A Survey of Fellowship Education in Mechanical Ventilation

Brescia, Donald; Pancoast, Thomson C.; Kavuru, Mani S.; Mazer, Mark A.

doi:10.1378/chest.134.4_meetingabstracts.s62004

Cited by 5 publications

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“…Despite this, there is no universally accepted curriculum related to MV training, so the educational approach varies widely across programs ( 5 ). In fact, only 50% of surveyed fellows were satisfied with their MV education ( 6 ). Fellow satisfaction with MV education correlated with the presence of formal educational activities (introductory course, hands-on sessions, and longitudinal programs) as well as their own confidence in understanding respiratory physiology, ventilator waveform analysis, and management of patient–ventilator asynchronies ( 6 ).…”

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confidence: 99%

Impact of Novel Multiinstitutional Curriculum on Critical Care Fellow Ventilator Knowledge

et al. 2021

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Background: Management of mechanical ventilation (MV) is a curricular milestone for trainees in pulmonary critical care medicine (PCCM) and critical care medicine (CCM) fellowships. Though recognition of ventilator waveform abnormalities that could result in patient complications is an important part of management, it is unclear how well fellows recognize these abnormalities. Objective: To study proficiency of ventilator waveform analysis among first-year fellows enrolled in a MV course compared with that of traditionally trained fellows. Methods: The study took place from July 2016 to January 2019, with 93 fellows from 10 fellowship programs completing the waveform examination. Seventy-three fellows participated in a course during their first year of fellowship, with part I occurring at the beginning of fellowship in July and part II occurring after 6 months of clinical work. These fellows were given a five-question ventilator waveform examination at multiple time points throughout the two-part course. Twenty fellows from three other fellowship programs who were in their first, second, or third year of fellowship and who did not participate in this course served as the control group. These fellows took the waveform examination a single time, at a median of 23 months into their training. Results: Before the course, scores were low but improved after 3 days of education at the beginning of the fellowship (18.0 ± 1.6 vs. 45.6 ± 3.0; P < 0.0001). Scores decreased after 6 months of clinical rotations but increased to their highest levels after part II of the course (33.7 ± 3.1 for part II pretest vs. 77.4 ± 2.4 for part II posttest; P < 0.0001). After completing part I at the beginning of fellowship, fellows participating in the course outperformed control fellows, who received a median of 23 months of traditional fellowship training at the time of testing (45.6 ± 3.0 vs. 25.3 ± 2.7; P < 0.0001). There was no difference in scores between PCCM and CCM fellows. In anonymous surveys, the fellows also rated the mechanical ventilator lectures highly. Conclusion: PCCM and CCM fellows do not recognize common waveform abnormalities at the beginning of fellowship but can be trained to do so. Traditional fellowship training may be insufficient to master ventilator waveform analysis, and a more intentional, structured course for MV may help fellowship programs meet the curricular milestones for MV.

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confidence: 99%

Impact of Novel Multiinstitutional Curriculum on Critical Care Fellow Ventilator Knowledge

et al. 2021

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“…Our narrative review of the literature demonstrated substantial heterogeneity within MV education. Learners in GME are generally dissatisfied with their training in MV [22][23][24][25] and perform suboptimally on objective testing of MV management knowledge. 22,24 There are indications that the lack of educational rigor translates to the clinical environment, with practicing physicians demonstrating variable adoption of best practices and evidence-based interventions and inadequately recognizing important complications of MV, including ventilator-induced lung injury, delayed MV liberation, and patient-ventilator dyssynchrony.…”

Section: Discussionmentioning

confidence: 99%

“…Four articles reported survey responses regarding experience with MV education from physician trainees and program directors. [22][23][24][25] Surveys asked about satisfaction or comfort level with the current training environment. Two studies reported good response rates of 70% or higher, 22,25 1 had a poor response rate of 23%, 23 and 1 did not provide response rate information.…”

Section: Surveys Regarding Adequacy Of MV Trainingmentioning

confidence: 99%

“…Findings for pulmonary and critical care medicine and critical care medicine fellows were similar: 50% reported satisfaction with their education in MV in the 2008 study evaluating fellow satisfaction, though the response rate was very low. 23 In a 2017 study of internal medicine residents in Brazil, nearly 30% of third-year residents said they would fear for patient safety if their patients required MV, and only 52% thought they would be able to safely manage a ventilated patient with significant airflow obstruction. 24 In a 2015 study, only 53% of emergency medicine residents reported feeling comfortable caring for mechanically ventilated patients despite having frequent contact with ventilated patients.…”

