Impact of Longitudinal Mechanical Ventilation Curriculum on Decay of Knowledge

Background: Prior evidence suggests that critical care trainees and attendings may have trouble recognizing common, potentially life-threatening mechanical ventilation (MV) waveform asynchronies. Although dedicated workshops may improve knowledge in MV, this knowledge may be prone to decay over time. Longitudinal, preceptorial-based curriculums may prevent this decay in knowledge. Objective: To determine if the addition of a year-long, longitudinal MV preceptorial curriculum to a two-part, small-group, simulation-based education block curriculum reduces decay in MV knowledge compared with the education block curriculum alone. Methods: This was a multicenter prospective cohort study including 123 first-year fellows from 12 critical care fellowship programs who completed a two-part simulation-based education block (control) after the first and sixth months of fellowship. Fellows from one of these programs also participated in a year-long preceptorial curriculum (intervention). MV waveform examination scores over time during fellowship were compared between control versus intervention groups. Results: Mean test scores increased for both control and intervention groups after the education block courses at Months 1 and 6 of fellowship. Mean (standard deviation) test scores at Month 12 were higher for the intervention group than the control group (89.3 14.8 vs. 47.7 21.4; P < 0.0001). Between 6 months and 3 years of fellowship, there was a significant decay in test scores for the control group (slope estimate standard error, −13.4 1.7; P < 0.0001). However, there was no significant decay in test scores for the intervention group (slope estimate, −2.0 4.7; P = 0.67; difference in slope estimates, 11.4 5.0; P = 0.02). Conclusion: The ability of critical care fellows to identify MV waveform asynchronies declines over fellowship training, despite a dedicated two-part, simulation-based MV educational curriculum. The addition of an MV preceptorial course decreased decay of MV knowledge over the course of fellowship training.