Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Online Learning and Residents’ Acquisition of Mechanical Ventilation Knowledge

Sequencing Matters

Wolbrink, Traci A. MD, MPH1,2; van Schaik, Sandrijn M. MD, PhD3; Turner, David A. MD4; Staffa, Steven J. MS1; Keller, Eleanor BS1; Boyer, Donald L. MD, MSEd5,6; Chong, Grace MD7; Cross, Jarrod MD8; del Castillo, Sylvia MD9; Feng, Andrew MD10; Hum, R. Stanley MD11; Jacob James, Ebor MD12; Johnson, Amanda MD1,13; Kandil, Sarah MD14; Kneyber, Martin MD, PhD, FCCM15; Rameshkumar, Ramachandran DM16; Levin, Amanda MD17; Lodha, Rakesh MD18; Jayashree, Muralidharan MD19; Olivero, Anthony MD20; Oberender, Felix MD21; Panesar, Rahul S. MD22; Pooni, Puneet A. MD23; Rehder, Kyle J. MD4; Sankaranarayanan, Shuba MD24; Scheffler, Margaret MD25; Sharara-Chami, Rana MD26; Siems, Ashley L. MD17; Padur Sivaraman, Rajakumar MD25; Tegtmeyer, Ken MD27,28; Valentine, Stacey MD, MPH29; Villois, Florencia MD30; von Saint Andre-von Arnim, Amelie MD31; Winkler, Margaret MD32; Dede, Chris EdD33; Burns, Jeffrey P. MD, MPH1,2 on behalf of the Game-based Education in Residency (GamER) Study Group

doi: 10.1097/CCM.0000000000004071
Online Clinical Investigation: PDF Only

Objective: Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents’ knowledge and improve knowledge retention in mechanical ventilation when compared with a clinical rotation and whether the timing of intervention had an impact on overall knowledge gains.

Design: A prospective, interventional crossover study conducted from October 2015 to December 2017.

Setting: Multicenter study conducted in 33 PICUs across eight countries.

Subjects: Pediatric categorical residents rotating through the PICU for the first time. We allocated 483 residents into two arms based on rotation date to use an online intervention either before or after the clinical rotation.

Interventions: Residents completed an online virtual mechanical ventilation simulator either before or after a 1-month clinical rotation with a 2-month period between interventions.

Measurements and Main Results: Performance on case-based, multiple-choice question tests before and after each intervention was used to quantify knowledge gains and knowledge retention. Initial knowledge gains in residents who completed the online intervention (average knowledge gain, 6.9%; SD, 18.2) were noninferior compared with those who completed 1 month of a clinical rotation (average knowledge gain, 6.1%; SD, 18.9; difference, 0.8%; 95% CI, –5.05 to 6.47; p = 0.81). Knowledge retention was greater following completion of the online intervention when compared with the clinical rotation when controlling for time (difference, 7.6%; 95% CI, 0.7–14.5; p = 0.03). When the online intervention was sequenced before (average knowledge gain, 14.6%; SD, 15.4) rather than after (average knowledge gain, 7.0%; SD, 19.1) the clinical rotation, residents had superior overall knowledge acquisition (difference, 7.6%; 95% CI, 2.01–12.97;p = 0.008).

Conclusions: Incorporating an interactive online educational intervention prior to a clinical rotation may offer a strategy to prime learners for the upcoming rotation, augmenting clinical learning in graduate medical education.

1Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA.

2Department of Anaesthesia, Harvard Medical School, Boston, MA.

3Division of Pediatric Critical Care Medicine, University of California San Francisco, San Francisco, CA.

4Division of Pediatric Critical Care, Department of Pediatrics, Duke Children’s Hospital, Durham, NC.

5Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA.

6The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

7Division of Pediatric Critical Care, University of Chicago, Comer Children’s Hospital, Chicago, IL.

8Paediatric Critical Care, Perth Children’s Hospital, WA, Australia.

9Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

10Kapiolani Medical Center for Women and Children, Honolulu, HI.

11Division of Pediatric Critical Care Medicine, Department of Pediatrics, Columbia University, New York, NY.

12Christian Medical College, Vellore, India.

13Division of Pediatric Critical Care Medicine, University of Massachusetts Children's Medical Center, Worcester, MA.

14Department of Pediatrics, Critical Care Medicine, Yale University School of Medicine, New Haven, CT

15Beatrix Children’s Hospital, University Medical Center Groninger, University of Groningen, Groningen, The Netherlands.

16Division of Pediatric Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

17Division of Critical Care Medicine, Children’s National Health System, Washington, DC.

18Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

19Postgraduate Institute of Medical Education and Research, Chandigarh, India.

20Helen DeVos Children’s Hospital, Grand Rapids, MI.

21Pediatric Critical Care Medicine, Monash Children’s Hospital, Melbourne, VIC, Australia.

22Stony Brook Children’s Hospital, Stony Brook, NY.

23Dayanand Medical College and Hospital, Ludhiana, India.

24Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India.

25Hasbro Children’s Hospital, Providence, RI.

26Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

27Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

28Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

29Division of Pediatric Critical Care Medicine, University of Massachusetts Children’s Medical Center, Worcester, MA.

30Garrahan Hospital, Buenas Aires, Argentina.

31Division of Pediatric Critical Care, Department of Pediatrics, Seattle Children’s and University of Washington, Seattle, WA.

32University of Alabama at Birmingham, Birmingham, AL.

33Harvard Graduate School of Education, Cambridge, MA.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Supported, in part, by the Department of Anesthesiology, Critical Care and Pain Management at Boston Children’s Hospital.

Dr. Boyer received funding from University of Pennsylvania Graduate School of Education (MedEd Master’s Program leadership and teaching). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail:

Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.