Sepsis guidelines have been published for a long time, but challenges remain in clinical application. The main problem is that the clinical diagnosis and treatment cannot be done with strict adherence to guidelines. In this study, we found that among doctors in tertiary Chinese hospitals, attending lectures, self-study guides, and ward rounds by senior doctors are considered the most effective learning methods and can quickly influence clinical diagnosis and treatment. However, nearly half of the doctors choose self-study guide to acquire relevant knowledge on sepsis and the proportion is significantly higher than that of those using other methods. However, clinicians are more willing to attend lectures and recognize the effect of this learning method. The reason being that medicine is an empirical subject based on theoretical knowledge and most of the teachers are doctors with rich clinical experience. Therefore, although there are some conflicts with guidelines, treatment methods in line with China’s national condition are easier to follow for Chinese doctors. It should be noted that the impact of senior doctor’s ward round teaching, especially to junior doctors, is significantly lower than we expected, indicating that compared to attending lectures, superior doctor’s guidance is not enough, or does not induce the participants to think and discuss problems. This has a negative impact on clinical diagnosis and treatment.
Fluid resuscitation is an important part of sepsis management . In this survey, > 90% of the doctors believed that rapid and large-scale fluid replacement was needed, followed by administration of high-dose vasoactive drugs and human serum albumin supplements. However, when talking about the principle of fluid replacement in sepsis, most of the doctors thought that it should be used with vasoactive drugs, and that the amount of fluid replacement should not be too high. This kind of contradictory conclusion reflects that there is a certain deviation in our understanding of the guidelines on clinical diagnosis and treatment, which is also obviously reflected in the use of antibiotics. In our study, we found that more than half of the doctors who participated in the survey chose the empirical antibiotic use strategy first, and then adjusted based on clinical outcomes. Nearly 1/3 chose the empirical antibiotic use. According to the investigation on the basis of drug use plan, most doctors think that their choice of antibiotic treatment plan comes from studying guidelines. The reason for confusion in the diagnosis and treatment process is that we lack standardized training, which leads to unclear concepts and biased interpretation of treatment strategies. This needs urgent correction [5, 6].
How should standardized training on sepsis be done? Through investigation and analysis, we found that although the proportion of doctors practicing self-study is higher, they are actually more willing to accept lectures and training. This is because experienced senior doctors can explain the guidelines during clinical practice, analyze patient condition in clinical settings, interpret guidelines in detail, and ensure the safety of each participant during diagnosis and treatment with the doctors participating. This is more conducive for accumulation of clinical experience by junior doctors and provides better “closed-loop learning” . However, at this stage, our survey indicates that there are great omissions in ward rounds and explanations by senior doctors, which necessitates that young doctors learn by themselves or go out to learn in order to obtain more knowledge. Consequently, variations in knowledge and skills cognition and mastery is inevitable. Therefore, to realize standardized training on sepsis, we should first improve the quality of our clinical rounds and then adopt targeted training methods like special lectures, case sharing, online exchange learning, and organizing sepsis related knowledge competitions, to improve the quality and effectiveness of training.
Additionally, training may be improved by optimizing content, for example, by using charts, tables, and other intuitive teaching methods, and minimizing text content in order to facilitate memory. A foreign survey of emergency department nurses found that training employees through pocket cards, posters, and electronic accessible guides can improve their recognition of sepsis .
For training effect, we should pay attention to follow-up, clinical application of training guidelines, and fully compare prognosis and symptom improvement time of patients treated according to clinical experience and standardized guidelines. In addition to emergency physicians, the number of physicians in respiratory and critical care departments should be increased. If the situation permits, we can compare differences between emergency physicians and respiratory critical care physicians in the process of sepsis diagnosis and treatment so as to carry out targeted training .
Onsite training (i.e., education in actual clinical setting) can enhance learning. With the popularity of simulation centers and computerized laboratories, core technologies play an increasingly important role in teaching clinical skills , such as setting up virtual online patients, allowing students to give diagnosis and treatment plans according to described cases. This method can help educators identify knowledge gaps in sepsis management students and focus on weak links. We can strengthen the curriculum to cultivate students’ ability to identify and treat sepsis, and then improve safety and treatment effectiveness . Currently, online learning is especially suitable and critical in the fight against the COVID-19(Corona Virus Disease 2019) pandemic .