Critical Care Education Research Articles

Trauma, Critical Care, and Medical Education in the Face of COVID-19

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Knowledge and Confidence of Final-Year Medical Students Regarding Critical Care Core-Concepts, a Comparison between Problem-Based Learning and a Traditional Curriculum.

Background:Medical undergraduates should be prepared to recognize life threating critical conditions. Undergraduate medical curriculum development to incorporate more critical care education is an essential requirement. Problem Based Learning curriculum has a potential advantage in providing more focused critical care education to medical undergraduate.Objectives:We aimed to evaluate the final year medical students’ knowledge and confidence in key critical care concepts in Problem Based Learning (PBL) curriculum compared to those in Traditional (Lecture) Based Learning curriculum. We also aimed to evaluate undergraduate’s level of satisfaction with the exposure to critical care education during medical education and training.Materials and methods:This is a cross-sectional anonymous self-administered survey questionnaire completed by two groups of final-year medical students (PBL and TBL) from three Saudi medical schools to assess the degree of undergraduate exposure to critical care and their knowledge of key critical care assessment parameters.Results:The responses of 279 final year medical students was analyzed (70% response rate). The majority (53%) was male and the mean age 23.9 ± 1.4 years. Only 13% of students felt confident to manage hypovolemic shock and 15% could recognize the signs of a threatened airway. One third of the students (29%) correctly identified the critical level of lactic acid in shock and less than 2% of the sample responded correctly to all the questions related to the formal assessment of critically ill patients. Lectures were the main source of information in acute care. More than two-thirds (46%) of the sample indicated that they received tuition in critical care, however the total duration spent in a critical care rotation or teaching was 1 day or less. The medical students, who completed their training with a Problem-Based Learning curriculum, had a higher knowledge base and were more confident in many critical care concepts. Only 6.5% choose critical care as their likely future career.Conclusion:Medical undergraduates in PBL have an overall better knowledge on key concepts and assessment tools applicable to evaluating and managing critically ill patients compared to students in TBL. However the gap in knowledge and confidence in assessing ill patients in both groups is evident. Critical care was not chosen as a preferred future career in all surveyed students. There is a need for institutional support and endorsement of undergraduate critical care exposure and education in Saudi Universities both to better prepare medical students for their imminent post-graduates exposure to ill patients and to help in closing the gap in critical care physicians through promoting the specialty.

Critical Care Education in a Pandemic through Tele-ICU.

Critical Care Education in a Pandemic through Tele-ICU.

Medical Education in Pulmonary, Critical Care, and Sleep Medicine: Advanced Concepts and Strategies

