University of Washington
Seattle, WA
Program Director: Andrew Luks, MD
Program Associate Director: Nick Johnson, MD
Program Type: Critical Care
Abstract Authors: Jenelle Badulak MD, Pablo Sanchez MD PhD, Andrew Luks MD, Matthew Plourde RN, Basak Coruh MD
Description of Fellowship Program: Our critical care medicine fellowship trains internal medicine or emergency medicine trained applicants over one (internal medicine sub-speciality trained, i.e. cardiology, nephrology, etc) or two years (internal medicine or emergency medicine) to become board certified through the American Board of Internal Medicine. This fellowship is housed within the Division of Pulmonary, Critical Care and Sleep and run in conjunction with the pulmonary and critical care fellowship.
Abstract
Background
Extracorporeal membrane oxygenation (ECMO) use for cardiopulmonary failure is increasing and is an important component of critical care fellowship training. The Extracorporeal Life Support Organization (ELSO) recommends that ECMO centers provide didactic, simulation and bedside training, and proficiency testing for physicians. However, simulation poses time and logistical constraints, time for in-person didactics is limited, and few educational materials are available.
Methods
Using Kern’s model of curriculum development, an e-learning program was developed for critical care fellows. corECMO (www.corECMO.com) was developed as part of a multimodality ECMO curriculum along with high-fidelity simulation and bedside clinical training. A literature search revealed no established curricula for ECMO education. A needs assessment of senior critical care fellows was performed to determine prior ECMO experience, perceptions regarding ECMO education, and desired educational strategies. The results of the needs assessment, literature review, and consultation with expert clinicians informed selection of eight episodes and development of corresponding learning objectives and content. corECMO is composed of core content as well as simulated interactive cases (Figure 1). A pilot version with half of the planned content was released for use by critical care fellows. Prior to use of corECMO, fellows completed a survey regarding their comfort with ECMO management.
Results
The needs assessment revealed that 67% of fellows had no prior ECMO experience and 95% strongly believed ECMO should be a part of critical care fellowship training. In-person simulation and online interactive cases were the preferred educational modalities. The pre-curriculum survey, completed by 22 fellows, revealed limited prior ECMO didactic education: 41% of fellows had received < 1 hour of prior training. Fellows also had low levels of confidence in twelve aspects of ECMO management (Table 1), with lowest confidence in selection of blood flow rate upon initiation of VA ECMO and troubleshooting low blood flow and hypotension in VA ECMO. The survey will be readministered to fellows after viewing corECMO.
Discussion
corECMO is an e-learning product that facilitates interactive asynchronous education as part of a multimodality ECMO curriculum for critical care fellows. Preliminary data suggests that fellows have low confidence in their ability to manage patients on ECMO. A post-curriculum survey to evaluate perceptions of confidence, group interviews, and a knowledge assessment following use of corECMO will be used to revise and complete the pilot version. Next steps include expansion of corECMO to a broader audience and validation of an ECMO knowledge assessment tool.
Table 1. Pre-curriculum confidence levels of critical care fellows with ECMO management, 1= strongly disagree and 5= strongly agree.
