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Mavis SC, Brumbaugh JE, Carey WA, Kelm DJ. A Flipped Classroom Pilot in Neonatal Mechanical Ventilation. ATS Sch 2024; 5:162-173. [PMID: 38638918 PMCID: PMC11025347 DOI: 10.34197/ats-scholar.2023-0085in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/14/2023] [Indexed: 04/20/2024] Open
Abstract
Background Pediatric residents frequently manage critically ill neonates but have limited systematic training in mechanical ventilation (MV). Competing demands, varying learner levels, and topic complexity contribute to inconsistent education. A blended learning approach may be ideally suited to achieve meaningful learning but has not been described for this topic and learner. Objective To design, implement, and evaluate a flipped classroom for pediatric residents in neonatal MV. Methods We used Kern's six-step framework for curricular development to create a flipped classroom curriculum in neonatal MV. Individual prework included interaction with six prerecorded animated whiteboard videos, while in-person learning occurred in small groups at the bedside of a ventilated infant. A mixed-methods evaluation included surveys, quantitative knowledge test scores (before, immediately after, and six months after course completion), and qualitative analysis of participant focus groups. Results Twenty-six learners participated in the curriculum. Mean knowledge test scores rose and were sustained after course completion (51% baseline, 82% immediate posttest, 90% retention; P < 0.001). Learners identified various design elements, technology affordances, and instructor factors as meaningful, and they identified unexpected impacts of the curriculum beyond knowledge acquisition, including effects on professional identities, interdisciplinary communication skills, and contribution to the culture of safety. Conclusion This curriculum aligned with resident roles, was meaningful to learners, and led to long-term increases in knowledge scores and access to quality education; flipped classroom design using meaningful learning theory and leveraging animated whiteboard technology may be a useful strategy for other highly complex topics in graduate medical education.
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Affiliation(s)
- Stephanie C. Mavis
- Division of Neonatal Medicine, Department
of Pediatric and Adolescent Medicine, and
| | - Jane E. Brumbaugh
- Division of Neonatal Medicine, Department
of Pediatric and Adolescent Medicine, and
| | - William A. Carey
- Division of Neonatal Medicine, Department
of Pediatric and Adolescent Medicine, and
| | - Diana J. Kelm
- Division of Pulmonary and Critical Care
Medicine, Mayo Clinic, Rochester, Minnesota
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2
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Khan MF, Aziz A, Riaz Q, Ghaffar WB, Khan F, Latif A. The Impact of Short Intensive Care Rotation on Residents' Experience in the COVID-19 Pandemic: A Mixed-Methods Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231222084. [PMID: 38143724 PMCID: PMC10748624 DOI: 10.1177/23821205231222084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/06/2023] [Indexed: 12/26/2023]
Abstract
Objectives To assess the impact and utility of an intensive care unit (ICU) rotation during the coronavirus disease 2019 (COVID-19) pandemic and the need for mandatory ICU rotations in training for all clinical specialties. Methods A mixed methods study was conducted from January to September 2021 at the Aga Khan University Hospital, including resident doctors who rotated through COVID ICU between May and September 2020. An online survey was undertaken, followed by two focused group discussions (FGDs). Results Fifty-nine complete responses out of a total of 86 were analyzed. Around 42.3% (n = 25) of doctors belonged to medicine/allied specialties and 57.6% (n = 34) had previous ICU experience. Both groups, with and without prior ICU experience, found the rotation equally challenging (82.3% (n = 28) versus 84% (n = 21), P = .776) and gained similar practical skills (35.3% (n = 12) versus 16% (n = 4), P = .072), however, those with experience gained significantly more knowledge (58.5% (n = 20) versus 32% (n = 8), P = .047). On opinion regarding mandatory ICU rotation, the majority agreed to have a mandatory rotation (82% (n = 28) versus 72% (n = 18), P = .421)) with an optimal duration of 1 to 2 months. The FGDs found that all residents encouraged the idea of mandatory training in ICU which must be tailored to their training specialty and suggested extending the duration beyond 1 week to ensure learning. Conclusions COVID ICU rotation was a good avenue for learning and the idea of mandatory ICU training was supported. Mandating ICU rotation might theoretically enhance response to emergencies. More research is needed to understand for feasible incorporation of ICU training in the curriculum.
