Impact of a respiratory ICU rotation on resident knowledge and confidence in managing mechanical ventilation

Fátima Kiyoko Hayashi, Pedro Paulo Marino Rodrigues Ayres, Anna Miethke Morais, Mayson Laércio de Araújo Sousa, Carmen Sílvia Valente Barbas, Eduardo Leite Vieira Costa, Pedro Caruso, Juliana Carvalho Ferreira

To develop and apply a competency-based test to assess learning among internal medicine residents during a respiratory ICU rotation at a university hospital. We developed a test comprising 19 multiple-choice questions regarding knowledge of mechanical ventilation (MV) and 4 self-assessment questions regarding the degree of confidence in the management of MV. The test was applied on the first and last day of a 30-day respiratory ICU rotation (pre-rotation and post-rotation, respectively). During the rotation, the residents had lectures, underwent simulator training, and shadowed physicians on daily bedside rounds focused on teaching MV management. Fifty residents completed the test at both time points. The mean score increased from 6.9 ± 1.2 (pre-rotation) to 8.6 ± 0.8 (post-rotation; p < 0.001). On questions regarding the approach to hypoxemia, the recognition of patient-ventilator asynchrony, and the recognition of risk factors for extubation failure, the post-rotation scores were significantly higher than the pre-rotation scores. Confidence in airway management increased from 6% before the rotation to 22% after the rotation (p = 0.02), whereas confidence in making the initial MV settings increased from 31% to 96% (p < 0.001) and confidence in adjusting the ventilator modes increased from 23% to 77% (p < 0.001). We developed a competency-based test to assess knowledge of MV among residents before and after an rotation in a respiratory ICU. Resident performance increased significantly after the rotation, as did their confidence in caring for patients on MV.