What effect does an educational intervention have on interns' confidence and knowledge regarding acute dyspnea management?. A randomized controlled trial

Abstract

Though acute dyspnea is commonly encountered in hospitalized patients, interns often receive only informal instruction in managing such patients. We hypothesized that formal instruction would improve interns' knowledge and confidence in managing patients with acute dyspnea. Twenty-six internal medicine interns were randomized to receive either standard education or standard education plus the educational intervention. The educational intervention included two small-group, case-based discussions on acute dyspnea management. All participants completed pre- and post-intervention surveys over four months that assessed their knowledge and confidence in managing patients with acute dyspnea. Of the 16 interns in the intervention group, 14 attended one of the two small-group sessions while seven attended both sessions. Mean confidence increased by 21.2% in the intervention group and 14.4% in the control group. The trend over time for both groups was significant (P < .001); the effect of the intervention was not (P = .19). Mean knowledge scores increased 7.6% in the intervention group and 5.5% in the control group. Again, the trend over time for both groups was significant (P < .01), but the effect of the intervention was not (P = .65). A per-protocol analysis revealed a trend toward significance with mean scores increasing 15.6% (P = .067). Our trial found that intern confidence and knowledge about acute dyspnea management increased significantly over time; however, no significant differences between the intervention and control groups were seen. The complete intervention was not administered to the majority of the intervention group, thereby skewing results to the null. The per-protocol analysis suggests attendance at educational sessions may improve knowledge. Future interventions should use a more sensitive testing instrument, a larger sample, and a more powerful intervention.