Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room D108, Toronto, ON, M4N3M5, Canada.
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2021 Feb;68(2):235-244. doi: 10.1007/s12630-020-01850-x. Epub 2020 Nov 10.
Residency programs need to understand the competencies developed by residents during an intensive care unit (ICU) rotation, so that curricula and assessments maximize residents' learning. The primary study objective was to evaluate the feasibility for training programs and acceptability by residents of conducting a multi-competency assessment during a four-week ICU rotation.
We conducted a prospective, multicentre observational pilot study in three ICUs. During weeks 1 and 4 of an ICU rotation, we conducted repeated standardized assessments of non-critical care specialty residents' competencies in cognitive reasoning (script concordance test [SCT]), procedural skills (objective structured assessment of technical skills [OSATS]-global rating scale], and communication skills through a written test, two procedural simulations, and a simulated encounter with a "family member". The feasibility outcomes included program costs, the proportion of enrolled residents able to complete at least one three-station assessment during their four-week ICU rotation, and acceptability of the assessment for the trainees.
We enrolled 63 (69%) of 91 eligible residents, with 58 (92%) completing at least one assessment. The total cost to conduct 90 assessments was CAD 33,800. The majority of participants agreed that the assessment was fair and that it measured important clinical abilities. For the 32 residents who completed two assessments, the mean (standard deviation) cognitive reasoning and procedural skill scores increased between weeks 1 and 4 [SCT difference, 3.1 (6.5), P = 0.01; OSATS difference for bag-mask ventilation and central line insertion, 0.4 (0.5) and 0.6 (0.8), respectively; both P ≤ 0.001]. Nevertheless, the communication scores did not change significantly.
A monthly multi-competency assessment for specialty residents rotating in the ICU is likely feasible for most programs with appropriate resources, and generally acceptable for residents. Specialty residents' cognitive reasoning and procedural skills may improve during a four-week ICU rotation, whereas communication skills may not.
住院医师培训计划需要了解住院医师在重症监护病房（ICU）轮转期间所培养的能力，以便课程和评估能够最大限度地提高住院医师的学习效果。主要研究目的是评估培训计划的可行性以及住院医师在四周 ICU 轮转期间进行多项能力评估的可接受性。
我们在三个 ICU 进行了一项前瞻性、多中心观察性试点研究。在 ICU 轮转的第 1 周和第 4 周，我们对非重症监护专业住院医师的认知推理能力（脚本一致性测试[SCT]）、程序技能（客观结构化评估技术技能[OSATS]-全球评分）和沟通技能进行了重复的标准化评估，通过书面测试、两个程序模拟和与“家属”的模拟接触来进行。可行性结果包括计划成本、在四周 ICU 轮转期间至少完成一次三站评估的入组住院医师比例以及住院医师对评估的接受程度。
我们入组了 91 名符合条件的住院医师中的 63 名（69%），其中 58 名（92%）完成了至少一次评估。进行 90 次评估的总费用为 33800 加元。大多数参与者认为评估公平，并能衡量重要的临床能力。对于完成两次评估的 32 名住院医师，认知推理和程序技能评分在第 1 周和第 4 周之间有所增加[SCT 差异为 3.1（6.5），P=0.01；袋面罩通气和中心静脉置管的 OSATS 差异分别为 0.4（0.5）和 0.6（0.8），均 P≤0.001]。然而，沟通评分没有显著变化。
对于大多数有适当资源的计划来说，每月对在 ICU 轮转的专科住院医师进行多项能力评估可能是可行的，并且通常也能被住院医师接受。专科住院医师的认知推理和程序技能可能会在四周的 ICU 轮转期间有所提高，而沟通技能可能不会。
