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Effectiveness of Medical Resident Education in Mechanical Ventilation

Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, California; Department of Medicine, University of Colorado School of Medicine, Denver, Colorado; Department of Medicine, New York University School of Medicine, New York, New York; Upper Chesapeake Health System, Bel Air, Maryland; and Department of Medicine, University of Chicago School of Medicine, Chicago, Illinois

Correspondence and requests for reprints should be addressed to Shannon S. Carson, M.D., UNC-Chapel Hill Division of Pulmonary and Critical Care Medicine, CB #7020, Chapel Hill, NC 27599-7020. E-mail: scarson{at}med.unc.edu

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.

Key Words: clinical competence • education, medical • educational measurement • internship and residency • mechanical ventilation

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