Abstract
Background:
Clinical rotations are foundational to student learning in respiratory therapy (RT) school. Telemedicine emerged as a means for managing critical care patients during the COVID-19 pandemic. We hypothesized that a clinical rotation at a tele-ICU would increase student knowledge of mechanical ventilation, telemedicine, and COVID-19.
Methods:
Students from two universities completed clinical rotations in a tele-ICU as a part of an IRB-approved observational study. Two, four-hour shifts were spent with an RT preceptor. RTs rounded on 320 ICU beds at 5 hospitals. Patient assessments were completed at the request of RTs in the ICUs and clinical emergencies were addressed in real time via remote monitoring. Students completed a pre-rotation survey assessing their confidence evaluating and managing mechanical ventilation, experience with telemedicine and technology, ARDS and COVID-19 patients. At the end of the rotation, students completed a second survey assessing knowledge of the same concepts. Wilcoxon signed ranks was applied to compare pre- and post-clinical rotation self-confidence surveys (Likert scale 1 – 10). Data are reported as median (IQR). P < 0.05 was significant. Data was analyzed with SPSS 26 (IBM, Armonk, NY).
Results:
Thirty-three out of 37 students (89%) completed surveys pre- and post-clinical rotations. Of those, 67% (n = 22) were female. Fifty-five percent of students reported prior knowledge of telemedicine, while 52% had observed interactions with the tele-ICU in previous clinical rotations. Mean self-confidence in mechanical ventilation, assessing waveforms, and knowledge of ARDS increased after the clinical rotation (pre-rotation 7.0–8.0 [5.0–9.0], post-rotation 8.7–9.5 [8.0–10]; P = 0.001). Similarly, reported knowledge related to spontaneous breathing protocols, lung protective ventilation, patient care planning, and use of data collection tools increased from the beginning to the end of the clinical rotation (pre-rotation 6.5– 8.3 [5–9.5], post-rotation 8.8–9.9 [7.5–10]; P = 0.001– 0.009). Student confidence in interprofessional communication increased from 8.5 [6.9–9.8] to 9.5 [7.8–10] (P = 0.03). Overall, the largest change was students’ ability to assess COVID-19 patients (pre-rotation 5 [1.2–6.8], post-rotation 8 [5.9–10]; P = 0.001).
Conclusions:
Students’ knowledge and skills in assessing patients via remote monitoring increased in a tele-ICU clinical rotation. Knowledge related to COVID-19 also increased statistically significantly.
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