Impact of Longitudinal Mechanical Ventilation Curriculum on Decay of Knowledge

Michael Keller; Megan Acho; Junfeng Sun; Eric Kriner; Nitin Seam; Burton W Lee

doi:10.34197/ats-scholar.2023-0051IN

Impact of Longitudinal Mechanical Ventilation Curriculum on Decay of Knowledge

ATS Sch. 2024 Oct 30;5(2):302-310. doi: 10.34197/ats-scholar.2023-0051IN. eCollection 2024 Jun 1.

Authors

Michael Keller^{1

2}, Megan Acho³, Junfeng Sun¹, Eric Kriner⁴, Nitin Seam¹, Burton W Lee¹

Affiliations

¹ Critical Care Medicine Department, National Institutes of Health Clinical Center, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
² Department of Pulmonary Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
³ Division of Pulmonary and Critical Care, University of Michigan Hospital, Ann Arbor, Michigan; and.
⁴ Pulmonary Services, MedStar Washington Hospital Center, Washington, D.C.

Abstract

Background: Prior evidence suggests that critical care trainees and attendings may have trouble recognizing common, potentially life-threatening mechanical ventilation (MV) waveform asynchronies. Although dedicated workshops may improve knowledge in MV, this knowledge may be prone to decay over time. Longitudinal, preceptorial-based curriculums may prevent this decay in knowledge.

Objective: To determine if the addition of a year-long, longitudinal MV preceptorial curriculum to a two-part, small-group, simulation-based education block curriculum reduces decay in MV knowledge compared with the education block curriculum alone.

Methods: This was a multicenter prospective cohort study including 123 first-year fellows from 12 critical care fellowship programs who completed a two-part simulation-based education block (control) after the first and sixth months of fellowship. Fellows from one of these programs also participated in a year-long preceptorial curriculum (intervention). MV waveform examination scores over time during fellowship were compared between control versus intervention groups.

Results: Mean test scores increased for both control and intervention groups after the education block courses at Months 1 and 6 of fellowship. Mean (standard deviation) test scores at Month 12 were higher for the intervention group than the control group (89.3 [14.8] vs. 47.7 [21.4]; P < 0.0001). Between 6 months and 3 years of fellowship, there was a significant decay in test scores for the control group (slope estimate [standard error], -13.4 [1.7]; P < 0.0001). However, there was no significant decay in test scores for the intervention group (slope estimate, -2.0 [4.7]; P = 0.67; difference in slope estimates, 11.4 [5.0]; P = 0.02).

Conclusion: The ability of critical care fellows to identify MV waveform asynchronies declines over fellowship training, despite a dedicated two-part, simulation-based MV educational curriculum. The addition of an MV preceptorial course decreased decay of MV knowledge over the course of fellowship training.

Keywords: critical care; education; simulation; training.