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Affiliation(s)
- Muhammad F. Khan
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Ayesha Aziz
- Department of Nephrology, Ayub Teaching Hospital, Abbottabad, Pakistan
| | - Qamar Riaz
- Department for Educational Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Waleed B. Ghaffar
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Fiza Khan
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Asad Latif
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
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Bambi S, Parente E, Bardacci Y, Baldassini Rodriguez S, Forciniti C, Ballerini L, Caruso C, El Aoufy K, Poggianti M, Bonacaro A, Rona R, Rasero L, Lucchini A. The Effectiveness of NIV and CPAP Training on the Job in COVID-19 Acute Care Wards: A Nurses' Self-Assessment of Skills. NURSING REPORTS 2022; 13:17-28. [PMID: 36648976 PMCID: PMC9844455 DOI: 10.3390/nursrep13010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Noninvasive ventilation (NIV) in COVID-19 patients outside of intensive care unit (ICU) settings was a feasible support during the pandemic outbreak. The aim of this study was to assess the effectiveness of an “on the job” NIV training program provided to 66 nurses working in 3 COVID-19 wards in an Italian university hospital. Methods: A quasi-experimental longitudinal before−after study was designed. The NIV Team education program, provided by expert ICU nurses, included: 3 h sessions of training on the job during work-shifts about the management of helmet-continuous positive airway pressure (CPAP) Venturi systems, and NIV with oronasal and full-face masks. An eleven-item “brief skills self-report tool” was administered before and after the program to explore the perception of NIV education program attendees about their level of skills. Results: In total, 59 nurses responded to the questionnaire. There was an improvement in the skill levels of the management of Helmet-CPAP (median before training 2, inter-quartile range (IQR) 0−6; median after training 8, IQR 3−9; p < 0.0001), and mask-NIV (median before training 2, IQR 0−6; median after training 8, IQR 3−9; p < 0.0001). Conclusions: Training on the job performed by expert ICU nurses can be a valuable and fast means to implement new Helmet-CPAP and mask-NIV skills outside of ICUs.
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Affiliation(s)
- Stefano Bambi
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Eustachio Parente
- Neuroscience—Neurosurgery, Meyer Children’s Hospital, 50139 Florence, Italy
| | - Yari Bardacci
- Emergency and Trauma Intensive Care Unit, Careggi University Hospital, 50134 Florence, Italy
| | | | - Carolina Forciniti
- Medical and Surgical Intensive Care Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Ballerini
- Emergency Department, Careggi University Hospital, 50134 Florence, Italy
| | - Christian Caruso
- Emergency Medical System—AUSL Toscana Centro, 50122 Florence, Italy
| | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Marta Poggianti
- Hospital Healthcare Management, Careggi University Hospital, 50134 Florence, Italy
| | - Antonio Bonacaro
- School of Health and Sports Sciences, University of Suffolk, Ipswich IP4 1QJ, UK
| | - Roberto Rona
- General Intensive Care Unit, San Gerardo Hospital—ASST Monza, Milano Bicocca University, 20900 Monza, Italy
| | - Laura Rasero
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Alberto Lucchini
- General Intensive Care Unit, San Gerardo Hospital—ASST Monza, Milano Bicocca University, 20900 Monza, Italy
- Correspondence: or
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4
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Simulation-based Assessment to Measure Proficiency in Mechanical Ventilation among Residents. ATS Sch 2022; 3:204-219. [PMID: 35924199 PMCID: PMC9341499 DOI: 10.34197/ats-scholar.2021-0130oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022] Open
Abstract
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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Uejima T, Ota I, Hamaguchi M, Shigeoka H, Kurita T, Hiraide A. Medical students' perceptions of emergency medical care before and during the coronavirus disease 2019 pandemic. Acute Med Surg 2022; 9:e747. [PMID: 35414940 PMCID: PMC8987347 DOI: 10.1002/ams2.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Ikuo Ota
- Department of Emergency Medicine Nagayama Hospital Osaka Japan
| | | | | | - Takashi Kurita
- Division of Cardiovascular Center Kindai University Osaka Japan
| | - Atsushi Hiraide
- Department of Emergency Medical Science Kyoto Tachibana University Kyoto Japan
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Vogt L, Schmidt M, Klasen M, Bickenbach J, Marx G, Sopka S. [Medical students as helpers in the pandemic : Innovative concept for recruitment, training and assignment planning of medical students as medical personnel during the COVID-19 pandemic]. Anaesthesist 2021; 71:21-29. [PMID: 34283258 PMCID: PMC8290386 DOI: 10.1007/s00101-021-01009-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The COVID-19 pandemic posed enormous challenges to the German healthcare system and highlighted the need for strategies to recruit, train, and deploy medical personnel. Until now, no holistic concept existed to use medical students as support for professionals in intensive care units (ICU) to avoid staff shortages in medical care. METHOD In a large-scale pilot project 265 medical students were trained for an ICU assignment. The innovative training module was accompanied by a pre-post questionnaire for self-assessment of the skills learned. 22 weeks after the training module and still during the pandemic deployment, another questionnaire was used to evaluate experiences in deployment and the efficiency of the training module with respect to preparation for ICU deployment. RESULTS The analysis revealed significant mean differences for all COVID-19-specific variables (safety dimension) in favor of the training module (n = 168). The deployment evaluation showed that the training concept was inconsistently assessed as preparation for the work deployment for 69 of the 89 deployed students in total (53% agreement/47% disagreement). CONCLUSION The results show a good feasibility of an innovative training concept for medical students with respect to a pandemic deployment as assistants in intensive care units. The concept is suitable for providing additional helpers in intensive care units during a pandemic; however, the inconsistent evaluation indicates that the concept can be expanded and needs to be adapted.
