ABSTRACT
TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The need for swift international collaboration alongside rapidly deployable remote medical knowledge transition and implementation programs has been highlighted during the ongoing COVID-19 pandemic. Virtual programs have emerged as cost-effective alternatives to in-person education to spread best practices to resource-limited locations and garner purposeful learner engagement. Understanding local practice needs is paramount to the development of an effective quality improvement initiative. This study aimed to gain insight into the interests, clinical challenges, and attitudes of a group of interprofessional critical care providers from Bosnia and Herzegovina in preparation for a longitudinal remote education and quality improvement program. METHODS: A novel learning needs assessment tool was implemented in a cohort of critical care professionals from four hospitals in Bosnia and Herzegovina. A sequential explanatory design was employed, and a mixed-method assessment was conducted in three phases. 1) Utilizing the Delphi method, twenty statements containing common critical care entrustable professional activities (EPAs) were developed by a board of intensivists and medical education specialists. 2) Local learners used Q Sort methodology to rank-order EPAs based on self-perceived learning priorities, with subsequent by-person factor analysis. 3) Learners were invited for focus-group interviews to gather details of the rationale behind their rankings. RESULTS: Forty nine out of 105 participants completed the rank-order survey (response rate 47%). Factor analysis categorized the participants into two main groups based on the typology of their opinions, 22 participants into factor 1 and 9 participants into factor 2. The highest-ranked EPAs amongst the two factors were “evaluation and management of the patients with shock, stabilization, and resuscitation of critically ill patients” and “evaluation and management of ARDS,” respectively. Statements regarding common ICU complications and procedures were regarded as neutral. The lowest rank amongst factor 1 was “patient-centered care, communication skills, and interprofessional collaboration.” Participants in factor 2 ranked “preoperative evaluation and management” and “common hematologic and oncologic complications” the lowest. The rationale behind rank orders focused on the current patient population and perceived EPA importance to critical care practice. Participants in factor 1 displayed pessimistic attitudes toward patient-centered care and interprofessional collaboration due to cultural and healthcare system constraints. Interviewees in both factors described local challenges and expressed a need for change. CONCLUSIONS: We conducted a remote needs assessment in an international, interprofessional group of critical care providers. In addition to building trust with learners, the acquired knowledge of cultural differences, needs, and barriers to implementation will guide an ongoing remote education and quality improvement initiative. CLINICAL IMPLICATIONS: This investigation will shape a critical care best practices quality improvement initiative and remote education program in a country with limited resources. DISCLOSURES: No relevant relationships by Marija Bogojevic, source=Web Response No relevant relationships by Yue Dong, source=Web Response Patent/IP rights for a licensed product relationship with Ambient Clinical Analytics Please note: From 2016 Added 05/23/2021 by Ognjen Gajic, source=Web Response, value=Royalty no disclosure on file for Pedja Kovacevic;No relevant relationships by Heyi Li, source=Web Response No relevant relationships by Aida Mujakovic, source=Web Response No relevant relationships by Alexander Niven, source=Web Response No relevant relationships by Manja Spahalic, source=Web Response no disclosure on file for Slavenka Straus;No relevant relationships by Simon Zec, source=Web Response
ABSTRACT
BACKGROUND: Critical care medicine is a relatively young discipline, developed in the mid-1950s in response to the outbreak of poliomyelitis. The mass application of mechanical ventilation and its subsequent technical advancement helped manage large numbers of patients with respiratory failure. This branch of medicine evolved much faster in high-income (HIC) than low- and middle-income countries (LMIC). Seventy years later, mankind's encounter with coronavirus disease 2019 (COVID-19) represents another major challenge for critical care medicine especially in LMIC countries where over two thirds of the world population live. METHODS: Systematic analysis of written documents related to the establishment of the first multidisciplinary medical intensive care unit (MICU) in Bosnia and Herzegovina and its development to the present day. RESULTS: We describe the experience of setting up a modern critical care program under LMIC constraints as a promising way forward to meet the increased worldwide demand for critical care. Successful development is contingent on formal education and continued mentorship from HIC, establishment of a multidisciplinary team, the support from local health care authorities, development of a formal subspecialty training, academic faculty development, and research. Novel technologies including tele-education provide additional opportunities for rapid development and dissemination of critical care medicine programs in LMIC. CONCLUSION: Critical care medicine is a critical public health need in HIC and LMIC alike. The challenges associated with the coronavirus pandemic should serve as a wakeup call for rapid development of critical care programs around the world.