Medical education has evolved from simple transfer of knowledge to collaborative problem solving. Learners are encouraged to actively engage rather than passively consume. Most physicians will eventually serve as teachers for students, residents, fellows, and associated professionals. While teaching skills will be acquired by most over the course of their professional life, the art of teaching is not yet adequately addressed in medical education programs. Thus, a textbook on teaching focused on clinicians is filling a void. This was the first edition and was published in 2019. Both a paperback and an eBook edition are available. The contents of the eBook are identical to the print version. The book is part of a series on respiratory medicine. This book is first in providing guidance, practical teaching, and learning tips in the field of respiratory, critical care, and sleep medicine. The editors and most of the authors are senior specialists from renowned academic institutions in the United States. Two authors from Ireland add an international perspective. The preface is extensive and worth reading as it details how the content is set out, providing an orientation to the reader. While all chapters of the book are relevant, the introductory chapters enable a reader with time constraints to focus on passages that are most relevant. This book provides not only an educator’s perspective but also that of the learner, thus benefiting both parties involved. The book is divided into 15 chapters. It first covers teaching in the various stages of medical education. It continues with teaching in diverse clinical situations and concludes with various teaching techniques. Chapters 1–4 cover the learner’s journey from a preclinical student to the respiratory fellow. Methods of teaching in the clinical and classroom settings are elaborated. Techniques to engage learners in the learning process are explained, allowing learners to become motivated and more involved in the learning process. Chapters 5 and 6 detail classroom teaching in large as well as small groups (nonclinical environments). The pitfalls and advantages of both settings are included. Chapter 7 conveys the principles of bedside teaching. Chapters 8–10 detail teaching in clinical settings, where patient care, time constraints, and learning objectives come into play. Various settings are covered from teaching in clinic (Chapter 8), inpatient service (Chapter 9) to critical care (Chapter 10). Best practices and evidence-based material are provided to guide teaching and learning. Direct examples from the specialty are also incorporated to aid the reader in formulating teaching approaches. As an example, Chapter 10 focuses on teaching in the intensive care unit (ICU). It starts with expectations of learner and teacher, provides structures for rounding, and suggests teaching with clinical applications. In one case, a patient with hypercapnic respiratory failure is encountered during rounds, and the resident is guided to the appropriate therapy by the instructor. Chapters 11–15 focus on blended learning approaches such as simulation, web-based learning, and the use of feedback to enhance and promote learning. Practical tips to multiple feedback approaches are also given. The book covers the art of teaching from basic principles and teaching strategies to their application to several clinical settings with examples easily adaptable to settings relevant to the reader. Besides classroom and bedside teaching, simulation, web-based learning, and blended learning approaches are introduced. While written by different authors, the chapters build upon each other. The sections covering clinical situations use techniques covered in the first chapters of the book. Excellent examples with suggestions for actively engaging students are easily transferred to other clinical settings. We were able to use teaching principles, conversation strategies, and suggestions for feedback to the courses we teach in emergency medicine, anesthesiology, critical care, and pain medicine. The entire book is well written and easy to read. The content is clearly outlined and logically arranged. The book very nicely illustrates medical education principles with clinical examples relevant to pulmonary and critical care medicine. While different approaches are described for teaching at the various career stages, many of the concepts are broadly applicable. The written content is regularly interposed with illustrations and tables, which enhance the reading experience. While the book covers pulmonary, critical care and sleep medicine, we do recommend it for anesthesiologists: the principles of teaching and the methods suggested for different settings are universally applicable. The approaches for interactive teaching during ward rounds relate to the anesthesia setting as well. Thus, while not the original targeted readership, anesthesiologists involved in teaching or learning will welcome this book. Cynthia Szalai FRCA, MMEDepartment of Anesthesiology and Intensive Care MedicineUniversity Hospital EssenCurriculum Development and Competence, Dean’s OfficeFaculty of MedicineUniversity Duisburg-EssenEssen, Germany Frank Herbstreit, Dr medDepartment of Anesthesiology and Intensive Care MedicineUniversity Hospital EssenUniversity Duisburg-EssenEssen, Germany[email protected]

Rapid Deployment of Critical Care Nurse Education During the COVID-19 Pandemic

This study evaluated nurses’ perceptions of a rapidly deployed critical care education program conducted to prepare a community hospital for its transformation to a COVID-19 treatment center. The education included a traditional didactic approach and incorporated experienced nursing support staff at the bedside. Nurses were interviewed about the strengths and weaknesses of the program, and for their perceptions of the additional clinical support. A distributed learning model with small groups attending multiple trainings could have improved the didactic session. However, there was positive feedback about the use of a “buddy” system and critical care education specialist in the intensive care unit setting.

