Department of Respiratory Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Center for Connected Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Respir Care. 2022 Jul;67(7):789-794. doi: 10.4187/respcare.09896. Epub 2022 May 31.
In the course of their education, respiratory therapy students participate in clinical rotations, which are essential to their education. Recently, the number of clinical sites has decreased as some have been eliminated. During the COVID-19 pandemic, schools were challenged to find hospitals to accommodate students due to the risk of infection. Tele-ICU has emerged as a means for staff therapists to assess and monitor patients via remote monitoring systems. We hypothesized that a clinical rotation at a tele-ICU would strengthen students' knowledge of mechanical ventilation, telemedicine, and COVID-19.
In this study, students completed clinical rotations in a tele-ICU. Students spent two 4-h clinical rotations rounding on 320 ICU beds at 5 hospitals. Under the supervision of experienced therapists, students performed remote patient-ventilator assessments, including review and interpretation of ventilator waveforms, patient-ventilator interaction, arterial blood gases, and chest x-rays. Students completed pre- and post-rotation surveys assessing their confidence managing mechanical ventilation, experience with telemedicine, ARDS, and patients with COVID-19.
Mean self-confidence in mechanical ventilation ( = .001), assessing waveforms ( = .001), and knowledge of ARDS increased after the clinical rotation ( = .001). Similarly, reported knowledge related to spontaneous breathing trial protocols ( = .009), lung-protective ventilation ( = .002), patient care planning ( = .001), and use of Excel spreadsheets ( = .002) increased from the beginning to the end of the clinical rotation. Student confidence in interprofessional communication increased from 85 [69-98] to 95 [78-100]; = .03). Overall, the largest change was students' ability to assess patients with COVID-19 (pre-rotation 50.0 [11.5-65.7], post-rotation 80.0 [58.5-100]; = .001). Qualitative results revealed overwhelmingly positive results for both students and preceptors.
Students' confidence in assessing patients via remote monitoring increased in a tele-ICU clinical rotation. Self-assessed knowledge related to COVID-19 also increased to statistical significance.
在教育过程中，呼吸治疗专业的学生需要参加临床实习，这对他们的教育至关重要。最近，由于一些临床实习基地被取消，临床实习基地的数量有所减少。在 COVID-19 大流行期间，由于感染的风险，学校难以找到容纳学生的医院。远程重症监护已成为工作人员治疗师通过远程监测系统评估和监测患者的一种手段。我们假设在远程重症监护病房进行临床实习将加强学生对机械通气、远程医疗和 COVID-19 的知识。
在这项研究中，学生在远程重症监护病房完成临床实习。学生在五家医院的 320 张 ICU 病床进行为期两个 4 小时的临床轮转。在经验丰富的治疗师的监督下，学生进行远程患者-呼吸机评估，包括审查和解释呼吸机波形、患者-呼吸机相互作用、动脉血气和胸部 X 光片。学生在临床实习前后完成调查，评估他们对机械通气的管理信心、远程医疗、急性呼吸窘迫综合征 (ARDS) 和 COVID-19 患者的经验。
临床实习后，机械通气自我效能感（ =.001）、评估波形（ =.001）和 ARDS 知识（ =.001）均有所提高。同样，与自主呼吸试验方案（ =.009）、肺保护性通气（ =.002）、患者护理计划（ =.001）和 Excel 电子表格使用（ =.002）相关的报告知识也从临床实习开始到结束有所增加。学生对跨专业沟通的信心从 85 [69-98]增加到 95 [78-100]； =.03)。总的来说，最大的变化是学生评估 COVID-19 患者的能力（实习前 50.0 [11.5-65.7]，实习后 80.0 [58.5-100]； =.001）。定性结果显示，学生和导师对远程重症监护临床实习的结果均非常积极。
学生通过远程监测评估患者的信心在远程重症监护临床实习中有所提高。自我评估与 COVID-19 相关的知识也显著增加。