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Affiliation(s)
- Lina Vogt
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland. .,AIXTRA - Kompetenzzentrum für Training und Patientensicherheit, Medizinische Fakultät, RWTH Aachen, Forckenbeckstraße 71, 52074, Aachen, Deutschland.
| | - Michelle Schmidt
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland.,AIXTRA - Kompetenzzentrum für Training und Patientensicherheit, Medizinische Fakultät, RWTH Aachen, Forckenbeckstraße 71, 52074, Aachen, Deutschland
| | - Martin Klasen
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland.,AIXTRA - Kompetenzzentrum für Training und Patientensicherheit, Medizinische Fakultät, RWTH Aachen, Forckenbeckstraße 71, 52074, Aachen, Deutschland
| | - Johannes Bickenbach
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - Gernot Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - Saša Sopka
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland.,AIXTRA - Kompetenzzentrum für Training und Patientensicherheit, Medizinische Fakultät, RWTH Aachen, Forckenbeckstraße 71, 52074, Aachen, Deutschland
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7
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Motta D, Amaral LFTG, Silva BCDS, Gomes LDF, Barbosa WT, Coelho RS, Machado BAS. Collaborative and Structured Network for Maintenance of Mechanical Ventilators during the SARS-CoV-2 Pandemic. Healthcare (Basel) 2021; 9:754. [PMID: 34207413 PMCID: PMC8234581 DOI: 10.3390/healthcare9060754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 01/08/2023] Open
Abstract
The SARS-CoV-2 pandemic in Brazil has grown rapidly since the first case was reported on 26 February 2020. As the pandemic has spread, the low availability of medical equipment has increased, especially mechanical ventilators. The Brazilian Unified Health System (SUS) claimed to have only 40,508 mechanical ventilators, which would be insufficient to support the Brazilian population at the pandemic peak. This lack of ventilators, especially in public hospitals, required quick, assertive, and effective actions to minimize the health crisis. This work provides an overview of the rapid deployment of a network for maintaining disused mechanical ventilators in public and private healthcare units in some regions of Brazil during the SARS-CoV-2 pandemic. Data referring to the processes of maintaining equipment, acquiring parts, and conducting national and international training were collected and analyzed. In total, 4047 ventilators were received by the maintenance sites, and 2516 ventilators were successfully repaired and returned to the healthcare units, which represents a success rate of 62.17%. The results show that the maintenance initiative directly impacted the availability and reliability of the equipment, allowing access to ventilators in the public and private health system and increasing the capacity of beds during the pandemic.
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Affiliation(s)
- Daniel Motta
- Postgraduate Program MPDS/GETEC/MCTI, University Center SENAI CIMATEC, SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil; (D.M.); (L.F.T.G.A.); (B.C.d.S.S.); (L.d.F.G.); (W.T.B.); (R.S.C.)
| | - Luiz Fernando Taboada Gomes Amaral
- Postgraduate Program MPDS/GETEC/MCTI, University Center SENAI CIMATEC, SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil; (D.M.); (L.F.T.G.A.); (B.C.d.S.S.); (L.d.F.G.); (W.T.B.); (R.S.C.)
- SENAI Institute of Innovation (ISI) in Automation (CIMATEC ISI Automation), SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil
| | - Bruno Caetano dos Santos Silva
- Postgraduate Program MPDS/GETEC/MCTI, University Center SENAI CIMATEC, SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil; (D.M.); (L.F.T.G.A.); (B.C.d.S.S.); (L.d.F.G.); (W.T.B.); (R.S.C.)
