UGME in Critical Care

Medical Student Perspectives on the Need for Pre-Clinical Education in Critical Care Medicine

Montano N, Clarke S, Julie I, Danielson A. Medical Student Perspectives on the Need for Pre-Clinical Education in Critical Care Medicine. In: 2017 Western Group on Educational Affairs Regional Meeting; February 25-28, 2017; Salt Lake City, UT.

Introduction

There is a significant lack of ability and confidence in the application of critical care skills that exists among both graduating medical students and intern-year residents [1, 2]. This gap in clinical skill not only hinders the physician’s ability to perform effectively in emergency situations, but places the patient directly in harm’s way [3]. Currently, the Society of critical care medicine recommends teaching medical students critical care skills during undergraduate medical education (UGME) [1]. It is thought that incorporating critical care education during the pre-clinical years of UGME will improve the critical care skills of graduating medical students, but this has not been tested.

There has been limited research into what skills students at this level should be taught or what interest pre-clinical medical students have in critical care medicine. We found no published studies on pre-clinical medical students’ preference for or knowledge of critical care. This information would be helpful for designing UGME curricula. By identifying perceptions and levels of knowledge, appropriate points during training can then be identified. It would also be helpful to know how many students are interested in critical care training as this could be used to facilitate decisions about resource allocation.

The goal of this survey was to assess medical students’ attitudes and knowledge of critical care medicine, their perceptions of pre-clinical UGME exposure to critical care medicine, and their comfort with critical care knowledge and skills along with the need for that foundation before and during residency. Pre-clinical medical students interest in participating in a pre-clinical UGME elective course in critical care medicine, and what clinical content would be of most interest to these students, was also assessed in this survey.

Goal

The goal of this project was to assess medical students’ perspectives on the need for pre-clinical medical education in critical care medicine as well as the student perception of their critical care knowledge and skills during their careers.

Methods

We conducted a voluntary, anonymous, online survey of first through fourth year medical students at a single institution during the 2015-16 academic year. Survey questions were developed by content experts in critical care medicine with student input. These questions were then reviewed by a student focus group for both content and clarity. The survey was collected via Survey Monkey software. Questions were 5 point Likert scale style. Results reported as (mean, 95% confidence interval).

Results

77 Students participated in this survey (44 pre-clinical and 32 clinical), resulting in an 18% response rate. Students agree that pre-clinical medical education should include coursework in critical care medicine (3.89, [3.682- 4.098]) and that they expect be involved managing critically-ill patients during medical school or residency (4.21, [4.047-4.373]). Pre-clinical medical students felt significantly less comfortable than clinical medical students in all domains (p<0.05 for all questions). Despite being more comfortable than pre-clinical students, clinical medical students still reported that they are inadequately exposed to critical care (1.81, [1.609-2.011]), uncomfortable using presenting a critically-ill patient (1.28, [1.880-2.460]), and uncomfortable writing an ICU progress note (2.08, [1.806- 2.354]).

Discussion

In this single-center survey, we found that pre-clinical and clinical medical students are aware of the need for critical care skills and are interested in obtaining them. These data support the existing body of literature showing that current critical care training is inadequate. These data support, from the student perspective, the inclusion of critical care early in medical school curricula and show that medical student interest is critical care skills is unlikely to be a barrier to curriculum implementation. Limitations of this survey include a low survey response rate and inclusion of a single center. Further research is needed to confirm these conclusions.

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Bibliography

  1. Buchman, T.G., et al., Undergraduate education in critical care medicine. Crit Care Med, 1992. 20(11): p. 1595-603.
  2. Harrison, G.A., et al., The need for undergraduate education in critical care. (Results of a questionnaire to year 6 medical undergraduates, University of New South Wales and recommendations on a curriculum in critical care). Anaesth Intensive Care, 1999. 27(1): p. 53-8.
  3. Smith, C.M., et al., Undergraduate training in the care of the acutely ill patient: a literature review. Intensive Care Med, 2007. 33(5): p. 901-7.