title: Effectiveness of medical resident education in mechanical ventilation.
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.
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Cox
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Carson
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Govert
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Garrett
authors.forename: Roy G
authors.initials: RG
authors.lastname: Brower
authors.forename: David G
authors.initials: DG
authors.lastname: Morris
authors.forename: Edward
authors.initials: E
authors.lastname: Abraham
authors.forename: Vincent
authors.initials: V
authors.lastname: Donnabella
authors.forename: Antoinette
authors.initials: A
authors.lastname: Spevetz
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Hall
mesh_terms: D004521:Educational Measurement; D019317:Evidence-Based Medicine; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D010549:Personal Satisfaction; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires; D014481:United States