Impact of Longitudinal Mechanical Ventilation Curriculum on Decay of Knowledge

Abstract

Background: Prior evidence suggests that critical care trainees and attendings may have trouble recognizing common, potentially life-threatening mechanical ventilation (MV) waveform asynchronies. Although dedicated workshops may improve knowledge in MV, this knowledge may be prone to decay over time. Longitudinal, preceptorial-based curriculums may prevent this decay in knowledge.

Objective: To determine if the addition of a year-long, longitudinal MV preceptorial curriculum to a two-part, small-group, simulation-based education block curriculum reduces decay in MV knowledge compared with the education block curriculum alone.

Methods: This was a multicenter prospective cohort study including 123 first-year fellows from 12 critical care fellowship programs who completed a two-part simulation-based education block (control) after the first and sixth months of fellowship. Fellows from one of these programs also participated in a year-long preceptorial curriculum (intervention). MV waveform examination scores over time during fellowship were compared between control versus intervention groups.

Results: Mean test scores increased for both control and intervention groups after the education block courses at Months 1 and 6 of fellowship. Mean (standard deviation) test scores at Month 12 were higher for the intervention group than the control group (89.3 [14.8] vs. 47.7 [21.4]; P < 0.0001). Between 6 months and 3 years of fellowship, there was a significant decay in test scores for the control group (slope estimate [standard error], -13.4 [1.7]; P < 0.0001). However, there was no significant decay in test scores for the intervention group (slope estimate, -2.0 [4.7]; P = 0.67; difference in slope estimates, 11.4 [5.0]; P = 0.02).

Conclusion: The ability of critical care fellows to identify MV waveform asynchronies declines over fellowship training, despite a dedicated two-part, simulation-based MV educational curriculum. The addition of an MV preceptorial course decreased decay of MV knowledge over the course of fellowship training.

Keywords: critical care; education; simulation; training.

Figure 1.

Flow diagram demonstrating the timing of education block courses and waveform testing. Fourteen fellows from one of these programs also participated in a year-long preceptorial curriculum in addition to the education block courses.

Figure 2.

Longitudinal comparison of waveform examination scores between education block versus preceptorial block fellows over the course of fellowship training. Education block fellows demonstrated a significant decay in mechanical ventilation (MV) knowledge over the course of the fellowship, whereas preceptorial course fellows did not. Summer education block (SEB) pretest (control = 79; intervention n = 11), SEB posttest (control = 55; intervention n = 8), WEB pretest (control = 55; intervention n = 11), winter education block (WEB) posttest (control = 50; intervention n = 11), fellowship year 1 (FY1) inservice (control = 55; intervention n = 11), FY2 inservice (control = 44; intervention n = 4), FY3 (control = 27; intervention n = 3).