Effectiveness of medical resident education in mechanical ventilation

Christopher E. Cox, Shannon S. Carson, E. Wesley Ely, Joseph A. Govert, Joanne M. Garrett, Roy G. Brower, David G. Morris, Edward Abraham, Vincent Donnabella, Antoinette Spevetz, Jesse B. Hall

Research output: Contribution to journalArticle

Abstract

Specific methods of mechanical ventilation management reduce mortality and lower health care costs. However, in the face of a predicted deficit of intensivists, it is unclear whether residency programs are training internists to provide effective care for patients who require mechanical ventilation. To evaluate these educational outcomes, we administered a validated 19-item case-based test and survey to resident physicians at 31 diverse U.S. internal medicine residency programs nationwide. Of 347 senior residents, 259 (75%) responded. The mean test score was 74% correct (SD, 14%; range, 37 to 100%). Important items representing evidence-based standards of critical care answered incorrectly were as follows: use of appropriate tidal volume in the acute respiratory distress syndrome (48% incorrect), identifying a patient ready for a weaning trial (38% incorrect), and recognizing indication for noninvasive ventilation (27% incorrect). Most accurately identified pneumothorax (86% correct) and increased intrathoracic positive end-expiratory pressure (93% correct). Better scores were associated with "closed" versus "open" intensive care unit organization (76 versus 71% correct, p = 0.001), resident perception of greater versus lesser ventilator knowledge (79 versus 71% correct, p = 0.001), and graduation from a U.S. versus international medical school (75 versus 69% correct, p = 0.033). Although overall training satisfaction correlated strongly with program use of learning objectives (r = 0.89, p < 0.0001), only 46% reported being satisfied with their mechanical ventilation training. We conclude that senior residents may not be gaining essential evidence-based knowledge needed to provide effective care for patients who require mechanical ventilation. Residency programs should emphasize evidence-based learning objectives to guide mechanical ventilation instruction.

Original languageEnglish (US)
Pages (from-to)32-38
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume167
Issue number1
DOIs
StatePublished - Jan 1 2003

Keywords

  • Clinical competence
  • Education
  • Educational measurement
  • Internship and residency
  • Mechanical ventilation
  • Medical

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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  • Cite this

    Cox, C. E., Carson, S. S., Ely, E. W., Govert, J. A., Garrett, J. M., Brower, R. G., Morris, D. G., Abraham, E., Donnabella, V., Spevetz, A., & Hall, J. B. (2003). Effectiveness of medical resident education in mechanical ventilation. American journal of respiratory and critical care medicine, 167(1), 32-38. https://doi.org/10.1164/rccm.200206-624OC