The coronavirus pandemic forced the Association of Pulmonary and Critical Care Medicine Program Directors to change the 2020 annual conference to a virtual format with relatively short notice. Using the experience of the planning committee and survey feedback from attendees, we describe the steps taken to implement a virtual conference and lessons learned in the process. The lessons described include frequent and concise communication, establishment of roles within a discrete production team, preparing speakers with a protocolized training session, active moderation of the chat box, using interactive polling and online documents to improve interactivity, a shorter agenda with more frequent breaks, encouraging “virtual happy hours” to connect with colleagues, and establishing facilitators for breakout rooms.

Background Although it is well known that the coronavirus disease (COVID-19) pandemic has had a profound effect on health care, its impact on fellowship training in Pulmonary and Critical Care Medicine (PCCM) has not been well described. Objective We conducted an anonymous survey of PCCM program directors (PDs) to assess the impact of the COVID-19 pandemic on PCCM fellowship training across the United States. Methods We developed a 30-question web-based survey that was distributed to U.S. PCCM PDs through the Association of Pulmonary and Critical Care Medicine Program Directors. Results The survey was sent to 242 PDs, of whom 28.5% responded. Most of the responses (76.8%) came from university-based programs. Almost universally, PDs reported a decrease in the number of pulmonary function tests (100%), outpatient visits (94.1%), and elective bronchoscopies (96%). Three-quarters (77.6%) of the PDs reported that their PCCM fellows spent more time in the intensive care unit than originally scheduled. Conclusion The COVID-19 pandemic has had a variable impact on different aspects of fellowship training. PDs reported a significant decrease in the core components of pulmonary training, whereas certain aspects of critical care training increased. It is likely that targeted mitigation strategies will be needed to ensure no gaps in PCCM training while optimizing well-being.

Due to the limited number of critical care providers in the United States, even well-staffed hospitals are at risk of exhausting both physical and human resources during the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). One potential response to this problem is redeployment of non-critical care providers to increase the supply of available clinicians. To support efforts to increase capacity as part of surge preparation for the coronavirus disease (COVID-19) outbreak, we created an online educational resource for nonintensivist providers to learn basic critical care content. Among those materials, we created a series of one-page learning guides for the management of common problems encountered in the intensive care unit (ICU). These guides were meant to be used as just-in-time tools to guide problem-solving during the provision of ICU care. This article presents five guides related to managing complications that can arise in patients receiving invasive mechanical ventilation.

Due to the limited number of critical care providers in the United States, even well-staffed hospitals are at risk of exhausting both physical and human resources during the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). One potential response to this problem is redeployment of non-critical care providers to increase the supply of available clinicians. To support efforts to increase capacity as part of surge preparation for the coronavirus disease (COVID-19) outbreak, we created an online educational resource for nonintensivist providers to learn basic critical care content. Among those materials, we created a series of one-page learning guides for the management of common problems encountered in the intensive care unit (ICU). These guides were meant to be used as just-intime tools to guide problem-solving during the provision of ICU care. This article presents five guides related to the evaluation and management of patients with hypoxemic respiratory failure and the basics of invasive mechanical ventilation.

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Problem In the competency-based medical education literature, investigators have typically discussed notions of trust in the context of entrustment decision-making rather than as attitudes within competency frameworks. Complementarity between concepts of entrustable professional activities and of competencies created an opportunity to infuse the latter with notions of trust. Bedside cardiac assessment (BCA) exemplified one such competency. Traditional approaches to teaching and learning BCA addressed relevant knowledge and skills but not attitudes. We conceptualized entrustability as part of an attitudinal approach to teaching and learning BCA more holistically and effectively. The purpose of this thematic analysis was to explore students′ experience, in a medicine clerkship at one U.S. medical school, of participating in a newly developed BCA curriculum that aimed to foster attitudinal growth and a holistic approach to clinical learning. Approach Building upon Teaching for Understanding and conceptual change frameworks, the authors developed a flipped class curriculum utilizing pre-class short online videos and practice exercises followed by in-class activities and reflective discussions. Using a combination of content analysis and thematic analysis methodology of open-ended questionnaires administered from November 2017 to June 2018, the authors analyzed the experiences of medical students at one of the schools at which the curriculum was implemented. Outcomes Thematic analysis suggested learning strategies were effective and that peer encounters, skills practice, and encounters with educators were meaningful. The analysis also revealed opportunities to improve the original instructional design. Next Steps The authors will incorporate feedback into future iterations of the curriculum and make it widely available to better study its impact on learners′ abilities; entrustability as a construct; and transfer of learning from the classroom to the workplace. Further work is needed to clarify the value of incorporating notions of trust into competency frameworks. The authors intend this exploratory work to stimulate conversations around expanded roles of trustworthiness and entrustability in medical education.

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Chronic respiratory failure is a common complication of neuromuscular disease. The use of noninvasive ventilation and mechanically assisted cough can reduce symptoms of hypoventilation, slow lung function decline, improve sleep quality, and in some cases prolong survival in patients with neuromuscular disease. In this article, we review indications for the initiation of noninvasive ventilation and mechanically assisted cough as well as provide recommendations for settings and titration. We discuss the evidence supporting the use of noninvasive ventilation as an adjunct to rehabilitation in patients with neuromuscular disease. Lastly, we review the ethical considerations that are relevant to decisions regarding initiation and cessation of noninvasive ventilation. While noninvasive ventilation and mechanically assisted cough have become standards of care in many forms of neuromuscular disease, most current recommendations are based on expert opinion rather than much-needed data from prospective clinical trials and we emphasize topics requiring future research.