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 Table of Contents  
Year : 2020  |  Volume : 4  |  Issue : 5  |  Page : 34-39

A National Initiative: Training Nonintensivists in Critical Care, an Educational Response to the COVID-19 Pandemic

1 Department of Health Academy, Saudi Commission for Health Specialties; Department of Intensive Care, King Abdulaziz Medical City; Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
2 Department of Health Academy, Saudi Commission for Health Specialties; Emergency Medicine, Princess Nourah University, Riyadh, Saudi Arabia
3 Department of Intensive Care, King Abdulaziz Medical City; College of Medicine, King Saud Bon Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
4 Department of Health Academy, Saudi Commission for Health Specialties; Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
5 Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
6 Department of Health Academy, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
7 Training and Academic Affairs, Saudi Ministry of Health, Riyadh, Saudi Arabia
8 Department of Health Academy, Saudi Commission for Health Specialties; College of Nursing, King Saud University, Riyadh, Saudi Arabia

Date of Submission12-Sep-2020
Date of Decision29-Oct-2020
Date of Acceptance29-Sep-2020
Date of Web Publication7-Dec-2020

Correspondence Address:
Mustafa M Bodrick
Health Academy, Saudi Commission for Health Specialties, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sccj.sccj_50_20

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The World Health Organization declared COVID-19 a pandemic in March 2020. It is accepted that the associated severe acute respiratory syndrome requires intensive care unit (ICU) management. Therefore, considering the rapid spread of the disease, a specific educational response in the form of a critical care course was designed for non-ICU physicians. The course involved purpose-driven learning that used backward education design, the six-step curriculum process, and blended learning. The course included critical care essentials, COVID-19 infection prevention and control, nontechnical skills, and physician wellness. The course was implemented in two parts: A self-directed online knowledge-focused component and a practical hands-on approach to ensure non-ICU physicians gained the necessary critical care skills. The practical simulation-based part was implemented combined with infection control measures. The central coordination team provided on-going scientific, organizational, and logistical support for this non-ICU physician course that would directly address the identified need for surge capacity planning.

Keywords: COVID-19, critical care, educational response, intensive care

How to cite this article:
Alsolamy S, Cluntun A, Aldekhyl S, Sabbagh AY, Alshehri TO, Yousif S, Abuznadah WT, Alharthi S, Alshamrani A, Bodrick MM. A National Initiative: Training Nonintensivists in Critical Care, an Educational Response to the COVID-19 Pandemic. Saudi Crit Care J 2020;4, Suppl S1:34-9

How to cite this URL:
Alsolamy S, Cluntun A, Aldekhyl S, Sabbagh AY, Alshehri TO, Yousif S, Abuznadah WT, Alharthi S, Alshamrani A, Bodrick MM. A National Initiative: Training Nonintensivists in Critical Care, an Educational Response to the COVID-19 Pandemic. Saudi Crit Care J [serial online] 2020 [cited 2023 Jun 4];4, Suppl S1:34-9. Available from: https://www.sccj-sa.org/text.asp?2020/4/5/34/302585

  Introduction Top

The COVID-19 outbreak unfolded rapidly globally. The identified virus was named severe acute respiratory syndrome coronavirus 2, which the World Health Organization (WHO) designated as “COVID-19.”[1],[2] In March 2020, the WHO declared a global pandemic based on 118,000 COVID-19 cases across over 110 countries and territories worldwide.[1],[2],[3] An immediate implication of the pandemic was responding to a surge in critically ill patients.

This article describes the innovative educational use of backward design,[4] the six-step curriculum process,[5] and blended learning[6] in the design of a critical care course for non-intensive care unit (ICU) physicians, as an immediate pandemic response. This course is targeted at supporting non-ICU physicians who will care for critically ill patients with COVID-19.

