Critical care education during internal medicine residency: a national survey

Abstract

Background: Current training practices and teaching methods for critical care medicine education during internal medicine residency have not been well described. This study explored critical care medicine education practices and environments for internal medicine residents in the United States.

Methods: A web-based survey recruited Pulmonary and Critical Care Medicine fellowship program directors involved with internal medicine residency programs at academic institutions in the United States.

Results: Of 127 accredited Pulmonary and Critical Care Medicine programs in 2007, 63 (50%) responded. Demographics of the intensive care units varied widely in size (7-52 beds), monthly admissions (25-300 patients), and presence of a "night float" (22%) or an admissions "cap" (34%). All programs used bedside teaching, and the majority used informal sessions (91%) or didactic lectures (75%). More time was spent on resident teaching in larger (≥20 bed) medical intensive care units, on weekdays, in programs with a night-float system, and in programs that suspended residents' primary care clinic duties during their intensive care unit rotation.

Conclusions: Although similar teaching methods were used within a wide range of training environments, there is no standardized approach to critical care medicine education for internal medicine residents. Some survey responses indicated a correlation with additional teaching time.

Figure 1

Structure of Intensive Care Unit Rotations for Residents A minority of programs had admissions “cap” and “night-float” systems that limit resident workload or duty hours. The night-float system and the absence of the outpatient clinic during the ICU rotation correlated significantly with more time for teaching. Abbreviations: CCM, critical care medicine; ICU, intensive care unit.

Figure 2

Type of Teaching Methods Used in the Intensive Care Unit Almost all programs routinely used bedside teaching and informal (group discussion) or didactic (standardized format) lectures, while a minority used other technologies.

Figure 3

The Proportion of Programs Offering Teaching Time ≥4 Hours a Day Based on Different Intensive Care Unit (ICU) and Rotation Characteristics Programs with large, medical ICUs and “night-float” systems were more likely to offer ≥4 hours a day of teaching time to residents. * P < .05.