. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas -HCFMUSP - Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.
J Bras Pneumol. 2020 Jun 15;46(5):e20190108. doi: 10.36416/1806-3756/e20190108. eCollection 2020.
To develop and apply a competency-based test to assess learning among internal medicine residents during a respiratory ICU rotation at a university hospital.
We developed a test comprising 19 multiple-choice questions regarding knowledge of mechanical ventilation (MV) and 4 self-assessment questions regarding the degree of confidence in the management of MV. The test was applied on the first and last day of a 30-day respiratory ICU rotation (pre-rotation and post-rotation, respectively). During the rotation, the residents had lectures, underwent simulator training, and shadowed physicians on daily bedside rounds focused on teaching MV management.
Fifty residents completed the test at both time points. The mean score increased from 6.9 ± 1.2 (pre-rotation) to 8.6 ± 0.8 (post-rotation; p < 0.001). On questions regarding the approach to hypoxemia, the recognition of patient-ventilator asynchrony, and the recognition of risk factors for extubation failure, the post-rotation scores were significantly higher than the pre-rotation scores. Confidence in airway management increased from 6% before the rotation to 22% after the rotation (p = 0.02), whereas confidence in making the initial MV settings increased from 31% to 96% (p < 0.001) and confidence in adjusting the ventilator modes increased from 23% to 77% (p < 0.001).
We developed a competency-based test to assess knowledge of MV among residents before and after an rotation in a respiratory ICU. Resident performance increased significantly after the rotation, as did their confidence in caring for patients on MV.
开发并应用一项基于能力的测试，以评估在大学附属医院呼吸重症监护病房轮转期间内科住院医师的学习情况。
我们开发了一个包含 19 个关于机械通气（MV）知识的多项选择题和 4 个关于 MV 管理信心程度的自我评估题的测试。该测试分别在 30 天呼吸重症监护病房轮转的第一天（预轮转）和最后一天（后轮转）进行。在轮转期间，住院医师参加了讲座，接受了模拟培训，并在日常床边查房中跟随医生，重点学习 MV 管理。
50 名住院医师在两个时间点都完成了测试。平均分从 6.9 ± 1.2（预轮转）提高到 8.6 ± 0.8（后轮转；p < 0.001）。在关于低氧血症处理方法、识别患者-呼吸机不同步和识别拔管失败危险因素的问题上，后轮转的分数明显高于前轮转的分数。气道管理的信心从轮转前的 6%增加到轮转后的 22%（p = 0.02），而初始 MV 设置的信心从 31%增加到 96%（p < 0.001），调整呼吸机模式的信心从 23%增加到 77%（p < 0.001）。
我们开发了一项基于能力的测试，以评估住院医师在呼吸重症监护病房轮转前后对 MV 的了解程度。住院医师在轮转后表现显著提高，对 MV 患者护理的信心也有所增强。
