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Takeda K, Kasai H, Tajima H, Furukawa Y, Imaeda T, Suzuki T, Ito S. Mixed-methods education of mechanical ventilation for residents in the era of the COVID-19 pandemic: Preliminary interventional study. PLoS One 2023; 18:e0287925. [PMID: 37440546 PMCID: PMC10343156 DOI: 10.1371/journal.pone.0287925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION In the current era of the severe acute respiratory syndrome-coronavirus-2 epidemic, the need for respiratory care, including mechanical ventilatory (MV) management, has increased. However, there are no well-developed educational strategies for training medical personnel dealing with respiratory care in MV management. METHODS A novel mixed-methods hands-on seminar for learning MV management was conducted for the residents at Chiba University Hospital in March 2022. The seminar lasted approximately 2 hours. The learning goal for the residents was to develop skills and knowledge in performing basic respiratory care, including MV, during an outbreak of a respiratory infection. The seminar with a flipped classroom consisted of e-learning, including modules on respiratory physiology and MV management, hands-on training with a low-fidelity simulator (a lung simulator), and hands-on training with a high-fidelity simulator (a human patient simulator). The effectiveness of the seminar was evaluated using closed questions (scored on a five-point Likert scale: 1 [minimum] to 5 [maximum]) and multiple-choice questions (maximum score: 6) at the pre- and post-seminar evaluations. RESULTS Fourteen residents at Chiba University Hospital participated in the program. The questionnaire responses revealed that the participants' motivation for learning about MV was relatively high in the pre-seminar period (seven participants [50%] selected level 5 [very strong]), and it increased in the post-seminar period (all participants selected level 5) (p = 0.016). The responses to the multiple-choice questions revealed that the participants did not have enough knowledge to operate a mechanical ventilator, while the total score significantly improved from the pre- to post-seminar period (pre-seminar: 3.3 ± 1.1, post-seminar: 4.6 ± 1.0, p = 0.003). CONCLUSIONS The seminar implemented in this study helped increase the residents' motivation to learn about respiratory care and improved knowledge of MV management in a short time. In particular, the flipped classroom may promote the efficiency of education on MV management.
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Affiliation(s)
- Kenichiro Takeda
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Tajima
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yutaka Furukawa
- Clinical Engineering Center, Chiba University Hospital, Chiba, Japan
| | - Taro Imaeda
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoichi Ito
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
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Ward J, Noel C. Basic Modes of Mechanical Ventilation. Emerg Med Clin North Am 2022; 40:473-488. [DOI: 10.1016/j.emc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Multispecialty clinical settings are increasingly prevalent because of the growing complexity in health care, revealing challenges with overlaps in expertise. We study hospitalists and inpatient specialists to gain insights on how physicians with shared expertise may differentiate themselves in practice. PURPOSE The aim of this study was to explore how hospitalists differentiate themselves from other inpatient physicians when treating patient cases in areas of shared expertise, focusing on differences in patient populations, practice patterns, and performance on cost and quality metrics. METHODOLOGY We use mixed-effects multilevel models and mediation models to analyze medical records and disaggregated billing data for admissions to a large urban pediatric hospital from January 1, 2009, to August 31, 2015. RESULTS In areas of shared physician expertise, patients with more ambiguous diagnoses and multiple chronic conditions are more likely to be assigned to a hospitalist. Controlling for differences in patient populations, hospitalists order laboratory tests and medications at lower rates than specialists. Hospitalists' laboratory testing rate had a significant mediating role in their lower total charges and lower odds of their patients experiencing any nonsurgical adverse events compared to specialists, though hospitalists did not differ from specialists in 30- and 90-day readmission rates. PRACTICE IMPLICATIONS Physicians with shared expertise, such as hospitalists and inpatient specialists, differentiate their roles through assignment to ambiguous diagnoses and multisystem conditions, and practice patterns such as laboratory and medication orders. Such differentiation can improve care coordination and establish professional identity when roles overlap.
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Guinemer C, Boeker M, Fürstenau D, Poncette AS, Weiss B, Mörgeli R, Balzer F. Telemedicine in Intensive Care Units: Scoping Review. J Med Internet Res 2021; 23:e32264. [PMID: 34730547 PMCID: PMC8600441 DOI: 10.2196/32264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/03/2021] [Accepted: 09/18/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The role of telemedicine in intensive care has been increasing steadily. Tele-intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. OBJECTIVE This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. METHODS A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. RESULTS A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. CONCLUSIONS The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/19695.
