An interactive, self-study learning system for airway management instruction that utilizes a "sensorized" manikin head (Actronics Inc., Pittsburgh, PA) was compared to didactic instruction from anesthesiologists during third-year medical student anesthesia rotations. Before students were allowed to participate in airway management on anesthetized patients, they were randomly separated into two groups. One group received instruction from the learning system, and the other group was given a lecture with guided practice on a standard tracheal intubating manikin. Differences between groups were then assessed using 22 separate variables as all students performed actual airway management on patients undergoing general anesthesia. Anesthesia faculty, residents, and nurse anesthetists, blinded to group, served as assessors. There were 48 and 49 students in the didactic instruction and learning system groups, respectively. Beginning experience level of students with respect to airway management was similar between groups before the anesthesia rotations. There were 185 and 188 evaluation forms completed to assess the didactic instruction and learning system groups, respectively. Demographic data regarding patients were recorded. Patients in the learning system group on whom students performed airway management were older, had a larger average body mass index, and their airways more frequently received higher Mallampati classifications (glottic structures more difficult to visualize). No difference in the quality of airway management efforts or in students' appraisal of their own performances was seen between groups. Neither group demonstrated more rapid development of psychomotor skills. Students were equally satisfied with both methods of instruction.(ABSTRACT TRUNCATED AT 250 WORDS)