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. 2020 Jun 15;46(5):e20190108.
doi: 10.36416/1806-3756/e20190108. eCollection 2020.

Impact of a respiratory ICU rotation on resident knowledge and confidence in managing mechanical ventilation

[Article in English, Portuguese]
Fátima Kiyoko Hayashi  1 , Pedro Paulo Marino Rodrigues Ayres  1 , Anna Miethke Morais  1 , Mayson Laércio de Araújo Sousa  1 , Carmen Sílvia Valente Barbas  1 , Eduardo Leite Vieira Costa  1 , Pedro Caruso  1 , Juliana Carvalho Ferreira  1
Affiliations

Impact of a respiratory ICU rotation on resident knowledge and confidence in managing mechanical ventilation

[Article in English, Portuguese]
Fátima Kiyoko Hayashi et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To develop and apply a competency-based test to assess learning among internal medicine residents during a respiratory ICU rotation at a university hospital.

Methods: We developed a test comprising 19 multiple-choice questions regarding knowledge of mechanical ventilation (MV) and 4 self-assessment questions regarding the degree of confidence in the management of MV. The test was applied on the first and last day of a 30-day respiratory ICU rotation (pre-rotation and post-rotation, respectively). During the rotation, the residents had lectures, underwent simulator training, and shadowed physicians on daily bedside rounds focused on teaching MV management.

Results: Fifty residents completed the test at both time points. The mean score increased from 6.9 ± 1.2 (pre-rotation) to 8.6 ± 0.8 (post-rotation; p < 0.001). On questions regarding the approach to hypoxemia, the recognition of patient-ventilator asynchrony, and the recognition of risk factors for extubation failure, the post-rotation scores were significantly higher than the pre-rotation scores. Confidence in airway management increased from 6% before the rotation to 22% after the rotation (p = 0.02), whereas confidence in making the initial MV settings increased from 31% to 96% (p < 0.001) and confidence in adjusting the ventilator modes increased from 23% to 77% (p < 0.001).

Conclusions: We developed a competency-based test to assess knowledge of MV among residents before and after an rotation in a respiratory ICU. Resident performance increased significantly after the rotation, as did their confidence in caring for patients on MV.

Objetivo:: Desenvolver e aplicar um teste baseado em competências para avaliar o aprendizado de residentes de clínica médica em estágio na UTI respiratória de um hospital universitário.

Métodos:: Desenvolvemos um teste com 19 questões de múltipla escolha sobre conhecimento em ventilação mecânica (VM) e 4 questões de autoavaliação sobre o nível de confiança no manejo da VM. Os testes foram aplicados no primeiro (pré-estágio) e no último dia (pós-estágio) do estágio de 30 dias na UTI respiratória. Durante o estágio, os residentes tiveram aulas teóricas, treinamento com simulador e visitas diárias à beira do leito focadas no ensino de VM.

Resultados:: Cinquenta residentes completaram o teste nos dois momentos. A média de pontuação (0-10 pontos) aumentou de 6,9 ± 1,2 no pré-estágio para 8,6 ± 0,8 no pós-estágio (p < 0,001). Observamos um aumento significativo no pós-estágio comparado com o pré-estágio em questões sobre abordagem da hipoxemia, reconhecimento da assincronia paciente-ventilador e reconhecimento de fatores de risco para falha de extubação. A confiança na abordagem de vias aéreas aumentou de 6% para 22% ao final do estágio (p = 0,02). A confiança no ajuste inicial da VM subiu de 31% para 96% (p < 0,001), e a confiança no ajuste dos modos ventilatórios aumentou de 23% para 77% (p < 0,001).

Conclusões:: Desenvolvemos um teste baseado em competências para avaliar o conhecimento sobre VM entre residentes antes e depois de um estágio em UTI respiratória. O desempenho dos residentes ao final do estágio aumentou significativamente, assim como sua confiança para cuidar de pacientes sob VM.

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Figures

Figure 1
Figure 1. The blue bars represent the means and the error bars represent the standard deviation of the pre- and post-rotation scores (on a scale from 0 to 10).
Figure 2
Figure 2. Proportion of participants (n = 48) by degree of confidence as measured by the self-assessment questions before the rotation (light blue) and after the rotation (dark blue).
See this image and copyright information in PMC

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