Integrated Critical Care Curriculum for the Third-Year Internal Medicine Clerkship

Abstract

Introduction: A majority of residents provide care for critically ill patients, yet only a minority of medical schools require ICU rotations. Therefore, many medical students enter residency without prior ICU experience. The third-year internal medicine (IM) clerkship at our institution's Veterans Affairs Medical Center (VAMC) provided an opportunity for medical students to rotate through an open ICU as part of their inpatient ward rotation. Prior to March 2019, no structured critical care curriculum existed within the IM clerkship to prepare students for this experience. Methods: We created a seven-session ICU curriculum integrated within the VAMC IM clerkship addressing core critical care topics and skills including bedside presentations, shock, and respiratory failure. IM residents facilitated the curriculum's case-based, small-group discussions. We assessed curricular efficacy and impact with a pre-and posttest and end-of-curriculum survey. Results: Forty-one students participated in the curriculum from March to November 2019. As a result, students agreed that their overall clerkship experience improved (73% strongly agree, 24% agree). Students also reported increased comfort in their ability to participate in the management of critically ill patients (44% strongly agree, 51% agree). Objectively, student performance on a 15-question pre-and posttest improved from a precurricular average of 7.5 (50%) questions correct to a postcurricular average of 10.7 (71%) questions correct (p <.0001; CI 2.2-4.4). Discussion: Following implementation of our ICU curriculum, medical student attitudes regarding overall IM clerkship experience, self-perceived confidence in critically ill patient management, and medical knowledge all improved.

A Scoping Review of Assessment Methods Following Undergraduate Clinical Placements in Anesthesia and Intensive Care Medicine

“…A total of 2,435 results were returned from the initial search between the 5 databases, of which 17, published between 1983 and 2020, were selected for full-text review ( 6 , 20 – 34 , 36 ). The second search performed in August 2021 returned 2 further studies published in 2021 ( 19 , 35 ). The findings of these 19 studies are shown in Table 1 .…”

“…Of the 19 studies, 9 (47.4%) involved anesthesia ( 21 , 23 – 25 , 28 – 32 ), 8 (42.1%) intensive care medicine ( 6 , 19 , 20 , 26 , 27 , 33 – 35 ) and 2 (10.5%) a combination of both disciplines ( 22 , 36 ). The primary research focus was on the assessment instrument and on student learning in 9 ( 22 – 26 , 28 – 30 , 36 ) and 7 ( 19 – 21 , 27 , 32 , 33 , 35 ) studies respectively. The remaining 3 studies had equal research focus on learning and the assessment tool.…”

“…Twelve of 19 studies (63.2%) had a non-randomized design and collected assessment data at one timepoint only ( 20 – 25 , 28 – 32 , 36 ). Conversely, the remaining 7 studies (36.8%) were either RCTs and/or had a pre-/post-test study design ( 6 , 19 , 26 , 27 , 33 – 35 ). Despite all studies reporting solely or mainly quantitative data, none conducted a power analysis to evaluate the required sample size.…”

“…Ten studies (52.6%) considered the issues of the reliability and/or validity of their assessment tools ( 6 , 21 – 26 , 28 , 30 , 31 ). Two additional studies used standardized assessment questions from the Society of Critical Care Medicine and the American College of Physicians ( 20 , 35 ). The average MERQSI score was 12.3 (range 5–15) out of a maximum of 18.…”

“…These are shown in Table 2 . The most common methods were multiple choice questions (7 studies; 36.8%) ( 19 , 22 , 26 , 27 , 29 , 32 , 35 ), written assessment (6 studies; 31.6%) ( 20 , 22 , 23 , 29 , 32 , 34 ) and simulation (6 studies; 31.6%) ( 21 , 23 , 25 , 26 , 30 , 31 ).…”