insisting on a detailed airway exam and excellent mask ventilation technique before any laryngoscopy, I absolutely insist on the foam intubating head block support regardless of the student's prior experience/ success with just a plain pillow.

I'm surprised to find myself in a minority among my peers who tell me that these inexperienced intubators just need to find the way that feels comfortable for them.

I counter by saying that they have no idea what proper positioning looks like, nor how to properly adjust position given certain specific findings on airway exam. A reproducible, standard starting point for every patient(foam head positioner) is a better tool than a variable thickness, inconsistent pillow that just happens to come with the patient.

That so unreasonable?