Critical Care Education for Specialty Residents: A Scoping Review
CCCF ePoster library. Cao S. Nov 7, 2018; 233419
Dr. Sissi Cao
Dr. Sissi Cao
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Abstract
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Introduction:

The intensive care unit (ICU) is a complex environment that provides care to critically-ill patients. ICU’s are led by physicians certified in critical care medicine (CCM), but residents in postgraduate training from a variety of programs make up the service majority. Due variable expectations, the heterogeneous nature of the ICU and time constraints, a growing challenge is emerging in the age of competency-based medical education (CBME): how to best educate rotating residents to safely care for critically-ill patients. Large-scale projects worldwide have attempted to define and collate objectives at the medical student and fellow level, however, there is no standardized curriculum or set of teaching practices, nor are methods well-described, for critical care education at the specialty resident level.

 

Objectives:

1) To conduct a qualitative systematic review to identify high-yield curriculum topics, delivery practices and evaluation strategies for resident-appropriate critical care education.

2) To inform a competencies-based medical education framework for residents rotating through intensive care units.



Methods:

A search of 5 electronic databases (PubMed, EMBASE, ERIC, PsycINFO, Web of Knowledge) was conducted using MeSH terms. Potential articles were screened based on title and abstract, full texts of included citations were reviewed for inclusion. The following information was extracted: bibliographic information, study design and methodology, resident sample size and characteristics, area of educational focus (curriculum content and duration, delivery methods, and evaluation techniques), and results.

 

Results:

Study types and education initiatives were heterogeneous. Effective and innovative techniques for high-quality resident-level education were collated into Curriculum, Delivery and Evaluation categories, with further subdivisions. Curriculum initiatives in the form content included using patient outcomes in “evidence-guided education”, web-based and simulation teaching for bedside ultrasound, delivering bad news via small group sessions, and an end-of-life shared-decision making workshop at a resident retreat. Duration initiatives existed in the form of simulation modules and a longitudinal curriculum, and changing didactic teaching timing from morning to midday. Evaluation initiatives included using proficiency punch cards validated by RN’s at bedside for procedural skills, resident-developed order sets that were applied immediately, using a VitalTalk® video to train residents to hold family and using surveys to increase self-aware of competence and areas requiring attention. Little is known about the impact of ICU rotations on residents’ skills and knowledge for future practice.

 

Conclusion:

Despite recent interest and innovations, no unifying recommendations currently exist for high-yield resident-level education strategies. This qualitative systematic review will be the first of its kind and its impact will be to inform a unifying education framework for residents rotating through ICU's in the landscape of entrustable professional activities and CBME. The ultimate goal is to capitalize upon critical care education so residents can proficiently care for critically-ill patients in their future practice as non-CCM physicians.


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