Comparison of Web-Based and On-Site Lung Simulators for Education in Mechanical Ventilation

BACKGROUND: Training in mechanical ventilation is a key goal in critical care fellowship education. Web-based simulators offer a cost-effective and readily available alternative to traditional on-site simulators. However, it is unclear how effective they are as teaching tools. In this study, we evaluated the test scores of fellows who underwent mechanical ventilation training by using a web based simulator compared with fellows who used an on-site simulator during a mechanical ventilation course. METHODS: This was a nonrandomized controlled trial conducted as part of a mechanical ventilation course that involved 70 first-year critical care fellows. The course was identical except for the simulation technology used. One group of instructors used a traditional on-site simulator, the ASL 5000 Lung Solution (n 5 39). The second group was instructed in using a web-based simulator, Vent Sim (n 5 31). Each fellow completed a pre-course test and a post-course test by using a validated, case-based ventilator waveform examination that consisted of 5 questions with a total possible score of 100. The primary outcome was a comparison of the mean scores on the posttest between the 2 groups. The study was designed as a non-inferiority trial with a predetermined margin of 10 points. RESULTS: There was no significant difference in the mean 6 SD pretest scores between the web-based and the on-site groups (21.1 6 12.6 and 26.9 6 13.6 respectively; P 5.11). The mean 6 SD posttest scores were 45.6 6 25.0 for the web-based simulator and 43.4 6 16.5 for on-site simulator (mean difference 2.2; one-sided 95% CI –7.0 to ‘; Pnon-inferiority 5.02 [non-inferiority confirmed]). Changes in mean 6 SD scores (posttest – pretest) were 25.9 6 20.9 for the web-based simulator and 16.5 6 15.9 for the on-site simulator (mean difference 9.4, one-sided 95% CI 0.9 to ‘; Pnon-inferiority <.001 [non-inferiority confirmed]). CONCLUSIONS: In the education of first-year critical care fellows on mechanical ventilation waveform analysis, a web-based mechanical ventilation simulator was non-inferior to a traditional on-site mechanical ventilation simulator.