Non-Invasive Ventilation (NIV) a Study of Junior Doctor Competence

ABSTRACT

Background: There is currently no standardisation to undergraduate or postgraduate teaching in the use of NIV in the UK. Methods: A questionnaire-based survey (see appendix) was handed out to all foundation doctors (year 1 and year 2) at Derbyshire Hospitals NHS Foundation Trust between January 2008 and April 2008. NIV was provided in the emergency department, on the acute respiratory ward and in intensive care. Foundation trainees did not work in intensive care at the time of the study. The study primarily focused on NIV in the setting of acute exacerbations of chronic obstructive pulmonary disease (COPD). The questionnaire was designed to primarily test the subject's knowledge of the physiological principles of NIV including its indications and contradictions and some of the common problems surrounding its use. Results: There were 47 respondents from a cohort of 105 foundation trainees. 12 (26%) of doctors had received no undergraduate teaching/training about NIV. 33 (70%) rated the training they did have as poor. Knowledge surrounding the use of NIV was poor, only 15% had positive knowledge scores. 28 (60%) of the doctors who had used NIV stated that they had low confidence when using it. Interestingly of the doctors who scored highly 6 of the 7 had done a respiratory medicine job. A positive score on the questionnaire was directly related to having spent time working in respiratory medicine (p < 0.0001). Conclusions: There is no standardisation to undergraduate or postgraduate teaching in the use of NIV in the UK. Foundation level trainees have poor knowledge of NIV and low confidence in using it. Working in a respiratory job with an acute NIV service increases knowledge and confidence. Being competent to administer and manage a patient on NIV is an important competence for junior medical staff. At present great improvements need to be made in the delivery of training to achieve this competence.