Decay in Physiologic Knowledge since Medical School among Critical Care Fellows (DIP Study)

Background: Rapid accumulation of knowledge and skills by trainees in the intensive care unit assumes prior mastery of clinically relevant core physiology concepts. However, for many fellows, their foundational physiology knowledge was acquired years earlier during their preclinical medical curricula and variably reinforced during the remainder of their undergraduate and graduate medical training. Objective: We sought to assess the retention of clinically relevant pulmonary physiology knowledge among pulmonary and critical care medicine (PCCM) and critical care medicine (CCM) fellows. Methods: A composite examination was developed from an initial set of questions used in preclinical pulmonary physiology courses at four separate medical schools. These questions passed through multiple rounds of review by various educators to arrive at a set of 15 multiple-choice questions. The test was administered to incoming first-year PCCM and CCM fellows at seven institutions during their 2021 fellowship orientation. Results: Forty-one first-year PCCM (n = 24) and CCM (n = 17) fellows completed the examination, and the proportion correct among the fellows was compared with that of medical students for each item. Although all questions were deemed to be clinically relevant, preclinical medical students significantly outperformed the incoming fellows. Conclusion: These findings suggest considerable decay of clinically relevant pulmonary physiologic knowledge during residency training and point to a need for longitudinal retrieval practice to reinforce these concepts during the course of medical school clerkship years and postgraduate clinical training as well as consideration of dedicated pulmonary physiology curricula for PCCM and CCM fellowship programs.