PURPOSE:Managing patients requiring mechanical ventilation is complicated requiring integration of many different factors. There is no universally accepted method or curriculum used to teach mechanical ventilation. Teaching practices vary widely between fellowship training programs. Management practices vary considerably between physicians and new evidence can take years to be put into practice. As a first step towards developing a formal structured program for teaching mechanical ventilation to fellows, we surveyed program directors and fellows to determine how fellows are currently educated and to identify potential barriers to learning this skill.
METHODS:Separate surveys were sent via e-mail to program directors, selected faculty and fellows in pulmonary and or critical care fellowships using surveymonkey.com. The surveys consisted of 42 (faculty survey) or 45 (fellow survey) multiple choice questions with comment fields included for most questions. Data was collected and statistical analysis was performed with GraphPad Prism.
RESULTS:Responses were received from 108 of 155 programs (81 program directors, 27 other faculty) and 331 of 1440 fellows. Only 50% of fellows reported satisfaction with their education in mechanical ventilation. Presence of formal educational activities (longitudinal programs, hands on sessions, and an introduction course) correlated with fellow satisfaction in mechanical ventilation education (p</=0.0005). Similarly, confidence with management of secondary ventilator settings, waveform analysis, and identification and treatment of patient-ventilator asynchrony also correlated with fellow satisfaction in mechanical ventilation education (p<0.0001). Additionally, teaching methods, supervision, knowledge of respiratory physiology (p<0.0001), and active presence of respiratory therapists (p=0.0039) all correlated with fellow satisfaction in mechanical ventilation education.
CONCLUSION:Fellowship education in mechanical ventilation is not uniform and fellow satisfaction with the process is suboptimal. The key finding of this study is that formal education programs and knowledge leading to confidence in specific areas are desirable, yet not consistently offered nor taught. We conclude that a well-structured formal education program is necessary to teach fellows mechanical ventilation.
CLINICAL IMPLICATIONS:Providing a formal program for teaching mechanical ventilation may improve education and satisfaction with training and ultimately improve outcomes.
DISCLOSURE:Donald Brescia, No Financial Disclosure Information; No Product/Research Disclosure Information