A Study to Assess the Effectiveness of Critical Care Education on Knowledge of Students in Care of Patients with Mechanical Ventilator among Nursing Students in Srm College of Nursing, Kattankulathur, Tamil Nadu, India

Critical care education among nursing students is an emerging topic globally.Nurses lead a vital role in all hospital setting. Critical care nursing skills must be taught to the student nurses to provide optimum care during emergency situation.The present study assessed the impact of critical care education among students in SRM College of Nursing. A quantitative study with one group pre and posttest design was used.Totally hundred students between age group 18-20yrs participated in the study. After explaining and getting their consent by convenient sampling technique pretest was taken with 18 self structured objective type questions.Education on critical care was given by experts on current trends, technologies, evidenced based practice, pharmacological management, and role play, quality nursing care during ventilator support and legal responsibilities in critical care for 6 hrs. After the education post assessment was done with same questionnaire. Analysis was done with descriptive, MCNemar’s test, and student paired t test. The post knowledge of students with care of patient in mechanical ventilator was significant with p < 0.05. This study high lights the need for educating the staff in critical care in the hospital setting.

Using the Systems Engineering Initiative for Patient Safety (SEIPS) model to describe critical care nursing during the SARS-CoV-2 pandemic (2020).

Using the Systems Engineering Initiative for Patient Safety (SEIPS) model to describe critical care nursing during the SARS-CoV-2 pandemic (2020).

Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents

Critical care medicine (CCM) is central to emergency medicine (EM) resident education. We feel that the traditional lecture format is not the ideal way to teach EM critical care, which requires integration and prioritization of diagnostic workup and team-based resuscitation under time pressure. We describe a novel critical care education day where an interactive, practical, and multidisciplinary critical care educational experience was provided for EM residents using case-based small-group sessions and fast-paced simulation.

The alfred ICU international program: fiji-colonial war memorial hospital, suva & alfred icu collaboration teaching (fact) project

Introduction: Fiji is a low-income country. Health care services are distributed between four health care delivery Divisions. The Colonial War Memorial (CWM) Hospital in Suva is one of the three Divisional Hospitals, with the largest intensive care unit (ICU) in Fiji. CWM Hospital provides basic skills training for health care providers from other South Pacific countries. However, there is a lack of specialist medical and nurse training, including in critical care, in the region. In 2014 CWM Hospital partnered with The Alfred ICU to assist with the provision of critical care education and training. Aims: To improve critical care delivery in the South Pacific by sharing the expertise of Alfred ICU staff. To evaluate the delivery of intensive care education by the Alfred ICU in CWM Hospital. Methods: Alfred ICU staff have delivered courses to doctors at CWM Hospital since 2015 on a variety of topics, including Medical Basic Assessment and Support in Intensive care (BASIC) course. To further enhance delivery of care, in 2019 the Alfred ICU team provided the first formal Nursing BASIC course for intensive care and high dependency unit nurses. Course evaluation was undertaken with pre- and post-course testing of participants. Results: Over 150 doctors from different South Pacific countries have participated in courses delivered by the Alfred ICU at CWM Hospital since 2015. In 2019 the delivery of our first formal nursing course has showed an improvement of knowledge related to critical care nursing of up to 40% by comparing pre and post-course MCQ marks. Conclusion: The Alfred ICU has supported critical care education for both medical and nursing staff in Fiji. Through an ongoing partnership, we will continue to assist CWM Hospital and Fiji National University to develop an appropriate curriculum for both medical and nursing Intensive care training in the South Pacific.

Application Value of Evidence-based Nursing in Patients with Multiple Myeloma and Evaluation of Nursing Quality

<i>Objective</i> to explore the application value and quality of evidence-based nursing in patients with multiple myeloma. <i>Methods</i> A total of 92 patients with multiple myeloma from December 2016 to December 2019 were selected as observation objects, and they were divided into control group 46 and observation group 46 according to the order of admission. The control group was given routine nursing care, and the observation group was given evidence-based nursing care. The bone pain relief rate, Pittsburgh Sleep Quality Score (PSQI), anxiety self-rating scale (SAS) score, depression self-rating scale (SDS) score and nursing quality were compared between the two groups. <i>Results</i>: The relief rate of bone pain in the observation group was higher than that in the control group (P <0.05). The quality of sleep, sleep time, sleep time, sleep efficiency, sleep disorders, daytime dysfunction scores and PSQI total scores in the observation group were lower than those in the control group after nursing (P <0.05). P <0.05); SAS and SDS scores in the observation group were lower than those in the control group after nursing (P <0.05). After the implementation of evidence-based nursing, the quality of basic nursing, specialist nursing, critical care, ward management, and health education nursing care of nursing staff was higher than that before implementation (P <0.05). <i>Conclusion</i> Applying evidence-based nursing to patients with multiple myeloma can improve bone pain relief, improve sleep quality, reduce anxiety and depression, and improve the quality of care.