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Affiliation(s)
- Camille Guinemer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Boeker
- Intelligence and Informatics in Medicine, Medical Center rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Digitalization, Copenhagen Business School, Copenhagen, Denmark
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rudolf Mörgeli
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Enhancing Resident Skills in Mechanical Ventilation. What Do Residents Learn during Intensive Care Unit Rotations? ATS Sch 2021; 2:1-4. [PMID: 33871485 PMCID: PMC8043281 DOI: 10.34197/ats-scholar.2021-0012ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Secombe P, Brown A, Bailey M, Litton E, Pilcher D. Characteristics and outcomes of patients admitted to regional and rural intensive care units in Australia. CRIT CARE RESUSC 2020; 22:335-343. [PMID: 38046878 PMCID: PMC10692579 DOI: 10.51893/2020.4.oa6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe the characteristics and outcomes of patients admitted to regional and rural intensive care units (ICUs). Design, setting and participants: Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for admissions between January 2009 and June 2019. Characteristics and outcomes of patients admitted to regional and rural ICUs were compared with metropolitan and tertiary ICUs. Main outcome measures: Primary outcome was hospital mortality. Secondary outcomes included patient characteristics, ICU mortality, ICU and hospital length of stay, need for mechanical ventilation and need for interhospital transfer. Results: Over the sampling period, admissions to regional/rural ICUs averaged nearly 19 000 episodes per annum and comprised 20% of critical care admissions in Australia. Unadjusted mortality was lower, a result that persisted after adjustment for a range of confounders (odds ratio, 0.73; 95% CI, 0.67-0.80; P < 0.01). Admissions are more likely to be emergencies, and patients are more likely to live in areas of relative disadvantage and to require interhospital transfer, but are less likely to require mechanical ventilation. Conclusions: Although illness severity is lower for patients admitted to regional/rural ICUs, hospital mortality after adjustment for a range of confounders is lower. Compared with tertiary ICUs, emergency admissions are more likely, which may have implications for surge capacity during pandemic illness, while mechanical ventilation is less frequently required. Regional/rural ICUs provide care to a substantial proportion of critically ill patients and have a crucial role in the support of regional Australians.
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Affiliation(s)
- Paul Secombe
- Intensive Care Unit, Alice Springs Hospital, Alice Springs, NT, Australia
- School of Medicine, Flinders University, Adelaide, SA, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
| | - Alex Brown
- Aboriginal Health Equity, South Australian Health and Medical Research Institute (SAHMRI), , Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Edward Litton
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
- Intensive Care Unit Fiona Stanley Hospital, Perth, WA, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
- Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia
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Tallo FS, Vendrame LS, Baitello AL. Comparison of three methods for teaching mechanical ventilation in an emergency setting to sixth-year medical students: a randomized trial. Rev Assoc Med Bras (1992) 2020; 66:1409-1413. [DOI: 10.1590/1806-9282.66.10.1409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/23/2020] [Indexed: 11/22/2022] Open
Abstract
SUMMARY OBJECTIVE: To determine if there are significant differences between the tutorial, simulation, or clinical-case-based discussion teaching methods regarding the transmission of medical knowledge on mechanical ventilation. METHODS: A randomized, multicenter, open-label controlled trial was carried out using 3 teaching methods on mechanical ventilation: clinical-case-based discussion, simulation, and online tutorial. Voluntary students of the sixth year of medical school from 11 medical colleges answered a validated questionnaire on knowledge about mechanical ventilation for medical students before, immediately after, and 6 months after in-person training consisting of 20 multiple-choice questions, and 5 questions about the participants' demographic profile. RESULTS: Immediately after the test there was no difference between the scores in the simulation and clinical case groups,[15,06 vs 14,63] whereas, after some time, there was a significant difference in retention between the case-based and simulation groups, with the score in the simulation group 1.46 [1.31; 1.64] times higher than the score of the case group (p-value < 0.001). In the multivariate analysis, an individual who had received more than 4 hours of information showed an increase of 20.0% [09.0%; 33.0%] in the score (p-value = 0.001). CONCLUSIONS: Our results indicate that, in comparison with other forms of training, simulation in mechanical ventilation provides long-lasting knowledge in the medium term. Further studies are needed to improve the designing and evaluation of training that provides minimal mechanical ventilation skills.