  Course Design Top

The COVID-19 critical care course was designed to provide essential knowledge and skills to non-ICU physicians who must manage critically ill patients with suspected or confirmed COVID-19 in ICU settings. An education backward design model[4] guided the initial planning phase through the identification of desired competencies and the practice scope for non-ICU physicians. There were three stages: (i) identify desired outcomes, (ii) identify acceptable evidence, and (iii) plan learning experiences. This design was adopted as a tailored training approach in response to identified needs. An interprofessional subject matter expert team met to identify the curriculum’s desired outcomes [Table 1]a.

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In response to the identified desired outcomes and by building capacity through education using a blended learning[6] approach, the following three competency themes, which steered the development of the course curriculum, were identified:

  1. Critical care essentials for nonintensivists, which included the ability to: recognize and assess critically ill patients, provide patient care support to adults in ICU settings, diagnose and initiate treatment for shock, provide essentials for airway management, diagnose and initiate management of acute respiratory failure, and gain the necessary fundamental skills for the care of mechanically ventilated patients[7],[8]
  2. COVID-19 infection prevention and control, which involved: demonstrating an understanding of infection prevention and control principles, management of critically ill COVID-19 patients, and safe adherence to personal protective equipment guidelines[7],[8]
  3. Nontechnical skills and physician wellness-related skillsets, including: demonstrating effective teamwork and ethics in intensive care multidisciplinary teams, utilizing appropriate communication and interactional skills, demonstrating appropriate physical self-care protocols, maintaining mental well-being, and implementing self-management techniques to work and cope with stress in intensive care settings.[7],[8]

The Kern six-step curriculum development process was applied to guide the logical progression of the curriculum [Table 1]b.[5] Minimum required knowledge, skills, and attitudes were identified as prerequisites before the transition to practice components and supervised clinical practice. Formative and summative assessment approaches were then designed as integral parts of the educational process. Formative assessments were designed for use in providing learners with on-going feedback, which was concurrent to gaining knowledge and learning skills. Furthermore, the summative assessments were designed for evaluating performance levels and aimed at indicating successful course completion.

  Course Implementation Top

The course was implemented in two parts, which facilitated the building of participants’ knowledge progressively and simultaneously with other related skills throughout the course. Self-directed online learning materials and virtual lectures in the first component were designed to be asynchronous and self-paced. The interactive and adaptive online platform facilitated countrywide access for participants and faculty. The summative knowledge assessment component of self-directed learning in the first course component contained single-best-answer multiple-choice questions. The aim was to ensure that the participants mastered the knowledge provided by material resources. Immediate feedback provision was based on the adaptive learning process[6] in such a way that the online learning process facilitated participants’ mastery of each step as they progressed through the course.

To bridge theory-practice gaps, the second component was developed to utilize simulation-based learning activities. Appendix 1 of this paper provides an outline of the course’s educational themes and contents [Supplementary Appendix 1].[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] Formative assessment implementation in this component permitted participants to complete a self-evaluation checklist that integrated the knowledge gained from self-directed learning with deliberate practice development until they were able to practice safely. The practical simulation-based part was implemented while maintaining all required infection control measures throughout the learning activities. This component focused on participants’ mastery of technical and nontechnical critical care bedside skills. To successfully complete this part, learners had to practice necessary skills until they achieved competency. After completing the second part, summative assessment was conducted to evaluate the participants by utilizing the simulation checklist to indicate successful course completion.

Standardized outcomes that were dependent on two factors were targeted. First, content specificity was verified to ensure that identical objectives were delivered to all participants throughout Saudi Arabia. This was achieved by constructing specific and clear content with detailed instructional steps. The second factor focused on the quality of instructors who conducted the sessions. Therefore, a central scientific and logistics team consisting of selected experts was formed that also provided support in the practical training (see [Table 2]). Emphasis was placed on supporting training departments across Saudi Arabia during planning and implementation. Regular meetings were conducted online with executive teams from each healthcare authority to introduce the program and share the recommended implementation plan. Intercity collaboration and cooperation were fostered between the teams, thus facilitating experience and idea exchanges with the goal of ensuring standardization nationwide. Implemented activities included establishing steps for launching and troubleshooting as well as coordination of faculty and instructors’ assessments for quality control purposes and safeguarding standards. In addition, virtual methods provided structured support for maintaining open inter-team communication channels. The central consultation and coordination team provided continuous scientific, organizational, and logistical support.
Table 2: An example of support provided by scientific and logistics team to the training groups during the practical component

