Creation of an International Interprofessional Simulation-enhanced Mechanical Ventilation Course

Abstract

Background: Evidence shows poor adherence to strategies for reducing morbidity and mortality in intensive care unit (ICU) patients receiving mechanical ventilation globally. Best practice management relies on training all members of the interprofessional ICU team, each with complementary roles in patient management.

Objectives: To develop and evaluate a novel two-phase, train-the-trainer, interprofessional and multicultural "Best Practice Management of the Ventilated ICU Patient" multimodality, simulation-enhanced curriculum for Thai education leaders in critical care.

Methods: In phase 1 (Oregon Health and Science University cohort), two groups of nine ICU nurses and one critical care physician representing experts in critical care and education from a large hospital system in Thailand participated in a weeklong, immersive course consisting of didactic, simulation, and in situ immersive sessions focused on best practice management of mechanically ventilated ICU patients, as well as training in our educational techniques. Outcomes were assessed with pre- and postcourse knowledge assessments and overall course evaluation. In phase 2 (Thai cohort), participants from phase 1 returned to Thailand and implemented a lower fidelity curriculum in two hospitals, using the same pre- and posttest knowledge assessment in 41 participants, before the onset of the coronavirus disease (COVID-19) 6 pandemic.

Results: In the Oregon Health and Science University cohort, the mean pretest knowledge score was 58.4 ± 13.2%, with a mean improvement to 82.5 ± 11.6% after completion of the course (P , 0.05). The greatest improvements were seen in respiratory physiology and advanced/disease-specific concepts, which demonstrated absolute improvements of 30.4% and 30.6%, respectively (P < 0.05). Participants had a high degree of satisfaction, with 90% rating the course as "excellent" and .90% reporting that the course "greatly improved" their understanding of best practices and comfort in managing mechanical ventilation. The Thai cohort had a mean baseline score of 45.4 ± 15.0% and a mean improvement to 70.3 ± 19.1% after training (P < 0.05). This cohort also saw the greatest improvement in respiratory physiology and advanced/disease-specific concepts, with 26.2% and 26.3% absolute improvements, respectively (P < 0.05).

Conclusion: A novel, two-phase, interprofessional, multicultural, simulation-enhanced train-the-trainer curriculum was feasible and effective in improving education in best practice management of mechanically ventilated patients and may be a useful model for improving the care of ICU patients across the world.

Keywords: curriculum; intensive care unit best practices; interprofessional; mechanical ventilation; simulation.

Figure 1.

Overview of Oregon Health and Science University on-site curriculum. Didactic sessions (in blue) consisted of one-hour slide presentations on core topics, taught by authors S.A.N. and J.A.G., followed by a brief Q&A session. Three-hour high-fidelity simulation sessions (in green) reinforced these core topics with deliberate practice of applied skills and structured debriefing. For the in situ experiences (in yellow), the cohort was split into three groups (A, B, and C) for a direct shadowing experience with a bedside intensive care unit (ICU) nurse (RN), an ICU RT, or the interprofessional ICU team for daily rounds. ABCDEF = assess, prevent, and manage pain; both spontaneous awakening trials and spontaneous breathing trials; choice of analgesia and sedation; delirium assessment, prevention, and management; early mobility and exercise; and family engagement and empowerment; ARDS = acute respiratory distress syndrome; Q&A = question-and-answer; RN = registered nurse; RT = respiratory therapist; SAT = spontaneous awakening trial; SBT = spontaneous breathing trial.

Figure 2.

OHSU cohort knowledge assessment: results from a 33-question knowledge assessment completed before and after participation in our course (n = 19 participants). (A) Overall scores of participants increased from a mean of 58.4 ± 13.2% to 82.5 ± 11.6% after completion of the course (P < 0.01). (B) The greatest improvements were seen in the major subject areas of respiratory physiology (from 52.1 ± 16.9% to 82.5 ± 15.7%) and advanced/disease specific (from 50.7 ± 16.9% to 81.3 ± 14.7%), followed by basics (from 64.7 ± 13.4% to 86.8 ± 10.7%) (P < 0.01). Pre- and posttest scores were compared using a paired t test. Blue dashed line denotes mean. OHSU = Oregon Health and Science University.

Figure 3.

Participant assessment of course elements and impact. Oregon Health and Science University cohort participants were asked to rate the quality and impact of this course using a five-point Likert scale. (A) Course impact on participant knowledge and comfort in managing ICU patients requiring mechanical ventilation. (B) Assessment of overall quality and quality of different aspects of the weeklong course. Average Likert rating is shown to the right of graph. ARDS = acute respiratory distress syndrome; ICU = intensive care unit; RT = respiratory therapist.

Figure 4.

BDMS/Thailand cohort knowledge assessment: results from a 33-question knowledge assessment completed before and after participation in our course (n = 41 participants). (A) Overall scores of participants increased from a mean of 45.4 ± 15.0% to 70.3 ± 19.1% after completion of the course (P < 0.01). (B) The greatest improvements were seen in the major subject areas of respiratory physiology (from 44.8 ± 19.2% to 71.0 ± 19.2%) and advanced/disease specific (from 34.2 ± 17.6% to 60.5 ± 21.3%), followed by basics (from 49.7 ± 17.6% to 74.7 ± 18.4%) (P < 0.01). Pre- and posttest scores were compared using a paired t test. Blue dashed line denotes mean. BDMS = Bangkok Dusit Medical Services.