Variation in Intensive Care Unit Intubation Practices in Pulmonary Critical Care Medicine Fellowship

Brady, Anna K.; Brown, W. G.; Denson, Joshua L.; Winter, Gretchen; Niroula, Abesh; Santhosh, Lekshmi; Carlos, W. Graham

doi:10.34197/ats-scholar.2020-0004oc

Cited by 5 publications

(9 citation statements)

References 17 publications

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“…While completion of the postmodule survey was optional, fellowship program directors required participation from fellows in this educational initiative since competency in the content of this module is required by the ACGME. 8,9…”

Section: Methodsmentioning

confidence: 99%

“…8 The Accreditation Council for Graduate Medical Education (ACGME) specifies that PCCM fellowship programs must have trainees achieve endotracheal intubation and airway management competency, though the methods of acquiring competency are not clearly described. [8][9][10] The COVID-19 pandemic has further highlighted the importance of critical care trainees acquiring competency in airway management. A targeted needs assessment performed through informal interviews of fellows and faculty identified gaps in fellows' knowledge in assessing preintubation airway assessment.…”

Section: Introductionmentioning

confidence: 99%

“…There is a paucity of literature on how the topic of airway management is taught in Critical Care Medicine (CCM) and Pulmonary and CCM (PCCM) fellowship programs since most of the relevant literature involves Anesthesiology and Emergency Medicine (EM) trainees. 8 The Accreditation Council for Graduate Medical Education (ACGME) specifies that PCCM fellowship programs must have trainees achieve endotracheal intubation and airway management competency, though the methods of acquiring competency are not clearly described. [8][9][10] The COVID-19 pandemic has further highlighted the importance of critical care trainees acquiring competency in airway management.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of a Web-Based Preintubation Preparation Module on the Knowledge, Confidence, and Behavior of Critical Care Fellows: A Single-Center Pilot Study

Alroumi,

Dinino,

Tidswell

et al. 2023

Journal of Medical Education and Curricular Development

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OBJECTIVES The objectives of this study were to standardize airway management among critical care fellows and to evaluate whether the completion of a web-based preintubation airway preparation module improves their knowledge and behaviors in the identification and preparation of difficult airways. METHODS Critical care experts used international guidelines to develop the module, which contained mandatory readings, brief lectures, and a case-based activity. We measured learner satisfaction, improvements in fellows’ preintubation preparation knowledge, and safety-oriented behavior. The paired t-test was used to compare knowledge assessment scores and the chi-square test was used to compare the categorical variables in the evaluation of the behavior construct. RESULTS All trainees ( N = 14) completed the module and were satisfied with its contents and structure. Fellows logged 114 intubations during the study period. The mean score on the knowledge test increased (pre 79% vs post 90%, P = .02) postmodule and there was a significant increase in documentation of airway risk stratification in fellows’ procedure notes (65.9% vs 72.9%, P = .049). All respondents were confident that they would be able to apply what they learned in the module into clinical practice and that their patients would likely benefit from their new knowledge. CONCLUSION The implementation of an asynchronous web-based module on airway assessment and intubation preparation was feasible. The module was engaging, enhanced the knowledge of our trainees, and improved procedural documentation.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of a Web-Based Preintubation Preparation Module on the Knowledge, Confidence, and Behavior of Critical Care Fellows: A Single-Center Pilot Study

Alroumi,

Dinino,

Tidswell

et al. 2023

Journal of Medical Education and Curricular Development

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“…For pulmonary and critical care medicine (PCCM) fellows, one crucial aspect of such training is procedural education, with a range of invasive procedures expected to be mastered by the completion of fellowship ( 1 ). However, although fellowship experience with individual procedures such as bronchoscopy ( 2 ) and endotracheal intubation ( 3 , 4 ) has been characterized, there have been little data describing if and how PCCM trainees more globally achieve the procedural experience and competence they need.…”

mentioning

confidence: 99%

“…Community programs or those located elsewhere in the country may have different practices when it comes to procedural teaching. For instance, programs in the northeastern United States were outliers when it came to performance of endotracheal intubation in the intensive care unit during fellowship ( 3 ). Second, the classification of procedures into HRLV and LRHV, although useful, is not all-inclusive, and there are important procedures that may not fit into these classifications—such as endotracheal intubation, which one could argue is a high-risk, high-volume procedure at many institutions.…”

mentioning

confidence: 99%

Not All Procedures Are Treated Equally by Pulmonary and Critical Care Fellowships

Brady

2021

ATS Scholar

Self Cite

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Impact of the COVID-19 pandemic on the education and procedural volume of fellows in critical care medicine – a cross-sectional survey

et al. 2023

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Background The COVID-19 pandemic has changed the way medical education is delivered. The purpose of this study was to assess the impact of the COVID-19 pandemic on the education and procedural volume of critical care and pulmonary critical care fellows. Methods We conducted a cross-sectional, internet-based, voluntary, anonymous, national survey of adult critical care fellows and academic attending physicians in critical care and pulmonary critical care fellowship programs in the United States between December 2020 and February 2021. Survey questions covered both didactic and non-didactic aspects of education and procedural volumes. Answers were ranked on a 5-point Likert scale. Survey responses were summarized by frequency with percentage. Differences between the responses of fellows and attendings were assessed with the Fisher’s exact or Chi-Square test, using Stata 16 software (StataCorp LLC, College Station, TX). Results Seventy four individuals responded to the survey; the majority (70.3%) were male; less than one-third (28.4%) female. Respondents were evenly split among fellows (52.7%) and attendings (47.3%). 41.9% of survey respondents were from the authors’ home institution, with a response rate of 32.6%. Almost two-thirds (62.2%) reported that fellows spend more time in the ICU since the onset of the pandemic. The majority noted that fellows insert more central venous catheters (52.7%) and arterial lines (58.1%), but perform fewer bronchoscopies (59.5%). The impact on endotracheal intubations was mixed: almost half of respondents (45.9%) reported fewer intubations, about one-third (35.1%) more intubations. Almost all respondents (93.0%) described fewer workshops; and one-third (36.1%) fewer didactic lectures. The majority (71.2%) noted less time available for research and quality improvement projects; half (50.7%) noted less bedside teaching by faculty and more than one-third (37.0%) less fellow interaction with faculty. Almost one-half of respondents (45.2%) reported an increase in fellows’ weekly work hours. Conclusion The pandemic has caused a decrease in scholarly and didactic activities of critical care and pulmonary critical care fellows. Fellows spend more time in ICU rotations, insert more central and arterial lines, but perform fewer intubations and bronchoscopies. This survey provides insights into changes that have occurred in the training of critical care and pulmonary critical care fellows since the onset of the COVID-19 pandemic.

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Variation in Intensive Care Unit Intubation Practices in Pulmonary Critical Care Medicine Fellowship

Cited by 5 publications

References 17 publications

The Impact of a Web-Based Preintubation Preparation Module on the Knowledge, Confidence, and Behavior of Critical Care Fellows: A Single-Center Pilot Study

The Impact of a Web-Based Preintubation Preparation Module on the Knowledge, Confidence, and Behavior of Critical Care Fellows: A Single-Center Pilot Study

Not All Procedures Are Treated Equally by Pulmonary and Critical Care Fellowships

Impact of the COVID-19 pandemic on the education and procedural volume of fellows in critical care medicine – a cross-sectional survey

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