An asynchronous online video curriculum improves resident anxiety, confidence, and preparation before critical care rotations

Rationale: Fear and anxiety surround the decision to pursue a critical care elective during the fourth year of medical school. Comparatively, little is known about intern and resident perceptions of upcoming medical intensive care unit (ICU) rotations. The COVID-19 pandemic dramatically changed both undergraduate and graduate medical education, decreasing the number of in-person patient encounters and teaching opportunities while increasing trainee anxiety. In response to pandemic-associated educational changes, we created an asynchronous, online video curriculum for Internal Medicine (IM) trainees to complete in preparation for their ICU rotation to reduce pre-rotation anxiety, increase confidence, and improve overall sense of preparedness. Methods: A 7-session video curriculum was created and distributed to post-graduate year (PGY) 1-3 IM residents 1 week prior to the start of their ICU rotation. The video series covered core critical care topics including bedside presentations, support devices, shock, and respiratory failure. Overall, the series contained approximately 1.5 hours of critical care-focused content. The impact of the videos on resident anxiety, confidence, and level of preparation prior to the start of their ICU rotation was assessed with a pre-and post-survey with respondents rating their level of agreement on a scale of 0-100. Differences between pre-and post-survey scores were evaluated using a paired t-test. Results: Eighty-five trainees completed the pre-survey and 44 trainees completed the post-survey between June and December 2020. Thirty-six paired responses were obtained (17 PGY-1, 13 PGY-2, 6 PGY-3). Eighty-six percent of paired respondents reported watching all 7 videos. Before the video curriculum, trainees reported a mean anxiety level of 56.8±23.0 (0 = no anxiety, 100 = severe anxiety), mean confidence level of 42.9±20.3 (0 = least confident, 100 = most confident), and mean preparation level of 52.9±20.8 (0 = not prepared, 100 = extremely prepared). Following the video curriculum, trainees reported decreased anxiety (mean anxiety level 46.3±17.2, p=0.0012), increased confidence (mean confidence level 58.0±17.6, p<0.0001), and increased level of preparation (mean preparation level 63.6±17.8, p=0.0002). PGY-1 residents improved most in regard to anxiety (mean difference-12.4, p=0.171) and confidence (mean difference 16.9, p<0.0001), while PGY-2 residents demonstrated significant improvements in preparation (mean difference 12.7, p=0.016). Conclusion: An asynchronous, online video curriculum delivered to IM residents prior to the start of their ICU rotation decreases trainee anxiety while improving confidence and subjective sense of preparation. Asynchronous video curricula represent one possible avenue for addressing pandemic-related constraints on inperson educational opportunities.