Development and implementation of a simulation training program for acute respiratory-failure management in the pulmonary intensive care unit

Background
Many medical institutes and centers employ simulation in medical education, however, there is still limited experience regarding its use, especially in low–middle-income countries such as Egypt.


Objective
We conducted this work to investigate the effectiveness of simulation-based training (SBT) as an educational tool for teaching pulmonary-medicine postgraduate students the ICU management of acute respiratory failure (ARF).


Patients and methods
Thirty postgraduate students enrolled in the Master of Pulmonary Medicine at Ain Shams School of Medicine without previous experience in SBT were randomly categorized into two groups (1 : 1), namely SBT and lecture-based training in the period between January 2019 and January 2020. Both groups attended lectures on management of ARF in ICU patients; however, the SBT group received additional SBT. We assessed clinical knowledge after the lectures with multiple-choice written exams. The SBT group received the same exams after simulation to assess its impact in addition to a satisfaction survey. The ventilator skills of the SBT team were evaluated after a video presentation of the ventilator chart recorded in a real case using a 12-item checklist before and after simulation training.


Results
Total knowledge scores of all scenarios were almost similar between the two groups at baseline (SBT: 56.6 vs. 55.2, P=0.581). Simulation training significantly improved the total knowledge score of the SBT group, compared with the presimulation score (56.6 vs. 69.4, P≤0.001) and the lecture-based training group (69.4 vs. 55.2, P≤0.001). Compared with baseline, the SBT group’s skill score significantly increased after simulation (46.9 vs. 65.6, P≤0.001). The improvement in knowledge and skills scores was independent of baseline-knowledge score, age, and years of experience, except for the acute-asthma scenario. All SBT participants were either very satisfied (86.7%) or satisfied (13.3%). It should be noted that satisfaction with this type of training was not correlated with the sociodemographic characteristics of the participants. Most of the candidates (80.7%) believe that such training has successfully improved their communication skills.


Conclusion
The current study indicates a positive impact of a simulation-based program regarding team training on ARF in an ICU.