Study Objective: This study was conducted to determine the natural history of airway management skill decay and examine the effect of independent practice and periodic feedback on airway management skill maintenance. Methods: This prospective, randomized controlled study conducted at Dalhousie University in Halifax, Nova Scotia, Canada, between November 1997 and September 1998. A convenience sample of 84 health sciences students with no prior airway management experience was used. Participants were trained using an advanced airway manikin and then were randomly assigned to control (n=24), periodic feedback only (n=30), and independent practice plus periodic feedback (n=30) groups. Performance was measured by a 52-point weighted checklist at 0, 16, 25, and 40 weeks after the initial program. Results: Group scores were analyzed using a mixed-model repeated-measures analysis of variance and Bonferroni-adjusted P values. Overall group (P=.0002) and time (P=.0001) effects were significant. At time 0, there was no statistical difference in mean scores between groups (range 45.0 to 45.2). Control group performance fell over the first time interval (0 to 16 weeks) (mean score=34.0, P=.002) and remained lower at all intervals without further significant change. Scores in the independent practice plus feedback group revealed no significant changes over time and were significantly higher than the control group throughout. Performance in the periodic feedback only group showed a nonsignificant trend to improved performance over the control group. Conclusion: Airway management skill performance declines early after initial training. Independent practice combined with periodic feedback was effective in maintaining performance scores in an advanced airway management simulation. Periodic evaluation with feedback alone showed a nonsignificant trend toward improvement over control. [Kovacs G, Bullock G, Ackroyd-Stolarz S, Cain E, Petrie D. A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance. Ann Emerg Med. October 2000;36:301-309.]