May 052012
(image: flickrCC)

Do protocols make trainees' brains go soft? That's the assertion of more than a few crusty hard-liners who miss the good old days -- when you got 2-liter tidal volumes for your ARDS and liked it, dad-gum-it!!

Prasad et al can't say whether critical care fellows can actually run ventilators in the post-protocol age ... but they do test well, apparently. Authors cleverly linked performance on the mechanical ventilation questions on the ABIM critical care boards to whether the test-taking fellow came from a program with ventilator protocols in place. They even tried to find a dose-response relationship, according to a program's number of extant protocols. (Interestingly, 31% of 88 programs reported using no protocols at all.)

Who wins this debate? Well, the presence of protocols had no relationship to fellows' performance on the vent questions on the ABIM critical care boards. But (I can hear it now) that doesn't prove anything! In my day, we had to build each ventilator ourselves -- using a radiator hose, a package of water balloons, and a Slinky. And don't even get me started on ECMO!

Prasad M et al. Clinical Protocols and Trainee Knowledge About Mechanical Ventilation. JAMA 2011;306:935-941. 

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Fellows: This is your brain on protocols