Development of an Undergraduate Medical Education Critical Care Content Outline Utilizing the Delphi Method

No consensus exists on a standardized critical care content outline for medical student education. The aim of this research is to develop a national undergraduate medical education critical care content outline. The authors used a Delphi process to reach expert consensus on a content outline that identified the core critical care knowledge topics and procedural skills that medical students should learn prior to entering residency. Over three iterative rounds, the expert panel reached consensus on a critical care content outline. An electronic survey of critical care medical educators, residency program directors, and residents in the United States. The expert panel included three groups as follows: 1) undergraduate medical education critical care educators, 2) residency program directors representing all core specialties, and 3) residents representing their core specialties. None. The expert panel included 28 members. Experts represented the following medical specialties: anesthesiology, emergency medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery. Seventeen experts had subspecialty training in critical care. The expert panel identified 19 highly recommended critical care knowledge topics and procedural skills. These topics and procedural skills were grouped into five broad categories as follows: 1) neurologic, 2) respiratory, 3) cardiovascular, 4) renal and electrolytes, and 5) supplemental ICU topics. Bag-mask ventilation was the only procedural skill identified as highly recommended. This study provides a national consensus undergraduate medical education critical care content outline. By including experts from multiple specialties, this content outline is meaningful for medical student education, independent of medical specialty. The content outline represents a first step in the development of a national undergraduate medical education critical care curriculum.

Reflective learning conversations as an approach for clinical learning and teaching in critical care

Background: Reflective practice has become an integral element in healthcare and education.1,2 Hamad Medical Corporation (HMC) is the largest healthcare organization in Qatar and it aims to: develop highly competent healthcare practitioners, promote nurses’ critical thinking, enhance the implementation of evidence-based practice, encourage deep learning approaches, create positive learning environments, maintain patient safety, and bridge the gap between theory and practice in the critical care clinical settings.3 To achieve this, in 2015, reflective learning conversations and debriefing educational methods have been introduced by the HMC Nursing Education and Research Department. Methods: The HMC critical care education team introduced a new one-hour Continuing Professional Development (CPD) educational activity under the title of “Reflective learning conversation and debriefing”. This educational activity has been officially added to the critical care monthly and annual education plans and calendars. The reflective and debriefing discussion aims to give the chance for the critical care practitioners to share their real clinical experiences.1,2,4,5 The critical care nurses of HMC attend each session in a group of 5-7 clinicians and they are asked to reflect critically on a real clinical cases in relation to challenges, limitations, pitfalls, and improvement plan.2,5 A facilitator with a clinical and educational background facilitates the discussion and nurses are encouraged to summarize the learning lessons from that experience in addition to the recommendations and action plans which will be decided accordingly. This is then disseminated and shared with other healthcare facilities if it fits their scope of service. The reflective learning conversation and debriefing guidelines and protocol were established by the corporate nursing education team and are available to clinicians and facilitators (Table 1). Results: Reflective learning conversation with a debriefing improves nurses and health care practitioner's critical thinking and competency level which was evident by learners’ feedback and clinical competency assessment (Table 2). Furthermore, that educational activity is an attractive teaching and learning method to create dynamic learning environments in the critical care clinical settings which was evident by learners and facilitators’ feedback (Table 2). Moreover, nurse empowerment and active engagement were enhanced and encouraged by applying that educational method which was evidenced by the clinical experts’ feedback (Table 2). Finally, applying that method was effective to enhance evidence-based practice and patient safety in critical care settings (Table 3). Conclusion: Reflective learning conversations and debriefing has been perceived to be an effective learning method. Healthcare practitioners can learn from errors and previous experiences to avoid future mistakes in clinical practice. Sharing clinical experiences provides a medium to discuss cases from different angles and in depth which helps to promote deep learning, evidence-based practice, active learning, and patient safety. The recommendations of reflective learning conversations and debriefings can be applied and utilized to change current practice toward best practice and are applicable in all clinical domains and specialties. Although currently attended only by nurses, such sessions would be even more beneficial if attended by multiple professions.

