Training Residents in Neonatal Mechanical Ventilation: A Blended Learning Approach

Background: Knowledge and skills in mechanical ventilation (MV) are necessary for the care of the critically ill infant. Pediatric residents are first-line providers for infants with respiratory failure. Suboptimal ventilator management increases morbidity and mortality, but knowledge and skills can be taught and can improve patient care.

A blended learning approach, in which individualized, guided learning is complemented with active, small group learning, may be ideally suited to achieve meaningful learning but has not been described before for this topic and learner.

Methods: Using Kern’s framework for curricular development, we designed a novel technology-enhanced, flipped classroom for PGY-1 and 2 residents. The approach emphasized a practical, pathophysiology-based approach to neonatal mechanical ventilation. Learners independently viewed the six animated-whiteboard modules that we developed just prior to their NICU rotation, then subsequently participated in two small group learning sessions at the bedside with neonatology fellows.

We also developed related knowledge tests for pre-, post- and retention-testing. Validity evidence for knowledge tests was collected using Messick’s framework. Likert-type surveys were developed to assess learner perspectives. Paired t-tests were used to compare assessment score data and unpaired, two-sided t-tests were used to evaluate anonymous survey data.

Results: 21 residents completed the post-test and survey in June 2020, representing the learner group who received non-standardized MV education at the end of the academic year. 22 residents have participated in the blended curriculum during AY 2020-2021 to date.

Learner assessment data reveals significantly higher mean post-test scores after blended learning compared to pre-test scores (82% vs. 52%) (p < 0.001). Compared with control learners, post-test scores were slightly higher in learners after blended learning (82% vs. 76%), but this did not reach significance (p=0.29). Six-month retention test scores for those participating in the intervention are sustained (mean 88% to date).
Nearly all residents report that MV knowledge is either quite important or extremely important. Residents who participated in the blended learning curriculum reported a significant increase in satisfaction with mechanical ventilation training compared to controls (4.8 vs. 2.3, p<0.001) as well as improved confidence in skills related to both conventional (3.4 vs. 1.9, p<0.001) and high-frequency ventilation (2.6 vs. 1.2, p <0.001).

Conclusion: We have a developed a novel blended curriculum to improve and standardize mechanical ventilation training for pediatric residents. Despite a lack of learning objectives within the current CBME framework and broad career interests amongst residents, learners desire more training in neonatal mechanical ventilation. The blended learning curriculum we implemented this year is well accepted by pediatric residents and has led to significant improvements in learner satisfaction. Knowledge scores improve and appear to be maintained after this blended educational approach despite rotating out of the NICU.