PURPOSE:The intensive care unit (ICU) is a complex and evolving environment that is an important site for postgraduate medical training. However, the demands of patient care in the ICU coupled with residents’ duty restriction regulations have made critical care education challenging. To determine how different institutions provide resident education and training in critical care medicine, we surveyed academic institutions with pulmonary and critical care medicine (PCCM) fellowship programs.
METHODS:A web-based survey was sent to all PCCM program directors in the US. Up to 4 attempts at contact were made to non-responders. The questions focused on characteristics of ICU rotations, educational resources, and teaching practices. Statistical analyses were performed to identify teaching trends and relationships among measured variables.
RESULTS:Of 134 PCCM program directors, 63 (47%) responded. The median ICU size was 16 beds (range 7 to 52) and ICU teams most commonly had 8 residents from all PGY levels. 22% of programs had a “nightfloat” system, and 34% had a “cap” on resident admissions. Table 1 demonstrates the frequency of various teaching methods used. Teaching time was longer during weekdays than weekends (3.0+1.2 hr/day vs. 1.9+1.3 hr/day, p<0.001). 59% of programs that reported they spend >40% of ICU rounds on teaching. Of these programs, more time was spent teaching in medical vs. “mixed” ICUs (68% of programs vs. 38%, p<0.05), in larger (>20 beds) ICUs (76% vs. 49% in < 20 beds, p<0.05), and in programs with a “nightfloat” system (66% vs. 34% without, p<0.05). When asked about the effect of the 80-hour limit work week on resident education, most (58%) respondents felt it had a negative effect, and the majority (63%) reported it “somewhat or very likely” changed their approach to resident education in the ICU.
CONCLUSION:Educational practices vary across different ICUs. Teaching time is affected by ICU demographics and resident workload.
CLINICAL IMPLICATIONS:Further evaluation of current and novel educational methods and the development of an effective teaching system in critical care medicine are warranted.
DISCLOSURE:Khalid Almoosa, No Financial Disclosure Information; No Product/Research Disclosure Information