Hayashi Fatima K, Sousa Mayson L A, Garcia Marcos V F, Macedo Bruno R, Ferreira Juliana C
Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Interdepartmental Division of Critical Care Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
ATS Sch. 2022 Jun 30;3(2):204-219. doi: 10.34197/ats-scholar.2021-0130OC. eCollection 2022 Jun.
Mechanical ventilation (MV) skills are essential for clinicians caring for critically ill patients, yet few training programs use structured curricula and appropriate assessments. Objective structured clinical exams (OSCEs) have been used to assess clinical competency in many areas, but there are no OSCE models focused on MV.
To develop and validate a simulation-based assessment (SBA) with an OSCE structure to assess baseline MV competence among residents and identify knowledge gaps.
We developed an SBA using a lung simulator and a mechanical ventilator, and an OSCE structure, with six clinical scenarios in MV. We included internal medicine residents at the beginning of their rotation in the respiratory intensive care unit (ICU) of a university-affiliated hospital. A subset of residents was also evaluated with a validated multiple-choice exam (MCE) at the beginning and at the end of the ICU rotation. Scores on both assessments were normalized to range from 0 to 10. We used Cronbach's α coefficient to assess reliability and Spearman correlation to estimate the correlation between the SBA and the MCE.
We included 80 residents, of whom 42 also completed the MCE examinations. The final version of the SBA had 32 items, and the Cronbach's α coefficient was 0.72 (95% confidence interval [CI], 0.64-0.81). The average SBA score was 6.2 ± 1.3, and performance was variable across items, with 80% correctly adjusting initial ventilatory settings and only 12% correctly identifying asynchrony. The MCE had 24 questions, and the average score was 7.6 ± 2.4 at the beginning of the rotation and 8.2 ± 2.3 at the end of the rotation (increase of 0.6 points; 95% CI, 0.30-0.90; < 0.001). There was moderate correlation between the SBA and the MCE (rho = 0.41; = 0.002).
We developed and validated an objective structured assessment on MV using a pulmonary simulator and a mechanical ventilator addressing the main competencies in MV. The performance of residents in the SBA at the beginning of an ICU rotation was lower than the performance in MCE, highlighting the need for greater emphasis on practical skills in MV during residency.
机械通气（MV）技能对于照料重症患者的临床医生至关重要，但很少有培训项目采用结构化课程和适当的评估方法。客观结构化临床考试（OSCE）已被用于评估许多领域的临床能力，但尚无专注于MV的OSCE模式。
开发并验证一种具有OSCE结构的基于模拟的评估（SBA），以评估住院医师的MV基线能力并识别知识差距。
我们使用肺模拟器和机械通气机开发了一种SBA，并采用OSCE结构，包含六个MV临床场景。我们纳入了大学附属医院呼吸重症监护病房（ICU）轮转初期的内科住院医师。一部分住院医师在ICU轮转开始和结束时还接受了一项经过验证的多项选择题考试（MCE）。两项评估的分数均标准化为0至10分。我们使用Cronbach's α系数评估可靠性，并使用Spearman相关性来估计SBA与MCE之间的相关性。
我们纳入了80名住院医师，其中42人还完成了MCE考试。SBA的最终版本有32个项目，Cronbach's α系数为0.72（95%置信区间[CI]，0.64 - 0.81）。SBA的平均分数为6.2±1.3，各项目表现存在差异，80%的人能正确调整初始通气设置，只有12%的人能正确识别不同步。MCE有24个问题，轮转开始时平均分数为7.6±2.4，轮转结束时为8.2±2.3（提高了0.6分；95% CI，0.30 - 0.90；P<0.001）。SBA与MCE之间存在中度相关性（rho = 0.41；P = 0.002）。
我们使用肺模拟器和机械通气机开发并验证了一项关于MV的客观结构化评估，涵盖了MV的主要能力。ICU轮转初期住院医师在SBA中的表现低于MCE，这凸显了在住院医师培训期间需要更加强调MV的实践技能。