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  Discussion Top

The COVID-19 Critical Care Course for non-ICU Physicians makes an essential contribution in planning for the anticipated required capacity for the surge in critically ill patients.[7] This education response is aligned to the Ontario Health Plan for an Influenza Pandemic[3] that suggests a model for critical care responses. It, therefore, supports surge capacity by expanding the patient-intensivist ratio by adding more physicians to work in teams supervised by experienced ICU physicians. The Society of Critical Care Medicine (SCCM, 2020) tiered staffing strategy[2] for pandemics shows that one experienced ICU physician can supervise four non-ICU physicians within their respective ICU multidisciplinary teams while providing care for up to 24 critically ill patients treated by each team, that is, potentially 96 patients.

One of the strengths of this course is the inclusion of an online self-directed knowledge acquisition component that could be applied and reinforced through a second practice-based component, which enabled the acquisition of hands-on critical care skills under experienced ICU physicians’ direct clinical supervision. This approach allows non-ICU physicians who have acquired competent critical care skills to join the ICU workforce to provide care for COVID-19 patients who are seriously ill. This course’s innate limitation was its lack of pilot testing, that is, immediate implementation was necessary because the pandemic scenario required rapid responses.

  Conclusion Top

This paper introduced a healthcare course option that can be offered as a short-term education solution in practice for a national emergency situation that immediately demands rapid responses. It is suggested that further research and collaboration are necessary for reviewing this course’s impact on upskilling non-ICU physicians, and for establishing its value in providing care to critically ill COVID-19 patients.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  Supplementary Appendix 1 Top

Synopsis of the course contents for the COVID-19 critical care course

1. Goals and objectives

By the end of the course, non-ICU physician learners will be able to:

  • Practice COVID-19-related infection prevention and control measures
  • Apply basic knowledge and skills to support ICU physicians in patient management
  • Practice basic respiratory support for COVID-19 patients
  • Practice hemodynamic monitoring and support for COVID-19 patients
  • Practice resuscitation on patients with COVID-19 while adhering to personal protective equipment (PPE) and other important guidelines
  • Apply communication skills while working with multidisciplinary critical teams
  • Conduct recognized basic disaster measures and apply these in critical care including patient transport
  • Identify elements for self-care and wellness while working in critical care settings.

2. Self-directed learning components

A1. Basic critical care elements and infection prevention and control practice for COVID-19

A2. Virtual lectures-learning objectives:

  • To complement online self-directed learning to reinforce knowledge gained from online learning
  • To introduce nontechnical concepts of teamwork and communication skills, as well as physician wellness and self-care for working in critical care settings.

A3. Practical training through simulations-learning objective:

To provide competency-based learning opportunities through simulations in order to apply acquired knowledge with immediate feedback prior to the transition to clinical practice in ICU settings.

