Development of a short course on management of critically ill patients with acute respiratory infection and impact on clinician knowledge in resource-limited intensive care units.

ABSTRACT

BACKGROUND: The 2009 influenza A (H1N1) pandemic caused surges of patients in intensive care units (ICUs) in resource-limited settings. Several Ministries of Health requested clinical management guidance from the World Health Organization (WHO), which had not previously developed guidance regarding critically ill patients. OBJECTIVE: To assess the acceptability and impact on knowledge of a short course about the management of critically ill patients with acute respiratory infections complicated by sepsis or acute respiratory distress syndrome delivered to clinicians in resource-limited ICUs. METHODS: Over 4 years (2009-2013), WHO led the development, piloting, implementation and preliminary evaluation of a 3-day course that emphasized patient management based on evidence-based guidelines and used interactive adult-learner teaching methodology. International content experts (n = 35) and instructional designers contributed to development. We assessed participants' satisfaction and content knowledge before and after the course. RESULTS: The course was piloted among clinicians in Trinidad and Tobago (n = 29), Indonesia (n = 38) and Vietnam (n = 86); feedback from these courses contributed to the final version. In 2013, inaugural national courses were delivered in Tajikistan (n = 28), Uzbekistan (n = 39) and Azerbaijan (n = 30). Participants rated the course highly and demonstrated increased immediate content knowledge after (vs before) course completion (P < .001). CONCLUSIONS: We found that it was feasible to create and deliver a focused critical care short course to clinicians in low- and middle-income countries. Collaboration between WHO, clinical experts, instructional designers, Ministries of Health and local clinician-leaders facilitated course delivery. Future work should assess its impact on longer-term knowledge retention and on processes and outcomes of care.