Current teaching and evaluation methods in critical care medicine: Has the Accreditation Council for Graduate Medical Education affected how we practice and teach in the intensive care unit?

Objective: To determine the impact of the Accreditation Council for Graduate Medical Education mandates for duty hours and competencies on instruction, evaluation, and patient care in intensive care units in the United States. Design: A Web-based survey was designed to determine the current methods of teaching and evaluation in the intensive care unit, barriers to changing methods of teaching and evaluation, and the impact of Accreditation Council for Graduate Medical Education regulations on teaching and patient care. Setting: An anonymous Web-based survey was used; cumulative data were analyzed. Subjects: A total of 125 of 380 program directors (33%) for pediatric critical care, pulmonary critical care, anesthesiology critical care, and surgery critical care fellowship programs completed questionnaires. Measurements and Main Results: Bedside case-based teaching and standardized lectures are the most common methods of education in the intensive care unit. Patient safety and resident demands are two factors most likely to result in changes in instruction in the intensive care unit. Barriers to changes in education include clinical workload and lack of protected time and funding. Younger respondents viewed influences to change differently than older respondents. Respondents felt that neither education nor patient care had improved as a result of the Accreditation Council for Graduate Medical Education mandates. Conclusions. Medical education teaching methods and assessment in the intensive care unit have changed little since the initiation of the Accreditation Council for Graduate Medical Education regulations despite respondents' self-report of a willingness to change. Instead, the Accreditation Council for Graduate Medical Education regulations are thought to have negatively impacted resident attitudes, continuity of care, and even availability for teaching. These concerns, coupled with lack of protected time and funding, serve as barriers toward changes in critical care graduate medical education. (Grit Care Med 2009; 37:49-60)