  References Top

Alterably WT, Alharthy AM, Faqihi F, Mady AF, Ramadan OE, Huwait BM, et al. Dynamics of SARS-CoV-2 outbreak in the Kingdom of Saudi Arabia: A predictive model. Saudi Crit Care J 2020;4:79-83.  Back to cited text no. 1
Pneumonia of unknown cause – China. Beijing, China: China - WHO Country Office, January 2020. Available from: https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en. [Last accessed on 2020 Aug 11].  Back to cited text no. 2
United States Resource Availability for COVID-19. The Society of Critical Care Medicine (SCCM), 2020. Available from: https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19. [Last accessed on 2020 Aug 11].  Back to cited text no. 3
Joyce BL, Swanberg SM. Using Backward Design for Competency Based Undergraduate Medical Education. In: Stefaniak J, ed. Advancing Medical Education Through Strategic Instructional Design. Medical Information Science Reference, 2017: DOI: 10.4018/978-1-5225-2098-6.ch003.  Back to cited text no. 4
Thomas PA, Kern DE, Hughes MT, Chen BY. Curriculum Development for Medical Education. 3rd Edition. Johns Hopkins University Press: Baltimore. 2016.  Back to cited text no. 5
Rowe M, Frantz F, Bozalek V. The role of blended learning in the clinical education of healthcare students: A systematic review, Med. Teach 2012;34:e216-e221. DOI: 10.3109/0142159X.2012.642831.  Back to cited text no. 6
Alhazzani W, Al-Suwaidan FA, Al Aseri ZA, Al Mutair A, Alghamdi G, Rabaan AA, et al. The Saudi Critical Care Society Clinical Practice Guidelines on the management of COVID-19 patients in the intensive care unit. Saudi Crit Care J 2020; 4:27-44.  Back to cited text no. 7
  [Full text]  
Behera S, Jha SK, Singh NK, Khilnani GC, Mahajan A, Kumar S, et al. COVID-19: What we all intensivists should know. Saudi Crit Care J 2020; 4:45-57.  Back to cited text no. 8
  [Full text]  
Brewster D, Chrimes N, Do T, Fraser K. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. The Medical Journal of Australia [Online] 2020. Available from: https://www.mja.com.au/journal/2020/212/10/consensus-statement-safe-airway-society-principles-airway-management-an. [Last accessed on 2020 Mar 30].  Back to cited text no. 9
Brindley P, Cardinal P. Optimizing Crisis Resource Management to Improve Patient Safety and Team Performance: A handbook for all health care professionals. [Online] Royal College of Physicians and Surgeons of Canada; 2017. Available from: http://www.royalcollege.ca/rcsite/documents/practice-performance-innovation/optimizing-crisis-resource-management-improve-patient-safety-team-performance-e.pd. [Last accessed on 2020 Mar 30].  Back to cited text no. 10
Highfield J. Advice for sustaining staff wellbeing in critical care during and beyond covid-19 [Online]. Intensive Care Society. Available from: https://www.ics.ac.uk/ICS/Education/Wellbeing/ICS/Wellbeing.aspx?hkey=92348f51-a875-4d87-8ae4-245707878a5c. [Last accessed on 2020 Mar 30].  Back to cited text no. 11
Saudi Center for Disease Prevention and Control. Coronavirus Disease 19 (COVID-19) Guidelines [Online]. Ministry of Health. Available from: https://www.moh.gov.sa/CCC/healthp/regulations/Documents/Coronavirus%20Disease%202019%20Guidelines%20v1.1..pdf. [Last accessed on 2020 Mar 30].  Back to cited text no. 12
The Society of Critical Care Medicine. Critical Care for Non-ICU Clinicians [Online]. Available from: https://www.sccm.org/covid1. [Last accessed on 2020 Mar 30].  Back to cited text no. 13
World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak [Online]. Available from: https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pd. [Last accessed 2020 Mar 30].  Back to cited text no. 14
ACET. Just in time training (JITT) with rapid turn-around Simulations for COVID19. [Online] King’s College Hospital, NHS. Available from: https://www.covid19repository.com/just-in-time-training-jitt-with-rapid-turnaround-simulationsfor-covid19. [Last accessed 2020 Mar 30].  Back to cited text no. 15
American Heart Association. Interim Guidance for Healthcare Providers during COVID-19 Outbreak [Online]. Available from https://professional.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_505872.pdf [Last accessed 2020 Mar 30].  Back to cited text no. 16


  [Table 1], [Table 2]


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