PURPOSE: We have noted that medical residents have an inadequate grasp of the appropriate use of non-invasive positive pressure ventilation (NPPV). This observation was supported by data presented by Nicholas Hill MD at a recent annual conference that confirmed that the main reason for NPPV underutilization is due to a lack of physician knowledge. We propose that medical residents can acquire a better understanding of the indications and proper utilization of NPPV by providing them with a structured lecture format addressing this topic.
METHODS: This is an observational study where internal medicine residents attended a lecture on NPPV and were given pre- and post-tests in order to assess the degree of knowledge acquired. The pre-test consisted of 20 questions given one day prior to the lecture. On the following day, a 45-minute lecture on NPPV was presented and an identical post-lecture test was administered. The participants were unaware that a study was being conducted throughout this period.
RESULTS: Forty-five residents completed the pre-test and 24 completed the post-test. The average pre-test percent correct was 63% and the post-test percent correct was 68%. Subanalysis of the percent correct based in each postgraduate class showed that PGY1s improved from 62% to 71%, PGY2s improved from 67% to 73% and PGY3s showed no change at 63%. Furthermore, based on an accompanying questionnaire, residents claimed to have an increased understanding of NPPV after the lecture (from 56% to 100%).
CONCLUSION: Prior studies have shown that NPPV is becoming increasing utilized for ventilatory support. Our goal was to better prepare residents in utilizing NPPV in our hospital where intensive care resources are limited and NPPV is used frequently in non-monitored units. We found that our residents had increased their knowledge base and that an increased comfort level in utilizing NPPV was noted.
CLINICAL IMPLICATIONS: We translate this as a positive outcome towards improving patient care and plan to further resident understanding by providing either a series of lectures or a weekend seminar on NPPV.
DISCLOSURE: Jeffrey Nascimento, None.