Update in Pulmonary Diseases

Mechanical Ventilation

Physician Training Did Not Provide Adequate Education on Mechanical Ventilation

Only 37% of critically ill patients receive care from an intensive care specialist. National surveys show that 67% of patients admitted to intensive care units remain in the care of their primary physicians and that 59% of general internists in practice use mechanical ventilation.

Cox and colleagues wanted to determine the level of understanding of mechanical ventilation among internal medicine residents. They administered a 19-question examination to 259 residents at 31 internal medicine residency programs. Of the participants, 46% were residents in a university hospital and 54% were residents in a community hospital. About half of the residents had more than 4 months of intensive care unit experience during training.

The average score on the test was 74% correct (range, 37% to 100%). More than one third of the residents answered fewer than 70% of the questions correctly, and 10% of the residents answered fewer than half correctly. Most residents correctly identified tension pneumothorax (86% correct) and clinical findings suggestive of severe hypotension secondary to auto-positive end-expiratory pressure (93% correct). High rates of incorrect answers were for questions on setting tidal volume in patients with the acute respiratory distress syndrome (48% incorrect), identifying whether a patient was ready for a weaning trial (38% incorrect), and recognizing an indication for noninvasive ventilation (27% incorrect).

Higher scores were associated with a closed-unit versus open-unit organization (76% vs. 71% correct), resident perception of greater versus lesser knowledge (79% vs. 71% correct), and graduation from a U.S. versus foreign medical school (75% vs. 69% correct). Only 46% of program directors thought residents had adequate knowledge of ventilators by graduation.

In summary, the data suggested that …