The ICU rotation at our hospital is often described as the most valuable educational experience in the internal medicine residency. Previously presented data demonstrated that this educational enhancement cannot be measured. We performed a subset analysis of this data to evaluate disparity among individual ICU topics.
A question bank of over 100 multiple-choice questions was created based on the ABIM Critical Care topics. All questions were reviewed independently by two board-certified intensivists. Interns and residents rotating through the ICU completed a randomized 25 question pre-test within the first 2 days of the month, and a randomized 25 question post-test within the last 2 days of the month (allowing for different call schedules). No changes were made in the standard ICU curriculum, which allows for a daily teaching conference, and twice-daily attending-led bedside rounds.
See Table 1.
The above results demonstrate a wide variance in the testable medical knowledge gained during the ICU rotation. While these results did not achieve statistical significance, likely secondary to small sample size, there was a trend towards significance in many categories. We believe that this illustrates a number of points: (a)In topics commonly encountered in our ICU (sepsis, DKA, and weaning), residents had a measurable increase in testable knowledge. (b)In topics not emphasized in our ICU (APACHE and PA catheters), residents did not demonstrate an increase in testable knowledge. (c)In topics emphasized throughout the internal medicine residency curriculum (Ethics and Acid-Base/Electrolytes), residents maintained an excellent fund of knowledge.
We believe that this information can be used to identify weaknesses and strengths in our ICU curriculum, and will allow us to modify that curriculum to further enhance residents’ testable knowledge.
Selected ABIM TopicPre-Test Percentage Correct (%)nPost-Test Percentage Correct (%)nPercent Change (+/-%)Pulmonary Artery Catheterization12.5815.311+2.8Acid-Base / Electrolyte Disorders50.01272.711+22.7COPD/Asthma72.71180.0107.3Nutrition in the Critical Care Patient33.3632.55-0.8DKA / Hyperosmolar Coma50.01077.79+27.7Sepsis23.01370.010+57.0APACHE14.2711.19-3.1Medical Ethics in the ICU85.7588.89+3.1GI Bleed60.0588.89+28.8Weaning22.2953.813+31.6DISCLOSURE: Jason Golbin, None.