Training non-intensivist doctors to work with COVID-19 patients in intensive care units

Abstract

Background: Due to an expected surge of COVID-19 patients in need of mechanical ventilation, the intensive care capacity was doubled at Rigshospitalet, Copenhagen, in March 2020. This resulted in an urgent need for doctors with competence in working with critically ill COVID-19 patients. A training course and a theoretical test for non-intensivist doctors were developed. The aims of this study were to gather validity evidence for the theoretical test and explore the effects of the course.

Methods: The 1-day course was comprised of theoretical sessions and hands-on training in ventilator use, hemodynamic monitoring, vascular access, and use of personal protective equipment. Validity evidence was gathered for the test by comparing answers from novices and experts in intensive care. Doctors who participated in the course completed the test before (pretest), after (posttest), and again within 8 weeks following the course (retention test).

Results: Fifty-four non-intensivist doctors from 15 different specialties with a wide range in clinical experience level completed the course. The test consisted of 23 questions and demonstrated a credible pass-fail standard at 16 points. Mean pretest score was 11.9 (SD 3.0), mean posttest score 20.6 (1.8), and mean retention test score 17.4 (2.2). All doctors passed the posttest.

Conclusion: Non-intensivist doctors, irrespective of experience level, can acquire relevant knowledge for working in the ICU through a focused 1-day evidence-based course. This knowledge was largely retained as shown by a multiple-choice test supported by validity evidence. The test is available in appendix and online.

Keywords: COVID-19; ICU; assessment; curriculum; education; pandemic response; skills preparation; test; training; viral outbreak.

FIGURE 1

Establishing a pass/fail‐standard using the contrasting groups' method. Comparison of the experts’ and novices’ scores in the final test (maximum 23 points), showed that the experts scored significantly better than novices (mean 19.6 (SD 1.8) vs. mean 9.5, (SD 3.2); P < .001, demonstrating a strong relation to experience. A credible pass/fail standard was established at 16 points.⁹ Only two novices achieved this score (3% false positives), whereas one experienced failed (3% false negatives). [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Test results for all participants. Each dot represents a test result by one participant. The solid black lines are the mean and standard deviation for each group. Validity evidence for the multiple‐choice test (MCQ) was assessed by distribution of the test to intensive care unit (ICU) specialists and final‐year medical students. The test was then distributed immediately before (pre‐test) and immediately after (post‐test) the course and again six to eight weeks after the course (retention‐test).

FIGURE 3

Individual results of pre‐, post‐ and retention‐tests. Post‐test scores were positively correlated with pre‐test scores, but the effect size was small: beta = 0.16 (P < .05), corresponding to an average of 1 additional point in the post‐test for every 6.3 additional points in the pre‐test.