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Effectiveness of medical resident education in mechanical ventilation.

Publication ,  Journal Article
Cox, CE; Carson, SS; Ely, EW; Govert, JA; Garrett, JM; Brower, RG; Morris, DG; Abraham, E; Donnabella, V; Spevetz, A; Hall, JB
Published in: Am J Respir Crit Care Med
January 1, 2003

Specific methods of mechanical ventilation management reduce mortality and lower health care costs. However, in the face of a predicted deficit of intensivists, it is unclear whether residency programs are training internists to provide effective care for patients who require mechanical ventilation. To evaluate these educational outcomes, we administered a validated 19-item case-based test and survey to resident physicians at 31 diverse U.S. internal medicine residency programs nationwide. Of 347 senior residents, 259 (75%) responded. The mean test score was 74% correct (SD, 14%; range, 37 to 100%). Important items representing evidence-based standards of critical care answered incorrectly were as follows: use of appropriate tidal volume in the acute respiratory distress syndrome (48% incorrect), identifying a patient ready for a weaning trial (38% incorrect), and recognizing indication for noninvasive ventilation (27% incorrect). Most accurately identified pneumothorax (86% correct) and increased intrathoracic positive end-expiratory pressure (93% correct). Better scores were associated with "closed" versus "open" intensive care unit organization (76 versus 71% correct, p = 0.001), resident perception of greater versus lesser ventilator knowledge (79 versus 71% correct, p = 0.001), and graduation from a U.S. versus international medical school (75 versus 69% correct, p = 0.033). Although overall training satisfaction correlated strongly with program use of learning objectives (r = 0.89, p < 0.0001), only 46% reported being satisfied with their mechanical ventilation training. We conclude that senior residents may not be gaining essential evidence-based knowledge needed to provide effective care for patients who require mechanical ventilation. Residency programs should emphasize evidence-based learning objectives to guide mechanical ventilation instruction.

Duke Scholars

Published In

Am J Respir Crit Care Med

DOI

ISSN

1073-449X

Publication Date

January 1, 2003

Volume

167

Issue

1

Start / End Page

32 / 38

Location

United States

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Respiratory System
  • Respiration, Artificial
  • Personal Satisfaction
  • Internship and Residency
  • Internal Medicine
  • Evidence-Based Medicine
  • Educational Measurement
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cox, C. E., Carson, S. S., Ely, E. W., Govert, J. A., Garrett, J. M., Brower, R. G., … Hall, J. B. (2003). Effectiveness of medical resident education in mechanical ventilation. Am J Respir Crit Care Med, 167(1), 32–38. https://doi.org/10.1164/rccm.200206-624OC
Cox, Christopher E., Shannon S. Carson, E Wesley Ely, Joseph A. Govert, Joanne M. Garrett, Roy G. Brower, David G. Morris, et al. “Effectiveness of medical resident education in mechanical ventilation.Am J Respir Crit Care Med 167, no. 1 (January 1, 2003): 32–38. https://doi.org/10.1164/rccm.200206-624OC.
Cox CE, Carson SS, Ely EW, Govert JA, Garrett JM, Brower RG, et al. Effectiveness of medical resident education in mechanical ventilation. Am J Respir Crit Care Med. 2003 Jan 1;167(1):32–8.
Cox, Christopher E., et al. “Effectiveness of medical resident education in mechanical ventilation.Am J Respir Crit Care Med, vol. 167, no. 1, Jan. 2003, pp. 32–38. Pubmed, doi:10.1164/rccm.200206-624OC.
Cox CE, Carson SS, Ely EW, Govert JA, Garrett JM, Brower RG, Morris DG, Abraham E, Donnabella V, Spevetz A, Hall JB. Effectiveness of medical resident education in mechanical ventilation. Am J Respir Crit Care Med. 2003 Jan 1;167(1):32–38.

Published In

Am J Respir Crit Care Med

DOI

ISSN

1073-449X

Publication Date

January 1, 2003

Volume

167

Issue

1

Start / End Page

32 / 38

Location

United States

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Respiratory System
  • Respiration, Artificial
  • Personal Satisfaction
  • Internship and Residency
  • Internal Medicine
  • Evidence-Based Medicine
  • Educational Measurement
  • 3202 Clinical sciences