Impact of Novel Multiinstitutional Curriculum on Critical Care Fellow Ventilator Knowledge

Abstract

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.

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

“…We found that performance on important clinical topics was variable. There was a high percentage of error for the item that evaluates recognition of patient–ventilator asynchrony, in agreement with previous studies emphasizing the difficulty health professionals have in recognizing and managing asynchrony ( 31 , 32 ). Considering that asynchrony is a common phenomenon and is associated with extubation failure ( 33 ) and mortality ( 34 , 35 ), this finding underscores the need for intentional training ( 32 ).…”

“…There was a high percentage of error for the item that evaluates recognition of patient–ventilator asynchrony, in agreement with previous studies emphasizing the difficulty health professionals have in recognizing and managing asynchrony ( 31 , 32 ). Considering that asynchrony is a common phenomenon and is associated with extubation failure ( 33 ) and mortality ( 34 , 35 ), this finding underscores the need for intentional training ( 32 ). The item requiring participants to measure respiratory system resistance also had a high percentage of error, possibly reflecting a lack in familiarity with performing such measurements at the bedside.…”

Developing and Implementing Noninvasive Ventilator Training in Haiti during the COVID-19 Pandemic

“…It is worth noting that these postcurriculum improvements are in line with previous work detailing trainings of similar content and in similar settings. In one recent study in the United States, a 3-day, multi-institutional, ventilator waveform training showed improvement in post-training knowledge examination of 37% ( 27 ). Another study of short-term, multimodal, advanced cardiac life support training, which occurred in Haiti, demonstrated postcurriculum knowledge improvement of 22% after one training ( 28 ).…”

Unintended Consequences of An Analog Fix in A Digital Era: Transport Ventilators Associated with Significantly Longer Duration of Intubation for Critically Ill COVID-19 Patients

“…However, optimizing such techniques and strategies is an acquired skill that takes time to develop, let alone master. Even still, it has been shown that, while most rst-year fellows in Pulmonary and Critical Care are not vent-savvy when starting fellowship, this skill is adequately acquired with training and practice when provided with standardized equipment [10]. Furthermore, recent analysis of disaster-readiness has shown that skilled intensivists and respiratory therapists continue to be a bottleneck in providing care during a surge situation such as the rst wave of the COVID-19 pandemic [11].…”