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Abstract
OBJECTIVES To determine the total numbers of privileged and full-time equivalent intensivists in acute care hospitals with intensivists and compare the characteristics of hospitals with and without intensivists. DESIGN Retrospective analysis of the American Hospital Association Annual Survey Database (Fiscal Year 2015). SETTING Two-thousand eight-hundred fourteen acute care hospitals with ICU beds. PATIENTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 2,814 acute care hospitals studied, 1,469 (52%) had intensivists and 1,345 (48%) had no intensivists. There were 28,808 privileged and 19,996 full-time equivalent intensivists in the 1,469 hospitals with intensivists. In these hospitals, the median (25-75th percentile) numbers of privileged and full-time equivalent intensivists were 11 (5-24) and 7 (2-17), respectively. Compared with hospitals without intensivists, hospitals with privileged intensivists were primarily located in metropolitan areas (91% vs 50%; p < 0.001) and at the aggregate level had nearly thrice the number of hospital beds (403,522 [75%] vs 137,146 [25%]), 3.6 times the number of ICU beds (74,222 [78%] vs 20,615 [22%]), and almost twice as many ICUs (3,383 [65%] vs 1,846 [35%]). At the hospital level, hospitals with privileged intensivists had significantly more hospital beds (median, 213 vs 68; p < 0.0001), ICU beds (median, 32 vs 8; p < 0.0001), a higher ratio of ICU to hospital beds (15.6% vs 12.6%; p < 0.0001), and a higher number of ICUs per hospital (2 vs 1; p < 0.0001) than hospitals without intensivists. CONCLUSIONS Analyzing the intensivist section of the American Hospital Association Annual Survey database is a novel approach to estimating the numbers of privileged and full-time equivalent intensivists in acute care hospitals with ICU beds in the United States. This methodology opens the door to an enhanced understanding of the current supply and distribution of intensivists as well as future research into the intensivist workforce.
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Affiliation(s)
- David J Wallace
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Keller JM. Mechanical Ventilation Training During Graduate Medical Education: Perspectives and Review of the Literature. J Grad Med Educ 2019; 11:389-401. [PMID: 31440332 PMCID: PMC6699526 DOI: 10.4300/jgme-d-18-00828.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/04/2019] [Accepted: 04/15/2019] [Indexed: 01/10/2023] Open
Abstract
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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Dewan MJ, Norcini JJ. Pathways to Independent Primary Care Clinical Practice: How Tall Is the Shortest Giant? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:950-954. [PMID: 30998577 DOI: 10.1097/acm.0000000000002764] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Patients can be treated by a physician, a nurse practitioner (NP), or a physician assistant (PA) despite marked differences in the education and training for these three professions. This natural experiment allows examination of a critical question: What is the minimum education and training required to practice primary care? In other words, how tall is the shortest giant? State licensing requirements, not educational bodies, legislate minimum training. The current minimum is 6 years, which includes 27.5 weeks of supervised clinical experience (SCE), for NPs. In comparison, PAs train for 6 years with 45 weeks of SCE, and physicians for at least 8 years with 110 weeks of SCE. Initial, flawed studies show equivalent patient outcomes among the professions. If rigorous follow-up studies confirm equivalence, the content and length of medical education for primary care physicians should be reconsidered. Unmatched medical school graduates, with 7 years of training and 65 weeks of SCE, more than the required minimum for NPs, deserve to practice independently. So do PAs. If equivalence is not confirmed, the minimum requirements for NPs and/or PAs should be raised, including considering a required residency (currently optional). Alternatively, the scope of practice for the three professions could be defined to reflect differences in training. There is an urgent need to set aside preconceived notions and turf battles, conduct rigorous independent studies, and generate meaningful data on practice patterns and patient outcomes. This should inform optimal training, scope of practice, and workforce development for each invaluable primary care clinical practitioner.
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Affiliation(s)
- Mantosh J Dewan
- M.J. Dewan is interim president and SUNY Distinguished Service Professor, Upstate Medical University, Syracuse, New York. J.J. Norcini is president and CEO, Foundation for the Advancement of International Medical Education and Research, Philadelphia, Pennsylvania
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Flanders SA, Cooke CR. Hospitalists in the ICU: Necessary But Not Sufficient. J Hosp Med 2018; 13:65-66. [PMID: 29240848 DOI: 10.12788/jhm.2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Scott A Flanders
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Colin R Cooke
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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