- SENAI Institute of Innovation (ISI) in Forming and Joining of Materials (CIMATEC ISI F&J), SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil
| | - Lucas de Freitas Gomes
- Postgraduate Program MPDS/GETEC/MCTI, University Center SENAI CIMATEC, SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil; (D.M.); (L.F.T.G.A.); (B.C.d.S.S.); (L.d.F.G.); (W.T.B.); (R.S.C.)
| | - Willams Teles Barbosa
- Postgraduate Program MPDS/GETEC/MCTI, University Center SENAI CIMATEC, SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil; (D.M.); (L.F.T.G.A.); (B.C.d.S.S.); (L.d.F.G.); (W.T.B.); (R.S.C.)
- SENAI Institute of Innovation (ISI) in Forming and Joining of Materials (CIMATEC ISI F&J), SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil
| | - Rodrigo Santiago Coelho
- Postgraduate Program MPDS/GETEC/MCTI, University Center SENAI CIMATEC, SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil; (D.M.); (L.F.T.G.A.); (B.C.d.S.S.); (L.d.F.G.); (W.T.B.); (R.S.C.)
- SENAI Institute of Innovation (ISI) in Forming and Joining of Materials (CIMATEC ISI F&J), SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil
| | - Bruna Aparecida Souza Machado
- Postgraduate Program MPDS/GETEC/MCTI, University Center SENAI CIMATEC, SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil; (D.M.); (L.F.T.G.A.); (B.C.d.S.S.); (L.d.F.G.); (W.T.B.); (R.S.C.)
- SENAI Institute of Innovation (ISI) in Advanced Health Systems (CIMATEC ISI SAS), SENAI CIMATEC, Av. Orlando Gomes, 1845 Piatã, Salvador 41650-010, BA, Brazil
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Macedo BRD, Garcia MVF, Garcia ML, Volpe M, Sousa MLDA, Amaral TF, Gutierrez MA, Barbosa AP, Scudeller PG, Caruso P, Carvalho CRR. Implementation of Tele-ICU during the COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 47:e20200545. [PMID: 33950091 PMCID: PMC8332846 DOI: 10.36416/1806-3756/e20200545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe the implementation of a Tele-ICU program during the COVID-19 pandemic, as well as to describe and analyze the results of the first four months of operation of the program. METHODS This was a descriptive observational study of the implementation of a Tele-ICU program, followed by a retrospective analysis of clinical data of patients with COVID-19 admitted to ICUs between April and July of 2020. RESULTS The Tele-ICU program was implemented over a four-week period and proved to be feasible during the pandemic. Participants were trained remotely, and the program had an evidence-based design, the objective being to standardize care for patients with COVID-19. More than 100,000 views were recorded on the free online platforms and the mobile application. During the study period, the cases of 326 patients with COVID-19 were evaluated through the program. The median age was 60 years (IQR, 49-68 years). There was a predominance of males (56%). There was also a high prevalence of hypertension (49.1%) and diabetes mellitus (38.4%). At ICU admission, 83.7% of patients were on invasive mechanical ventilation, with a median PaO2/FiO2 ratio < 150. It was possible to use lung-protective ventilation in 75% of the patients. Overall, in-hospital mortality was 68%, and ICU mortality was 65%. CONCLUSIONS Our Tele-ICU program provided multidisciplinary training to health care professionals and clinical follow-up for hundreds of critically ill patients. This public health care network initiative was unprecedented and proved to be feasible during the COVID-19 pandemic, encouraging the creation of similar projects that combine evidence-based practices, training, and Tele-ICU.
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Affiliation(s)
- Bruno Rocha de Macedo
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Marcos Vinicius Fernandes Garcia
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Michelle Louvaes Garcia
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Marcia Volpe
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo - UNIFESP - Santos (SP) Brasil
| | - Mayson Laércio de Araújo Sousa
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Talita Freitas Amaral
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Marco Antônio Gutierrez
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Antonio Pires Barbosa
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Paula Gobi Scudeller
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Pedro Caruso
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Carlos Roberto Ribeiro Carvalho
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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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.
