The overall goal of this mechanical ventilation boot camp is to teach residents the fundamentals of mechanical ventilation management. This method can help answer key questions in the medical education field such as to how best instruct residents on the fundamentals of mechanical ventilation management. The main advantage of this technique is that learners get one-on-one personalized instruction with content experts.
Learners are able to troubleshoot management strategies without exposing real patients to potential risk. The implications of this technique extends towards clinical management of pre-hospital settings, the emergency department, in-patient wards, and critical care medicine, because the patients in these clinical settings have the potential to de-compensate, warranting mechanical ventilation. Though this method can provide insight into mechanical ventilation fundamentals, it can also be applied to other concurrent pathologies such as acute respiratory distress syndrome, auto-PEEP, pneumothorax, or mucus plugging.
Begin by printing critical action checklists, pretest confidence surveys, and pretest cognitive multiple choice exams. Next, place three human patient simulators in ICU beds with the following designations:acute respiratory distress syndrome, also known as ARDS, complete lung atelectasis, secondary to mucus plugging, and pneumothorax. Set simulators in separate rooms in a dedicated learning space, such that they are enough apart that learners will not be able to easily hear the other simultaneously executed sessions.
Intubate the human patient simulators. Do not place the endotracheal tube in the trachea of the simulator, but rather through a hole in the simulator's inner cheek that leads to the back of the simulator's neck. Connect the corrugated airway tubing from the lung simulator to the endotracheal tube that is now hidden behind the simulator's neck.
Then use a pillow to conceal this connection to the functional lung. Then turn on the lung simulator. Choose the selected pathologic state from the menu in the patient library folder, and initiate the selected pathology on the lung simulator.
Connect the mechanical ventilator to the endotracheal tube coming out of the simulator's mouth. Next, connect human patient simulators to breathing simulators, then connect the intubated human patient simulators to mechanical ventilators. Place the simulated patient monitor by each human patient simulator.
Select the vital signs software within the lung simulator program. Choose appropriate initial vital signs for onset of simulated patient presentation and enable the vital signs monitor. Next, upload the preselected patient's vital signs, portable chest x-ray images, electrocardiograms, and arterial blood gas measurements for each patient case to each respective patient monitor.
Set out critical actions checklists at each station for each learner wherever faculty members will be observing the case, and assign one faculty member to each station. Have each learner pick a four-digit identifying code, teams for confidence surveys, cognitive exams, and critical action checklists. Then in a separate room administer a five-minute pretest confidence survey to the learners.
Upon its completion, administer a 25-minute pretest cognitive multiple choice exam to the learners. Have learners report to a station with one learner present at each station. Have learners provide their 4-digit identifying code to faculty for their critical action checklist.
Have faculty read the case STEM to the learner. Allow learners a maximum of 10 minutes per station to work through a scenario, and do not administer feedback during the case. Rotate learners through all stations individually until all learners have completed all stations.
Finally, after the scenario is complete, dismiss learners back to their separate room. Have faculty fill out critical action checklists for each learner upon completion of each case. Begin by setting up five stations with human patient simulators, breathing simulators, ventilators, and monitors as previously described.
Assign each station one of the following topics:ARDS, atelectasis secondary to mucus plugging, pneumothorax, altered mental status secondary to drug overdose, and dynamic hyperinflation. Arrange learners in groups of two or three people and assign one faculty member to each station. Then allow each team 10 minutes to work through a case scenario.
Give faculty 35 minutes to provide feedback and bedside instruction. On the final day, print critical action checklists, post-test confidence surveys, and post-test cognitive multiple choice exams. Then set up the stations identical to the pretest in the same manner.
Next, administer a five-minute post-test confidence survey, and a 25-minute post-test cognitive multiple choice exam to the learners. Then, have a learner report to a station and have them work through a scenario by administering the same steps as were executed during the pre-test. Finally, after the scenario is complete and the faculty have filled out critical action checklists for each learner, finish by administering a 10-minute post-curriculum survey to all learners.
Results indicated that cognitive knowledge assessed by the pre-and post-intervention multiple choice tests increased from a mean score of 40.3%to 67.1%The ARDS case had an initial mean of 1.5 critical actions met on day one, which increased to 4.1 on day three. The atelectasis secondary to mucus plugging case had an initial mean of 1.24 on day one and a post-intervention score of 4.47 on day three. Further, learners felt more confident after the boot camp intervention.
Their initial confidence on day one was rated as a mean score of 1.56 out of five, which increased to a mean score of 3.64 on day three. Once mastered, this technique can be completed in 15 hours if it is performed properly. While attempting this procedure, it's important to remember to perform a rehearsal to ensure that faculty are familiar with their responsibilities and that equipment is set up and working properly.
Following this procedure, other methods such as teaching different pathologies can be performed in order to evaluate how this curriculum would effect learners'confidence, medical knowledge, and performance. After its development, this technique paved the way for researchers in the field of medical simulation to explore setting up other curricula in other medical specialties to teach different topics or procedures. After watching this video, you should have a good understanding of how to establish a curriculum to teach the basic principles of mechanical ventilation.
