University of North Carolina
Chapel Hill, NC
Program Director: Ashley G. Henderson, MD
Program Type: Pulmonary and Critical Care Medicine
Abstract Authors: Kimtuyen Nguyen MD, Lydia Chang MD
RATIONALE
Cardiopulmonary Exercise Testing (CPET) is a required core competency for Pulmonary/Critical Care Medicine trainees. It is one of the eight procedures in pulmonary medicine for which the ACGME mandates documentation. Survey of current fellows at UNC revealed that they have performed and interpreted an average of 2.1 studies (range 0-4) and this low testing volume affects competency for independent monitoring and interpretation of cardiopulmonary exercise tests (CPET). We implemented a novel CPET curriculum involving three interactive online modules to help improve fellows’ understanding and comfort of all aspects of CPET.
METHODS
All fellows in the Pulmonary/Critical Care fellowship program at UNC were asked to fill out a questionnaire using a five point Likert scale regarding their comfort level with CPET. A pre-test was also administered to evaluate baseline understanding of the principles of CPET supervision and interpretation. Fellows were then able to access online interactive modules for CPET training. The first module addressed basic exercise physiology, the clinical indications and contraindications for ordering a CPET, and guidelines for supervising CPET. The second module focused on understanding the data obtained during CPET. In the third module, systematic interpretation of CPET data was taught using case-based scenarios. The three modules were posted sequentially over a three-week period. At the end of the three weeks, fellows were asked again to fill out the same questionnaire and a post test. Their questionnaire as well as pre and post test scores were analyzed using the paired t-test. Cardiopulmonary Exercise Testing (CPET) is a required core competency for Pulmonary/Critical Care Medicine trainees. It is one of the eight procedures in pulmonary medicine for which the ACGME mandates documentation. Survey of current fellows at UNC revealed that they have performed and interpreted an average of 2.1 studies (range 0-4) and this low testing volume affects competency for independent monitoring and interpretation of cardiopulmonary exercise tests (CPET). We implemented a novel CPET curriculum involving three interactive online modules to help improve fellows’ understanding and comfort of all aspects of CPET.
RESULTS
Seven out of nine fellows at UNC fully participated in the training course (3 first year fellows, 3 second year fellows, and 1 third year fellow.) Average pre-training comfort level with various aspects of CPET was 2.2 ±0.8 on the 5 point Likert scale and increased to 4 ±0.4 after completing the online modules (p = 0.0001). Mean pre-test score improved from 47% to a mean of 67% on the post-test (p=0.01). Results are further shown in Table 1 and Figures 1&2.
CONCLUSION
Implementation of a novel CPET curriculum consisting of three interactive web-based modules resulted in a significant increase in fellows’ comfort level with CPET as well as objective improvement in knowledge base and understanding of CPET performance and interpretation. We expect and are already starting to see an increase in the amount of CPET appropriately ordered, and this in turn will further increase the fellows’ learning opportunities and help sharpen their expertise.
Table 1: Survey and Test Scores Before and After Online Curriculum
Fellows' Test Scores Before and After Online Curriculum (out of 15)
Individual Fellow's Score on Comfort Level with CPET (Likert Scale) Before and After Curriculum
