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The Need for an Adult Intensive Care Unit Boot Camp for Residents and Fellows: A Cross-Sectional Survey among Intensive Care Unit Directors

Nao Umei^1,2,4, Masaji Nishimura³, Shingo Ichiba^1,2, Atsuhiro Sakamoto^1,2 and Benjamin Worth Berg⁴

¹Department of Anesthesiology, Nippon Medical School, Tokyo, Japan
²Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
³Aizenbashi Hospital, Osaka, Japan
⁴SimTiki Simulation Center, John A Burns School of Medicine, University of Hawaii, HI, USA

Background: The concept of "see one, do one, teach one" raises concerns regarding patient safety in the intensive care unit (ICU) and highlights the need for prior preparation of residents/fellows for ICU rotation. This study assessed the need for an adult pre-ICU "boot camp" training course.
Methods: An online questionnaire regarding the current ICU training and desirable course framework was distributed via e-mail to the ICU directors of 269 educational centers certified by the Japanese Society of Intensive Care Medicine.
Results: The response rate was 39% (106/269). The number of residents/fellows undergoing ICU rotation was 5.5 (IQR 2-12)/ICU/year, and the majority (63%) were second to fourth year post-graduate residents and fellows. ICU directors opined that of the fundamental critical care skills, residents/fellows performed well or very well in only seven out of 29 skills (24%). Only 18% of the ICU directors had an established ICU training curriculum. Overall, 72% of the directors were interested in the boot camp. The desirable course framework was 3-5 hours per day with simulations and lectures. The core skills that directors considered as important to acquire during ICU rotation were central venous catheter insertion, tracheal intubation, defibrillation, initiation of mechanical ventilation, physical examination of critically ill patients, and shock assessment.
Conclusions: Residents/fellows began ICU rotations with suboptimal skills as reported by ICU directors. In addition, most of the ICUs had not established a training curriculum. Therefore, having an ICU boot camp is necessary to enhance critical care skills and to decrease medical errors.

J Nippon Med Sch 2022; 89: 443-453

Keywords
boot camp, intensive care units, surveys and questionnaires, clinical competence, patient safety

Correspondence to
Nao Umei, Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
u-nao@nms.ac.jp

Received, November 14, 2021
Accepted, March 23, 2022