A Pilot Standardized Simulation-Based Mechanical Ventilation Curriculum Targeting Pulmonary and Critical Care Medicine and Critical Care Medicine Fellows

Amina Pervaiz; Asil Daoud; Abdulrazak Alchakaki; Shyam Ganti; Divya Venkat; Sarah Lee; Abdulghani Sankari

doi:10.1055/s-0043-1773792

A Pilot Standardized Simulation-Based Mechanical Ventilation Curriculum Targeting Pulmonary and Critical Care Medicine and Critical Care Medicine Fellows

Avicenna J Med. 2023 Oct 3;13(3):176-181. doi: 10.1055/s-0043-1773792. eCollection 2023 Jul.

Authors

Amina Pervaiz¹, Asil Daoud^{1

2}, Abdulrazak Alchakaki^{1

2

3}, Shyam Ganti^{1

4}, Divya Venkat^{1

2}, Sarah Lee^{1

2

5

6}, Abdulghani Sankari^{1

2

7}

Affiliations

¹ Division of Pulmonary and Critical Care, Detroit Medical Center - Wayne State University School of Medicine, Detroit, Michigan, United States.
² Division of Pulmonary and Critical Care, John D. Dingell VA Medical Center, Detroit, Michigan, United States.
³ Department of Pulmonary, Critical Care and Sleep Medicine, William Beaumont Hospital, Royal Oak, Michigan, United States.
⁴ Department of Pulmonary, Critical Care and Sleep Medicine, Appalachian Regional Healthcare Hospital, Harlan, Kentucky, United States.
⁵ Department of Education, John D. Dingell VA Medical Center, Detroit, Michigan, United States.
⁶ Division of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, Ohio, United States.
⁷ Department of Medical Education, Ascension Providence Hospital, Southfield, Michigan, United States.

Abstract

Introduction The mastery of mechanical ventilation (MV) management is challenging, as it requires the integration of physiological and technological knowledge with critical thinking. Our aim was to create a standardized curriculum with assessment tools based on evidence-based practices to identify the skill deficit and improve knowledge in MV management. Methods For 3 years, 3 hours of standardized curriculum for each first-year pulmonary critical care medicine (PCCM) and critical care medicine (CCM) fellows was integrated into the orientation (chronologically): (1) a baseline knowledge pretest; (2) a 1-hour one-on-one case-based simulation session with debriefing. A 34-item competency checklist was used to assess critically thinking and skills and guide the debriefing; (3) a 1-hour group didactic on respiratory mechanics and physiology; (4) a 45-minute hands-on session in small groups of one to three fellows for basic knobology, waveforms, and various modes of mechanical ventilators; (5) a 15-minute group bedside teaching of vented patients covering topics such as techniques to alleviate dyssynchrony and advanced ventilator modes; (6) a one-on-one simulation reassessment session; (7) a knowledge posttest. Fellows' performances at baseline, 1-month posttest, and end-of-first year post-test were compared. Results Fellows ( n = 24) demonstrated significant improvement at 1-month posttest in knowledge (54.2% ± 11.0 vs. 76.6 ± 11.7%, p < 0.001) and MV competency (40.7 ± 11.0% vs. 69.7 ± 9.3%, p < 0.001), compared with pretest. These improvements were retained at the end-of-year reassessments (knowledge 75.1 ± 14.5% and MV competency 85.5 ± 8.7%; p < 0.001). Conclusion Standardized simulation-based MV curriculum may improve the medical knowledge competency, and confidence of first-year PCCM and CCM fellows toward MV management before encountering actual ventilated patients.

Keywords: competency; fellowship; mechanical ventilation; simulation.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).