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Published ahead of print on September 25, 2002, doi:10.1164/rccm.200206-624OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 1, January 2003, 32-38

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Submitted on June 27, 2002
Accepted on September 23, 2002

Effectiveness of Medical Residents' Education in Mechanical Ventilation

Christopher E Cox1, Shannon S Carson2*, E. Wesley Ely3, Joseph A Govert4, Joanne M Garrett2, Roy G Brower5, David G Morris6, Edward Abraham7, Vincent Donnabella8, Antoinette Spevetz9, and Jesse B Hall10

1 Medicine, University of North Carolina at Chapel Hill Sc, Chapel Hill, NC, USA; Medicine, Duke University School of Medicine, Durham, NC, USA, 2 Medicine, University of North Carolina at Chapel Hill Sc, Chapel Hill, NC, USA, 3 Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA, 4 Medicine, Duke University School of Medicine, Durham, NC, USA, 5 Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 6 Medicine, University of California-San Francisco School of Medicine, San Francisco, CA, USA, 7 Medicine, University of Colorado School of Medicine, Denver, CO, USA, 8 Medicine, New York University School of Medicine, New York, NY, USA, 9 Medicine, Upper Chesapeake Health System, Bel Air, MD, USA, 10 Medicine, University of Chicago School of Medicine, Chicago, IL, USA

* To whom correspondence should be addressed. E-mail: scarson{at}med.unc.edu.

In the face of a predicted deficit of intensivists, it is unclear if 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 to resident physicians at 31 diverse US internal medicine residency programs nationwide. Of 347 senior residents, 259 (75%) responded. The mean test score was 74% correct (s.d. 14%, range 37% to 100%). Important items representing evidence-based standards of critical care answered incorrectly were: 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 non-invasive ventilation (27% incorrect). Better scores were associated with closed versus open ICU organization (76% vs. 71% correct, p=.001), resident perception of greater versus lesser ventilator knowledge (79% vs. 71% correct, p=.001), and graduation from a US versus international medical school (75% versus 69% correct, p=.033). Training satisfaction correlated strongly with program use of learning objectives (r = .89, p < .0001). 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: Education, medical; internship and residency; mechanical ventilation; clinical competence; educational measurement.




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