Non-invasive ventilation and high-flow oxygen system education for internal medicine residents utilizing high-fidelity simulation

SESSION TITLE: Education, Research, and Quality Improvement Posters 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Utilization of non-invasive ventilation (NIV) and high flow oxygen delivery system (HFNC) has substantially increased over time. A novel, simulation-based educational curriculum was designed to address the educational gap in resident education. Goals were to improve NIV/HFNC equipment familiarity and to enhance understanding of the physiology and application of NIV/HFNC. METHODS: The curriculum included an initial didactic session discussing management of acute respiratory failure, physiology behind different oxygen modalities, and indications/contraindications of NIV/HFNC. After an opportunity to familiarize themselves with various NIV/HFNC machines, a simulated case-based scenario followed, incorporating high-fidelity simulation modalities aimed at training the learners in the clinical application of oxygen delivery systems. A short debrief and feedback session was held thereafter. Learners filled out a pre-session and a post-session survey, evaluating a change in subjective comfort and objective knowledge on NIV/HFNC management. P-values were calculated using independent two-sample t-tests and p≤0.05 was considered to indicate statistical significance. RESULTS: 79 internal medicine residents participated in a pre-session survey, including 29 post-graduate year1 (PGY1)(36.7%), 24 PGY2 (30.4%), and 26 PGY3 (32.9%). Most confirmed having never received a formal training in NIV/HFNC (n=67, 84.8%). Whilst 38% (n=30) reported equipment familiarity, 87.3% (n=69) admitted to having needed help for titration of the machines. Less than half reported feeling comfortable in utilizing HFNC (n=28, 35.4%) and NIV (n=21, 26.6%) on the Likert scale. This improved to 90% (n=58/64) post-session (p=0.045). Evaluation of resident knowledge on NIV/HFNC revealed that only 2 (3.1%) knew how to correctly utilize CPAP (2.5%), which improved to 13 (20.3%) post-session (p=0.006). Initially, 48.1% (n=37) and 22.1% (n=17) incorrectly answered asthma and severe hypoxemia as one of the first-line indications of BiPAP, which improved to 9.4% (n=6) and 17.2% (n=11), respectively. Contraindications of BiPAP were correctly answered in 83.5%, which further improved to 95.3% (p=0.048). Only 31.6% (n=25) knew how to appropriately adjust NIV in worsening hypercarbic respiratory failure prior to the training, which drastically improved to 76.6% (n=49) (p=0.023). Correctly answered titration of HFNC also improved from 68.4% to 78.1% (p=0.001). CONCLUSIONS: Pre-session surveys demonstrated learners’ unfamiliarity and discomfort as well as knowledge deficits with NIV/HFNC systems. Post-session surveys held after a didactic and high-fidelity simulation session demonstrated statistically significant improvement in comfort and knowledge. CLINICAL IMPLICATIONS: This novel simulation-based curriculum educated residents on the recognition of patients with acute respiratory failure and the management of these patients utilizing NIV and HFNC. High fidelity simulation can be utilized as a training modality to improve knowledge and skill among clinicians and thus improve clinical care. DISCLOSURES: No relevant relationships by Matthew Alexander No relevant relationships by Jeeyune Bahk No relevant relationships by Susannah Kurtz No relevant relationships by Priscilla Loanzon No relevant relationships by Joseph Mathew No relevant relationships by Adam Rothman No relevant relationships by James Salonia No relevant relationships by Harrindra Seepersaud