ATS scholar最新文献

{"title":"Cognitive Task Analysis to Evaluate Resident Physician Decision Making in the Intensive Care Unit.","authors":"Jason N Mansoori, Stephanie Gravitz, Kathryne D Reed, Jennifer K Taylor, Edward P Havranek, Jodi S Holtrop, Ivor S Douglas","doi":"10.34197/ats-scholar.2025-0009OC","DOIUrl":"https://doi.org/10.34197/ats-scholar.2025-0009OC","url":null,"abstract":"<p><p><b>Background:</b> Heuristics are commonplace among novices and experts making clinical decisions, often guided by clinical intuition when there is diagnostic or therapeutic uncertainty. Compared with more experienced clinicians, trainees may lack the knowledge, insight, and intuition needed to appropriately select and apply heuristics and clinical decision rules. An improved understanding of the mental models and contextual factors that predispose trainees to misapplied heuristics, cognitive biases, and other decision-making errors is needed. <b>Objectives:</b> To test the use of cognitive task analysis for examining how trainees make high-risk decisions in complex, dynamic, and real-world practice environments. <b>Methods:</b> We conducted semistructured interviews between September 2019 and March 2020 using a cognitive task analysis technique called the critical decision method. Participants were third-year internal medicine resident physicians rotating in the medical intensive care unit at a major safety-net academic hospital. Interviews focused on fluid-resuscitation decisions for actual patients with septic shock. Data were coded and analyzed using a template approach with the Recognition-Primed Decision model as the guiding framework. <b>Results:</b> Eleven of 23 eligible residents completed a full interview. The median time from initial sepsis care to interview was 7 days (interquartile range, 6.5-11 d). Seven key domains related to fluid-resuscitation decisions were identified: cues, information, decision making, decision alternatives, analogs, expected outcomes, and goals. In addition to objective clinical data (e.g., serum lactate concentration), fluid-resuscitation decisions were most significantly influenced by clinical intuition, other nonphysiological contextual factors, and volume-based heuristics. For example, residents frequently prescribed fluid dependent on the total volume already administered. They assumed that patients receiving more than 3-5 L would not benefit from additional resuscitation, while using the same heuristic to disregard evidence-based predictors of fluid responsiveness. Evidence of related cognitive biases was also found, including premature closure, confirmation bias, and status quo (or default) bias. <b>Conclusions:</b> Cognitive task analysis is a promising tool for examining how trainees make high-risk clinical decisions. Better understanding the nature of trainees' heuristics and cognitive biases has implications for designing educational and training strategies that improve their clinical reasoning.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Care Cadets: A Serious Game for Managing Mechanical Ventilation.","authors":"Daniel Hassumani, Satid Thammasitboon, Fong Lam, Aarti Bavare, Moushumi Sur, Shelley Kumar, Thomas Reeves, Brian Rissmiller","doi":"10.34197/ats-scholar.2024-0080IN","DOIUrl":"https://doi.org/10.34197/ats-scholar.2024-0080IN","url":null,"abstract":"<p><p><b>Background:</b> Pediatric critical care medicine (PCCM) fellows require proficiency in mechanical respiratory support and ventilator management strategies. Traditional training methods have limitations, and there is a need to expedite the learning process. Serious games have emerged as effective supplements to traditional teaching methods, promoting knowledge acquisition through immersive and engaging experiences. However, there is a void in the context of complex decision making in mechanical ventilation management. <b>Objective:</b> To develop a serious game to enhance the knowledge and practical strategies of PCCM fellows in mechanical ventilation management. <b>Methods:</b> The game was designed on the basis of theory-informed design principles and employed an iterative development process. A mixed methods approach, grounded in the Model for the Evaluation of Educational Games, was used for evaluation of usability, player experience, satisfaction, and learning outcomes. Game play and evaluation occurred in July 2022. <b>Results:</b> Our game proved highly engaging, enjoyable, and facilitated learning among the PCCM fellows. The evaluation data indicated high ratings in all Model for the Evaluation of Educational Games domains. The fellows reported achieving the learning objectives and demonstrated knowledge gained in post-game play modified essay questions, and the game received positive feedback. <b>Conclusion:</b> The developed serious game fills an educational gap in complex decision making in mechanical ventilation management. By using theory-informed design principles and an iterative development process, the game effectively enhanced the knowledge and practical skills of PCCM fellows. The positive outcomes and feedback from the evaluation support the use of serious games as innovative educational tools in medical education.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"1-10"},"PeriodicalIF":1.