Little data have been published that define the knowledge base of US housestaff regarding critical care pharmacotherapy or whether this knowledge base can be effectively improved through a web-based self-study program. We therefore sought to determine housestaff knowledge of key critical care concepts, and to reassess this knowledge following completion of a series of educational modules.
This was a single center pilot study using housestaff (PGY1 through PGY3). Housestaff were given pretests consisting of 40 questions in ABIM format from several different aspects of critical care pharmacotherapy. This was followed by didactic powerpoint modules on each of the subjects designed by subspecialists in critical care. Following completion of each of the modules, a posttest consisting of the same questions was provided to evaluate objective improvement. The following subjects were included: antibiotics, antifungals, vasopressors and inotropes, status epilepticus, hypertensive emergencies, toxicology, sedation, neuromuscular blockade and nutrition.
Fifteen housestaff completed the pretest, modules, and posttest. The pretest showed a deficit in knowledge across all subjects with an average of 29% of the questions being answered correctly. Although the posttest showed a modest 5% relative improvement following the modules, this did not reach statistical significance (p=.18).
Our housestaff come from a multitude of medical schools across the country and have USMLE scores well above the national average. Despite this, there was a uniform lack of education and/or retention in this area despite formalized pharmacology education during medical school. It appears that this an area that needs either increased emphasis or periodic reeducation and exists as a significant vulnerability to patient safety in its current state.
Housestaff need to be able to properly manage critically ill patients. Didactic lectures may serve to improve knowledge of key concepts and facilitate appropriate patient management. Given the limited time and resources of busy academic critical care clinicicans and work hour restrictions of housestaff, this model allows residents an opportunity for structured didactic education without affecting patient care or lengthening rounds.
Brian Zeno, None.