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

Sami Safadi; Megan Acho; Stephanie I Maximous; Michael B Keller; Eric Kriner; Christian J Woods; Junfeng Sun; Bashar S Staitieh; Burton W Lee; Nitin Seam; Critical Care Education Research Consortium

doi:10.4187/respcare.12072

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

Respir Care. 2024 Oct 25;69(11):1353-1360. doi: 10.4187/respcare.12072.

Affiliations

¹ Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota. safad002@umn.edu.
² Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.
³ Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
⁴ Department of Critical Care Medicine, National Institutes of Health, Bethesda, Maryland.
⁵ Respiratory Therapy Department, Medstar Washington Hospital Center, Washington, DC.
⁶ Division of Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC.
⁷ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, Georgia.

PMID: 39379159
PMCID: PMC11549622 (available on 2025-11-01)
DOI: 10.4187/respcare.12072

Abstract

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 = 39). The second group was instructed in using a web-based simulator, VentSim (n = 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 ± SD pretest scores between the web-based and the on-site groups (21.1 ± 12.6 and 26.9 ± 13.6 respectively; P = .11). The mean ± SD posttest scores were 45.6 ± 25.0 for the web-based simulator and 43.4 ± 16.5 for on-site simulator (mean difference 2.2; one-sided 95% CI -7.0 to ∞; P _{non-inferiority} = .02 [non-inferiority confirmed]). Changes in mean ± SD scores (posttest - pretest) were 25.9 ± 20.9 for the web-based simulator and 16.5 ± 15.9 for the on-site simulator (mean difference 9.4, one-sided 95% CI 0.9 to ∞; P _{non-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.

Keywords: education; mechanical ventilation; medical education; simulation.

Publication types

Comparative Study
Controlled Clinical Trial

MeSH terms

Adult
Clinical Competence
Computer Simulation
Critical Care
Educational Measurement
Fellowships and Scholarships
Female
Humans
Internet*
Lung / physiology
Male
Respiration, Artificial* / methods
Simulation Training* / methods