Publication date: Feb 18, 2025

Background: Mechanical ventilation (MV) skills are crucial for clinicians who care for critically ill patients; however, few training programs incorporate structured curricula and appropriate assessments. The use of virtual simulators for teaching and assessments has not been evaluated and can offer advantages. Objective: To create an MV competency-based course for internal medicine residents using a virtual simulator and to evaluate course impact. Methods: We developed an online, 8 month, competency-based MV course for internal medicine residents, including virtual simulation. Each module included a 1-hour session (20 min of lecture, 40 min of virtual simulation) and self-directed learning material. Engagement was reinforced through live meetings, an online platform, and group chats. To evaluate competency, we adapted a validated simulation-based assessment to a virtual MV simulator (virtual simulation-based assessment [SBA]). Course impact was evaluated using the four-level Kirkpatrick model, including surveys for satisfaction and confidence (level 1), knowledge assessment with a multiple-choice examination (level 2), and deliberate practice with the simulator and clinical competence on the virtual SBA (level 3). Results: Eighty-one residents out of 103 completed the course and rated it as effective, with a net promoter score of 9. 2. The use of virtual simulation was rated as very useful by most participants. Confidence in caring for patients under MV in different scenarios before and after the course significantly increased. On a 10-point scale, the multiple-choice examination score increased 1. 19 points (95% confidence interval, 0. 91-1. 47; P 

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