Section: Surveys Regarding Adequacy Of MV Trainingmentioning

confidence: 99%

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Mechanical Ventilation Training During Graduate Medical Education: Perspectives and Review of the Literature

Keller

Claar

Ferreira

et al. 2019

Journal of Graduate Medical Education

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Background Management of mechanical ventilation (MV) is an important and complex aspect of caring for critically ill patients. Management strategies and technical operation of the ventilator are key skills for physicians in training, as lack of expertise can lead to substantial patient harm. Objective We performed a narrative review of the literature describing MV education in graduate medical education (GME) and identified best practices for training and assessment methods. Methods We searched MEDLINE, PubMed, and Google Scholar for English-language, peer-reviewed articles describing MV education and assessment. We included articles from 2000 through July 2018 pertaining to MV education or training in GME. Results Fifteen articles met inclusion criteria. Studies related to MV training in anesthesiology, emergency medicine, general surgery, and internal medicine residency programs, as well as subspecialty training in critical care medicine, pediatric critical care medicine, and pulmonary and critical care medicine. Nearly half of trainees assessed were dissatisfied with their MV education. Six studies evaluated educational interventions, all employing simulation as an educational strategy, although there was considerable heterogeneity in content. Most outcomes were assessed with multiple-choice knowledge testing; only 2 studies evaluated the care of actual patients after an educational intervention. Conclusions There is a paucity of information describing MV education in GME. The available literature demonstrates that trainees are generally dissatisfied with MV training. Best practices include establishing MV-specific learning objectives and incorporating simulation. Next research steps include developing competency standards and validity evidence for assessment tools that can be utilized across MV educational curricula.

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“…Yet, few medical training programs use a structured curriculum in MV ( 13 ), and there is considerable variation in curricula among training programs ( 11 ). As a result, trainees report low confidence in managing patients on MV ( 14 – 16 ). In addition, assessing learning has always been a challenge.…”

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Simulation-based Assessment to Measure Proficiency in Mechanical Ventilation among Residents

et al. 2022

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Background Mechanical ventilation (MV) skills are essential for clinicians caring for critically ill patients, yet few training programs use structured curricula and appropriate assessments. Objective structured clinical exams (OSCEs) have been used to assess clinical competency in many areas, but there are no OSCE models focused on MV. Objective To develop and validate a simulation-based assessment (SBA) with an OSCE structure to assess baseline MV competence among residents and identify knowledge gaps. Methods We developed an SBA using a lung simulator and a mechanical ventilator, and an OSCE structure, with six clinical scenarios in MV. We included internal medicine residents at the beginning of their rotation in the respiratory intensive care unit (ICU) of a university-affiliated hospital. A subset of residents was also evaluated with a validated multiple-choice exam (MCE) at the beginning and at the end of the ICU rotation. Scores on both assessments were normalized to range from 0 to 10. We used Cronbach’s α coefficient to assess reliability and Spearman correlation to estimate the correlation between the SBA and the MCE. Results We included 80 residents, of whom 42 also completed the MCE examinations. The final version of the SBA had 32 items, and the Cronbach’s α coefficient was 0.72 (95% confidence interval [CI], 0.64–0.81). The average SBA score was 6.2 ± 1.3, and performance was variable across items, with 80% correctly adjusting initial ventilatory settings and only 12% correctly identifying asynchrony. The MCE had 24 questions, and the average score was 7.6 ± 2.4 at the beginning of the rotation and 8.2 ± 2.3 at the end of the rotation (increase of 0.6 points; 95% CI, 0.30–0.90; P < 0.001). There was moderate correlation between the SBA and the MCE (rho = 0.41; P = 0.002). Conclusion We developed and validated an objective structured assessment on MV using a pulmonary simulator and a mechanical ventilator addressing the main competencies in MV. The performance of residents in the SBA at the beginning of an ICU rotation was lower than the performance in MCE, highlighting the need for greater emphasis on practical skills in MV during residency.

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A Survey of Fellowship Education in Mechanical Ventilation

Cited by 5 publications

References 0 publications

Impact of Novel Multiinstitutional Curriculum on Critical Care Fellow Ventilator Knowledge

Impact of Novel Multiinstitutional Curriculum on Critical Care Fellow Ventilator Knowledge

Mechanical Ventilation Training During Graduate Medical Education: Perspectives and Review of the Literature

Simulation-based Assessment to Measure Proficiency in Mechanical Ventilation among Residents

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