Rocha de Macedo Bruno, Lima Carolina Saldanha, Haydar Ahmed, Holanda Marcelo Alcantara, Hayashi Fatima Kiyoko, Ferreira Juliana Carvalho
Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; and.
ATS Sch. 2025 Jun;6(2):202-216. doi: 10.34197/ats-scholar.2024-0083OC. Epub 2025 Feb 18.
Mechanical ventilation (MV) skills are crucial for clinicians who care for critically ill patients; however, few training programs incorporate structured curricula and appropriate assessments. The use of virtual simulators for teaching and assessments has not been evaluated and can offer advantages. To create an MV competency-based course for internal medicine residents using a virtual simulator and to evaluate course impact. We developed an online, 8 month, competency-based MV course for internal medicine residents, including virtual simulation. Each module included a 1-hour session (20 min of lecture, 40 min of virtual simulation) and self-directed learning material. Engagement was reinforced through live meetings, an online platform, and group chats. To evaluate competency, we adapted a validated simulation-based assessment to a virtual MV simulator (virtual simulation-based assessment [SBA]). Course impact was evaluated using the four-level Kirkpatrick model, including surveys for satisfaction and confidence (level 1), knowledge assessment with a multiple-choice examination (level 2), and deliberate practice with the simulator and clinical competence on the virtual SBA (level 3). Eighty-one residents out of 103 completed the course and rated it as effective, with a net promoter score of 9.2. The use of virtual simulation was rated as very useful by most participants. Confidence in caring for patients under MV in different scenarios before and after the course significantly increased. On a 10-point scale, the multiple-choice examination score increased 1.19 points (95% confidence interval, 0.91-1.47; < 0.001) from baseline to the end of the course, and the virtual SBA score at the end of the course was 6.15 ± 1.26 for post-graduate year 1 residents and 6.48 ± 1.56 for post-graduate year 2 residents ( = 0.33). Performance on different competencies varied, with lower scores on tasks such as asynchrony correction. Ninety-nine percent of residents reported a very positive (58%) or positive (41%) impact of the course in their practice. We developed a satisfactory and effective MV course including virtual simulation for internal medicine residents during the COVID-19 pandemic. Confidence and knowledge increased by the end of the course, although performance on complex MV skills was suboptimal. The use of virtual simulators for teaching and assessment are valuable new tools for teaching MV.
机械通气（MV）技能对于护理重症患者的临床医生至关重要；然而，很少有培训项目纳入结构化课程和适当评估。虚拟模拟器在教学和评估中的应用尚未得到评估，但其具有诸多优势。为使用虚拟模拟器为内科住院医师创建一门基于MV能力的课程并评估课程效果。我们为内科住院医师开发了一门为期8个月的在线、基于能力的MV课程，包括虚拟模拟。每个模块包括1小时的课程（20分钟讲座、40分钟虚拟模拟）和自主学习材料。通过现场会议、在线平台和群组聊天加强参与度。为评估能力，我们将经过验证的基于模拟的评估改编为虚拟MV模拟器（基于虚拟模拟的评估[SBA]）。使用四级柯克帕特里克模型评估课程效果，包括满意度和信心调查（第1级）、多项选择题知识评估（第2级）以及在模拟器上的刻意练习和虚拟SBA上的临床能力（第3级）。103名居民中有81名完成了课程并认为其有效，净推荐值为9.2。大多数参与者认为虚拟模拟的使用非常有用。课程前后在不同场景下护理接受MV治疗患者的信心显著增强。在10分制中，多项选择题考试成绩从基线到课程结束时提高了1.19分（95%置信区间，0.91 - 1.47；P < 0.001），课程结束时一年级住院医师的虚拟SBA成绩为6.15 ± 1.26，二年级住院医师为6.48 ± 1.56（P = 0.33）。不同能力的表现有所不同，例如在异步校正等任务上得分较低。99%的居民报告该课程对他们的实践产生了非常积极（58%）或积极（41%）的影响。我们在新冠疫情期间为内科住院医师开发了一门令人满意且有效的包括虚拟模拟的MV课程。课程结束时信心和知识有所增加，尽管复杂MV技能的表现仍不理想。使用虚拟模拟器进行教学和评估是MV教学的有价值新工具。
