2004 OPEN FORUM Abstracts
RESIDENT PHYSICIAN COMPETENCY IN OPERATION OF MECHANICAL VENTILATORS IN THE SETTING OF NO SPECIALIZED RESPIRATORY CARE PRACTITIONERS
Yoshihiro Uzawa RRT/RPT1,
Norihiro Kaneko MD2, Junmei Fudoji MD3.
Rehabilitation Medicine1; Pulmonary Medicine2;
Emergency Department3; Kameda Medical Center, Kamogawa,
Introduction: Knowledge of the operation of mechanical ventilators (MV) and application of these principles to clinical practice are important and require formal education. There have been reported ventilator-related deaths and injuries associated with improper operation of MV. In many countries, specifically trained respiratory care practitioners (RCPs) provide MV management. However, in some countries there are no specialized health care practitioners for respiratory care. In this situation, staff or resident physicians have taken the responsibility to order and operate the MV, even though he/she is not specialized in respiratory care. In this study, we surveyed residents about their comfort level with their MV knowledge, how they were educated about MV before graduation, and what types of education they would like to have in the clinical setting.
Subjects and Methods: Thirty residents employed by an 800 bed general hospital were given written questionnaires. The residents were asked to describe their subjective feelings of confusion both when first operating MV and about their present situation, using a 100 mm visual analog scale (VAS) as well as in a comment section. They were asked of their educational experience with MV before graduation, and their perceived need for education regarding MV after graduation. We also administered a 20-item written examination based on established RCP MV competencies.
Results: Twenty-three subjects (76.6%) responded. All responders had operated MV except for one first year resident. VAS values were 86.0±15.5 at the first, 42.2±22.3 at the present. Their knowledge of initial settings, changes of parameters and skill of MV operation was limited. Ten of 23 had studied MV before graduation; however, training was insufficient to allow them to apply their knowledge to the clinical setting. Most residents hoped to receive additional education regarding MV within the first year of residency. The topics most desired are initial settings, alarm settings, trouble-shooting, mechanical operation of MV and weaning patients. The mean test score was 55.6% correct.
Conclusion: Resident knowledge and confidence about the use of MV was limited even though half of them had received some education regarding MV. Although an educational system for teaching MV at the clinical site has not been established yet in our country, the absence of RCPs requires physicians to pursue formal clinical education to maintain good job performance. To provide an increased level of patient safety, it is also important to train health care practitioners as specialized non-physician RCPs.