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10
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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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Holanda MA, Pinheiro BV. COVID-19 pandemic and mechanical ventilation: facing the present, designing the future. ACTA ACUST UNITED AC 2020; 46:e20200282. [PMID: 32696835 PMCID: PMC7567632 DOI: 10.36416/1806-3756/e20200282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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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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Tallo FS, Abib SDCV, Baitello AL, Lopes RD. Development and validation of a questionnaire to assess the knowledge of mechanical ventilation in urgent care among students in their last-year medical course in Brazil. Clinics (Sao Paulo) 2019; 74:e663. [PMID: 31644664 PMCID: PMC6794956 DOI: 10.6061/clinics/2019/e663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/17/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To develop and validate a questionnaire to assess the knowledge of mechanical ventilation among final-year medical students in Brazil. METHODS A cross-sectional study conducted between October 2015 and October 2017 involving 554 medical students was carried out to develop a questionnaire for assessing knowledge on mechanical ventilation. Reproducibility was evaluated with the intraclass correlation coefficient, internal consistency was evaluated with Cronbach's alpha, and construct validation was evaluated with a tetrachoric exploratory factor analysis. To compare the means of the competences among the same type of assessment tool, the nonparametric Friedman test was used, and the identification of the differences was obtained with Dunn-Bonferroni tests. RESULTS The final version of the questionnaire contained 19 questions. The instrument presented a clarity index of 8.94±0.83. The value of the intraclass correlation coefficient was 0.929, and Cronbach's alpha was 0.831. The factor analysis revealed five factors associated with knowledge areas regarding mechanical ventilation. The final score among participants was 24.05%. CONCLUSION The instrument has a satisfactory clarity index and adequate psychometric properties and can be used to assess the knowledge of mechanical ventilation among final-year medical students in Brazil.
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Affiliation(s)
- Fernando Sabia Tallo
- Departamento de Cirurgia, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | | | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, US
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Holanda MA, Vasconcelos RDS, Ferreira JC, Pinheiro BV. Patient-ventilator asynchrony. ACTA ACUST UNITED AC 2018; 44:321-333. [PMID: 30020347 DOI: 10.1590/s1806-37562017000000185] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/03/2017] [Indexed: 11/22/2022]
Abstract
Patient-v entilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow. Each of these types can be detected by visual inspection of volume, flow, and pressure waveforms on the mechanical ventilator display. Specific ventilatory strategies can be used in combination with clinical management, such as controlling patient pain, anxiety, fever, etc. Deep sedation should be avoided whenever possible. PVA has been associated with unwanted outcomes, such as discomfort, dyspnea, worsening of pulmonary gas exchange, increased work of breathing, diaphragmatic injury, sleep impairment, and increased use of sedation or neuromuscular blockade, as well as increases in the duration of MV, weaning time, and mortality. Proportional assist ventilation and neurally adjusted ventilatory assist are modalities of partial ventilatory support that reduce PVA and have shown promise. This article reviews the literature on the types and causes of PVA, as well as the methods used in its evaluation, its potential implications in the recovery process of critically ill patients, and strategies for its resolution.
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Affiliation(s)
- Marcelo Alcantara Holanda
- . Departamento de Medicina Clínica, Universidade Federal do Ceará, Fortaleza (CE) Brasil.,. Programa de Pós-Graduação de Mestrado em Ciências Médicas, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | | | - Juliana Carvalho Ferreira
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Bruno Valle Pinheiro
- . Faculdade de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
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Abstract
Patient-v entilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow. Each of these types can be detected by visual inspection of volume, flow, and pressure waveforms on the mechanical ventilator display. Specific ventilatory strategies can be used in combination with clinical management, such as controlling patient pain, anxiety, fever, etc. Deep sedation should be avoided whenever possible. PVA has been associated with unwanted outcomes, such as discomfort, dyspnea, worsening of pulmonary gas exchange, increased work of breathing, diaphragmatic injury, sleep impairment, and increased use of sedation or neuromuscular blockade, as well as increases in the duration of MV, weaning time, and mortality. Proportional assist ventilation and neurally adjusted ventilatory assist are modalities of partial ventilatory support that reduce PVA and have shown promise. This article reviews the literature on the types and causes of PVA, as well as the methods used in its evaluation, its potential implications in the recovery process of critically ill patients, and strategies for its resolution.
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Affiliation(s)
- Marcelo Alcantara Holanda
- . Departamento de Medicina Clínica, Universidade Federal do Ceará, Fortaleza (CE) Brasil.,. Programa de Pós-Graduação de Mestrado em Ciências Médicas, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | | | - Juliana Carvalho Ferreira
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Bruno Valle Pinheiro
- . Faculdade de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
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