Q&A: Simulation-based mechanical ventilation course benefits critical care fellows

Key takeaways:

• Inspired by the lack of consistency in mechanical ventilation training, doctors at Cleveland Clinic developed a simulation-based course for fellows.
• Fellows reported improvements 2 months after the course.

Caring for ventilated patients in critical condition requires expertise on mechanical ventilation; however, there is a lack of consistency in the teaching given to critical care fellows on this topic, according to a meeting presentation.

To solve this problem, Furquan Pathan, MD, of the department of surgical critical care in the Integrated Hospital-Care Institute at Cleveland Clinic, and colleagues developed a simulation-based course for training critical care fellows on mechanical ventilation, which they presented at the 2025 Critical Care Congress.

The course takes place over 1 day and features lectures, hands-on activities and simulations, according to the presentation.

Healio spoke with Pathan to learn more about drawbacks of current training programs, what is involved in the simulation-based course and how other facilities can use this model.

Healio: Could you generally describe current training programs for providing mechanical ventilation?

Pathan: Right now, most training programs for mechanical ventilation rely on a traditional model. Trainees attend some lectures, if at all, that provide them with theoretical knowledge on various ventilation modes, oxygen delivery devices and extubation strategies. I never attended any lectures when I was a fellow at another institute. Most trainees learn by watching and doing under the guidance of experienced attendings. The catch is that these clinical experiences can be quite variable; different attendings often bring their own personal anecdotes and practices to the table. This approach leaves trainees to piece everything together on their own as they care for real patients, sometimes without a consistent, evidence-based framework.

Healio: What are the drawbacks of these programs?

Pathan: The main issue with these programs is their inconsistency. Because learning is largely based on observation and informal mentoring, there isn’t a standardized method to ensure that every trainee gains the same depth of knowledge and practical skills. The variability in teaching methods — often relying on diverse clinical anecdotes — can lead to contradictory or non-evidence-based practices. Furthermore, the traditional model requires trainees to experiment in real-life, high-risk settings, which not only increases the likelihood of learning errors but also puts patients at potential risk. It’s an environment where mistakes in managing ventilator settings might have serious consequences if not caught in time.

Healio: How did you develop your training program?

Pathan: We recognized the gaps in traditional training, so we decided to innovate by developing a simulation-based course that merges both theory and practice in a controlled setting.

Our team created a 1-day course specifically for 10 anesthesiology critical care fellows annually. The structure of the course is divided neatly into a morning session and an afternoon simulation workshop. In the morning, the fellows get a refresher on the theoretical aspects, including lectures on oxygen delivery devices and different ventilation modes. Then, in the afternoon, they transition into hands-on training through simulation stations. This way, we not only standardize the teaching but also allow the fellows to experience realistic, emergent scenarios in a safe, risk-free environment.

Healio: Could you summarize what your program involves?

Pathan: Our program is structured around a single intensive day. In the morning session, we kick things off with a series of didactic lectures designed to cover the core principles of mechanical ventilation, including details on oxygen delivery and standard ventilation modes. After this foundational refresher, the afternoon is dedicated to simulation workshops. We set up several simulation stations — each designed to mimic real-life critical incidents. For example, in one station trainees work on interpreting ventilator waveforms, such as those seen in acute respiratory distress syndrome and auto-PEEP conditions, while another station challenges them to manage scenarios like high peak airway pressure alarms and tracheostomy dislodgements. Each simulation is followed by a debrief, which helps consolidate learning and encourages reflective discussion in a group setting.

Overall, the program not only emphasizes hands-on practice but also provides structured feedback to ensure that key competencies in mechanical ventilation are achieved.

Healio: Could you describe the data indicating the program’s impact on knowledge, skills and outcomes?

Pathan: The impact of the program has been quite clear. We measured knowledge and skill acquisition using pre- and post-tests, with the post-test administered 2 months after the course to assess retention. The results were very promising — post-test scores showed a statistically significant improvement compared with the pretest scores (P = .004).

Feedback from the fellows was equally encouraging. They reported that the simulations, which closely mirrored real-life scenarios, helped them become better at diagnosing respiratory issues, managing complex ventilator settings and even improving their communication and coordination during emergencies.

In essence, the hands-on, risk-free environment allowed the fellows to develop competencies that are essential in the fast-paced, high-stakes realm of the ICU.

Healio: What is the next step in developing and refining this program?

Pathan: Looking ahead, we see a lot of room for enhancement. One of our immediate plans is to incorporate additional simulation scenarios. This means expanding topics to include advanced oxygen delivery strategies and various noninvasive ventilation techniques. We also want to refine the current scenarios based on continuous feedback from participants.

Moreover, we’re planning to expand the workshop beyond anesthesiology fellows to include other health care providers who manage ventilators. This expansion will help standardize training across the board and ensure that all members of the care team are better prepared for emergent situations. The idea is to keep iterating on the model so that it remains state-of-the-art and widely applicable.

Healio: How can other facilities use this model?

Pathan: Other institutions can adopt our simulation-based model by using our standardized scenarios, which have been carefully designed to offer a comprehensive skill set in mechanical ventilation management. One useful approach is to integrate our model with established courses such as the Cleveland Clinic’s SEVA program, ensuring a consistent experience across different training centers.

The beauty of the simulation framework is that it creates a controlled, risk-free learning environment — allowing trainees from various backgrounds to practice in realistic, high-stakes situations without putting actual patients at risk. This model provides a clear benchmark that other facilities can replicate or adapt to their own educational contexts, ultimately leading to better patient care outcomes and more uniform training in critical care.

Reference:

• Pathan F, et al. 1085: Intensive breaths: Simulation-based mechanical ventilation training for critical care fellows. Presented at: 2025 Critical Care Congress; Feb. 23-25; Orlando.

For more information:

Furquan Pathan, MD, can be reached at pathanf@ccf.org.