Applying Educational Theory to Interdisciplinary Education in Pediatric Cardiac Critical Care.

At the 14th Annual International Meeting for the Pediatric Cardiac Intensive Care Society, the authors presented a simulation workshop for junior multidisciplinary providers focused on cardiopulmonary interactions. We provide an overview of educational theories of particular relevance to curricular design for simulation-based or enhanced activities. We then demonstrate how these theories are applied to curriculum development for individuals to teams and for novice to experts. We review the role of simulation in cardiac intensive care education and the education theories that support its use. Finally, we demonstrate how a conceptual framework, SIMZones, can be applied to design effective simulation-based teaching.

Education and Training in Pediatric Cardiac Critical Care: International Perspectives.

Pediatric cardiac intensive care is an evolving and maturing field. There have been advances in education and training in recent years, specifically progress toward standardization of curricula, competencies, and certifications. International partnerships have fostered similar advancements in less resourced countries. For all disciplines and levels of expertise, simulation remains a versatile and effective modality in education. Although there is improved standardization for the training of physicians and nurses, the certification process remains undetermined.

Competency framework for specialist critical care nurses: A modified Delphi study.

The specialist critical care nurse plays a vital role in the delivery of evidence-based practice, and specific competency guidance has been established to facilitate critical care nursing practice and education development in many developed countries. However, no research has been conducted to develop a competency framework for specialist critical care nurses in China. To construct a competency framework specific to specialist critical care nurses in China. A two-phased procedure was implemented. In phase 1, a literature review and four focus groups were used to develop the initial competency framework, which consisted of 101 statements. During phase 2, three rounds of a modified Delphi process were conducted and involved a national panel of 30 experts, including physicians, specialist critical care nurses, managers, and educators, who responded to the survey using a 5-point Likert-type scale to indicate their level of agreement with the competency framework. A 75% threshold for each competency was used to achieve panel consensus. Experts in the field of critical care responded to rounds 1 (n = 29), 2 (n = 28), and 3 (n = 28). Seventy-eight competencies were agreed upon after round 1, increasing to 88 after round 2 and 92 after round 3. The final competency framework was classified into six domains: evidence-based practice, complex decisions, professionalism, communication and co-operation, education and development, and leadership. The output of this study is an expert consensus competency framework that provides a sound foundation for the assessment and training of specialist critical care nurses. The proposed competency framework should be used to assess nursing performance, promote continuing professional development, and further improve the delivery of quality health care and optimal patient outcomes.

Effect of Simulation-based education for Critical Patient Care by applying Team-based Learning on Problem Solving Ability, Critical Thinking, Clinical Judgement of Nursing Students

Effect of Simulation-based education for Critical Patient Care by applying Team-based Learning on Problem Solving Ability, Critical Thinking, Clinical Judgement of Nursing Students

Education Empowers Emergency Department Nurses During Pediatric Traumas.

