So much to teach, so little time: a prospective cohort study evaluating a tool to select content for a critical care curriculum

Intensive Care Unit Critical Incident Analysis as an Objective Tool to Select Content for a Simulation Curriculum

INTRODUCTION

The intensive care unit (ICU) offers a unique environment where emergency events are frequent, high-stakes, and carefully documented, which makes it an ideal setting to research the specific technical skills, which are deployed during such events. This study aimed to describe a method of objectively identifying skills and scenarios, which should be prioritized for inclusion in a simulation curriculum.

METHOD

A retrospective audit of all available critical incident data (11 months) from a 36-bed tertiary ICU was performed. Code blue events were analyzed. Data were coded according to a rubric based on Le Guen and Costa-Pinto ( Intern Med J. 2020;51(8):1298-1303) tallying the occurrence of common ICU scenarios and skills.Documentation of each event was analyzed. The frequency with which a skill or scenario appeared in these events was considered as "high frequency" if it occurred in more than 20% of the events.The trainees' confidence in a particular skill was assessed by means of a self-assessment survey questionnaire (based on an anchored 6-item rating scale).

RESULTS

One hundred twenty-one incidents were analyzed. Sixteen were eliminated because of insufficient documentation. The most common skills during these emergency events were familiarity with the advanced life support trolley (34% of events), electrocardiogram (ECG) rhythm strip interpretation (32.4%), and the operation of an external defibrillator (29.5%).Most trainees surveyed are preparing to undergo training in anesthesia (58%) or intensive care (28%). Specialized areas of expertise (troubleshooting an extra-corporeal membrane oxygenation (ECMO) circuit or intra-aortic balloon pump) had the lowest confidence scores (average scores of 0.81 and 0.72).

CONCLUSIONS

We highlighted a novel, reproducible, and objective methodology by which critical incident data can be integrated with trainee self-assessment to generate a targeted simulation curriculum.

The "Flipped Classroom" Model for Teaching in the Intensive Care Unit

INTRODUCTION

The intensive care unit (ICU) is a dynamic and complex learning environment. The wide range in trainee's experience, specialty training, fluctuations in patient acuity and volume, limitations in trainee duty hours, and additional responsibilities of the faculty contribute to the challenge in providing a consistent experience with traditional educational strategies. The "flipped classroom" is an educational model with the potential to improve the learning environment. In this paradigm, students gain exposure to new material outside class and then use class time to assimilate the knowledge through problem-solving exercises or discussion. The rationale and pedagogical foundations for the flipped classroom are reviewed, practical considerations are discussed, and an example of successful implementation is provided.

METHODS

An education curriculum was devised and evaluated prospectively for teaching point-of-care echocardiography to residents rotating in the surgical ICU.

RESULTS

Preintervention and postintervention scores of knowledge, confidence, perceived usefulness, and likelihood of use the skills improved for each module. The quality of the experience was rated highly for each of the sessions.

CONCLUSION

The flipped classroom education curriculum has many advantages. This pilot study was well received, and learners showed improvement in all areas evaluated, across several demographic subgroups and self-identified learning styles.

Achieving the aims of education: curricular decisions in critical care

Curricula for residents on rotations through intensive care units are necessarily abbreviated. The selection (and omission) of topics can be informed by assessment of perceived needs. A curriculum cannot, however, be formed exclusively from the top-scoring needs. Topics that are encountered exclusively in the critical care unit (such as brain death) must be included.