Effect of a Peer Driven ARDS Curriculum: A Quality Improvement Project

Abstract

RATIONALE: Acute respiratory distress syndrome (ARDS) has a mortality rate that approaches 40%. While several studies have identified key strategies for managing ARDS, there are many potential barriers to adherence, particularly in a busy, trainee-driven ICU setting. As such, we created a fast, but high yield ARDS curriculum and aimed to improve knowledge and confidence in managing ARDS among residents. METHODS: This is a quality improvement (QI) project measuring resident performance on a 3-question test before and after a “crash-course” didactic on ARDS throughout a 4-week medical ICU (MICU) rotation. A resident and MICU attending developed the didactic, which reviewed ARDS definitions, evidence-based strategies for ARDS management, case examples and troubleshooting techniques. The didactic was delivered by the above-mentioned resident. The pre- and post-tests were identical;the questions addressed ARDS recognition, diagnosis and management, as well as each resident's comfort level in recognizing and managing ARDS. The pre- and post-tests were given at the start and end of the MICU rotation, respectively, and the didactic was given immediately after the pre-test. The correct answers were not directly revealed. RESULTS: Data was gathered over a total of nine 4-week blocks;50 residents participated, but 20 were excluded for not completing the post test. A majority of the cohort were second year medical residents and had only completed an average of 0.87 ICU rotations ± 0.82 prior to the study. The average correct score for the pre-test was 46.7% ± 27.1 and average score for posttest was 72.2% ± 21.6 with an absolute difference of +25.7% (p=0.0003, CI 95% 11.8-39.5%). There was also a significant increase in the subjective comfort levels and confidence regarding ventilator management and ARDS recognition and management. (Table 1). CONCLUSIONS: Statistically significant differences were seen in objective test scores pre- and postdidactic, highlighting the effectiveness of an informal, peer-delivered curriculum. Additionally, there was an increase in comfort level towards ventilator and ARDS management. A main limitation is that this study encompassed various times throughout the COVID-19 pandemic, therefore it is unclear whether differences in ARDS patient census also affected our results. Further studies should be conducted to see if these findings correlate with improved patient outcomes in a trainee-driven MICU. (Table Presented).