In January 2017, the Emergency Trauma Advocate (ETA) program was piloted at our Level 1 trauma center to promote patient advocacy, particularly in pediatric patients. The goal was to empower emergency department nurses by improving their knowledge base through interactive didactic sessions. This study reviews the preliminary findings of the program. Surveys were administered after each teaching session to participating ETA nurses to determine their personal academic interests and how to improve the program. We then performed a retrospective review of pediatric trauma admissions from January 2017 through April 2017 to delineate the most common injury patterns. Survey responses demonstrated the greatest nursing interest in learning critical care (n = 11), orthopedic management (n = 11), and neurosurgical trauma education (n = 9). During this study period, 113 pediatric patients arrived and had a mean age of 7.8 ± 5.2 years. The most common injury patterns were orthopedic (n = 38) and neurosurgical (n = 28), and 35 patients required critical care management. Bivariate analysis revealed a significant and positive relationship between injury frequency and educational interests (R = 98.8%, p = .0057). A nurse's interest in educational topics directly correlates with recent pediatric trauma injury patterns. Future work should focus on determining what impact the ETA program has had on pediatric outcomes.

Cognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies: Consensus Guidelines on Behalf of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee

Cognitive aids and evidence-based checklists are frequently utilized in complex situations across many disciplines and sectors. The purpose of such aids is not simply to provide instruction so as to fulfill a task, but rather to ensure that all contingencies related to the emergency are considered and accounted for and that the task at hand is completed fully, despite possible distractions. Furthermore, utilization of a checklist enhances communication to all team members by allowing all stakeholders to know and understand exactly what is occurring, what has been accomplished, and what remains to be done. Here we present a set of evidence-based critical event cognitive aids for neuroanesthesia emergencies developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee.

Psychometrics: Trust, but Verify.

There is a continued mandate for practicing evidence-based medicine and the prerequisite rigorous analysis of the comparative effectiveness of alternative treatments. There is also an increasing emphasis on delivering value-based health care. Both these high priorities and their related endeavors require correct information about the outcomes of care. Accurately measuring and confirming health care outcomes are thus likely now of even greater importance. The present basic statistical tutorial focuses on the germane topic of psychometrics. In its narrower sense, psychometrics is the science of evaluating the attributes of such psychological tests. However, in its broader sense, psychometrics is concerned with the objective measurement of the skills, knowledge, and abilities, as well as the subjective measurement of the interests, values, and attitudes of individuals-both patients and their clinicians. While psychometrics is principally the domain and content expertise of psychiatry, psychology, and social work, it is also very pertinent to patient care, education, and research in anesthesiology, perioperative medicine, critical care, and pain medicine. A key step in selecting an existing or creating a new health-related assessment tool, scale, or survey is confirming or establishing the usefulness of the existing or new measure; this process conventionally involves assessing its reliability and its validity. Assessing reliability involves demonstrating that the measurement instrument generates consistent and hence reproducible results-in other words, whether the instrument produces the same results each time it is used in the same setting, with the same type of subjects. This includes interrater reliability, intrarater reliability, test-retest reliability, and internal reliability. Assessing validity is answering whether the instrument is actually measuring what it is intended to measure. This includes content validity, criterion validity, and construct validity. In evaluating a reported set of research data and its analyses, in a similar manner, it is important to assess the overall internal validity of the attendant study design and the external validity (generalizability) of its findings.

Simulation in Neurocritical Care: Past, Present, and Future.

Simulation-based medical education is a technique that leverages adult learning theory to train healthcare professionals by recreating real-world scenarios in an interactive way. It allows learners to emotionally engage in the assessment and management of critically ill patients without putting patients at risk. Learners are encouraged to work at the edge of their expertise to promote growth and are provided with feedback to nurture development. Thus, the training is targeted to the learner, not the patient. Despite its origins as a teaching tool for neurological diseases, simulation-based medical education has been historically abandoned by neurocritical care educators. In contrast, other critical care educators have embraced the technique and built an impressive foundation of literature supporting its use. Slowly, neurocritical care educators have started experimenting with simulation-based medical education and sharing their results. In this review, we will investigate the historical origins of simulation in the neurosciences, the conceptual framework supporting the technique, current applications, and future directions.