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I Teach the Estimation of Right Ventricular Systolic Pressure Using Point-of-Care Ultrasound.","authors":"Edwin Jackson, Upasana Jarori, Evan Tomkiewicz, W Graham Carlos","doi":"10.34197/ats-scholar.2024-0076HT","DOIUrl":"https://doi.org/10.34197/ats-scholar.2024-0076HT","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) is a powerful diagnostic tool that combines image acquisition with bedside interpretation, enabling physicians to make rapid diagnoses at the bedside (1). Over the last decade, the popularity of POCUS has surged because of its versatility and the immediate insights it provides in clinical decision making (1). However, basic POCUS does not provide important hemodynamic information, such as intracardiac pressures, stroke volume, or valvular regurgitation assessment. Critical care echocardiography (CCE) becomes indispensable as a specialized application of POCUS focused on using Doppler techniques to provide detailed hemodynamic assessments in critically ill patients (2). Teaching hemodynamic evaluation in CCE, such as estimating right ventricular systolic pressure (RVSP), is a challenging yet essential aspect of modern critical care education. RVSP is used to assess the presence of pathologic elevation in right ventricular afterload, which has significant clinical implications for critically ill patients. Deriving RVSP requires understanding ultrasound physics, fluid mechanics, and Doppler techniques and mastery of cardiac image acquisition (3-4). These complex skills are not just important but crucial for effectively managing critically ill patients in the intensive care unit (ICU). In this edition of \"How I Teach,\" we introduce our methodology for instructing learners in our ICU on RVSP estimation using CCE. We use hands-on ultrasound training and e-learning strategies to optimize knowledge retention, ensure accurate interpretation, and promote practical application.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"1-10"},"PeriodicalIF":1.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out of Control.","authors":"Deepa Ramadurai","doi":"10.34197/ats-scholar.2024-0155SN","DOIUrl":"https://doi.org/10.34197/ats-scholar.2024-0155SN","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"1-10"},"PeriodicalIF":1.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-based Educational Intervention for Lung Cancer Screening for Non-Hispanic Black Adults.","authors":"Francesca C Duncan, Edwin J Jackson, Lauren D Nephew, Noah B Davis, Mychael T Spencer, Brendon D Truax, Catherine R Sears","doi":"10.34197/ats-scholar.2025-0010BR","DOIUrl":"https://doi.org/10.34197/ats-scholar.2025-0010BR","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"1-10"},"PeriodicalIF":1.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Modeling the Behaviors and the Interactions That We Value\": Critical Care Attending Physician Perspectives on Interprofessional Teaching in Graduate Medical Education.","authors":"Asha M Anandaiah, Camille R Petri, Christine P Beltran, Amy M Sullivan","doi":"10.34197/ats-scholar.2024-0134OC","DOIUrl":"https://doi.org/10.34197/ats-scholar.2024-0134OC","url":null,"abstract":"<p><p><b>Background:</b> Interprofessional teaching (IPT) has the potential to promote teamwork and collaborative patient care, but few studies have explored physician attitudes about the role of nonphysician clinical teachers in graduate medical education. <b>Objective:</b> This study aimed to elucidate critical care attending physician perspectives about the role of nurses, pharmacists, and respiratory therapists in teaching medical residents. <b>Methods:</b> Using a concurrent mixed methods approach, surveys and focus groups were administered to attendings in an urban tertiary academic medical center. Survey data were analyzed with descriptive statistics; focus group data were analyzed using the Framework method of content analysis. <b>Results:</b> Of attendings surveyed, 23/26 (88%) responded. Attendings reported positive attitudes about IPT; highly cited benefits included capitalizing on the unique expertise held by interprofessional providers (21/22, 95%), modeling respectful interprofessional relationships (21/22, 95%), and promoting collaborative patient care (20/22, 91%). Ten attendings participated in focus groups. Qualitative analysis revealed four major themes: overall low rates of IPT that vary by profession, potential role of attending as facilitator of IPT, multiple interpersonal and environmental characteristics that influence IPT, and impacts of IPT on education, patient care, and teamwork. <b>Conclusion:</b> Study results suggest that attending physicians are enthusiastic about the concept of IPT and their potential role in its promotion.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Competency-based Mechanical Ventilation Course Using Virtual Simulation.","authors":"Bruno Rocha de Macedo, Carolina Saldanha Lima, Ahmed Haydar, Marcelo Alcantara Holanda, Fatima Kiyoko Hayashi, Juliana Carvalho Ferreira","doi":"10.34197/ats-scholar.2024-0083OC","DOIUrl":"10.34197/ats-scholar.2024-0083OC","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Objective:</b> To create an MV competency-based course for internal medicine residents using a virtual simulator and to evaluate course impact. <b>Methods:</b> 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). <b>Results:</b> 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; <i>P</i> < 0.001) from baseline to the end of the course, and the virtual SBA score at the end of the course was 6.15 ± 1.26 for post-graduate year 1 residents and 6.48 ± 1.56 for post-graduate year 2 residents (<i>P</i> = 0.33). Performance on different competencies varied, with lower scores on tasks such as asynchrony correction. Ninety-nine percent of residents reported a very positive (58%) or positive (41%) impact of the course in their practice. <b>Conclusion:</b> We developed a satisfactory and effective MV course including virtual simulation for internal medicine residents during the COVID-19 pandemic. Confidence and knowledge increased by the end of the course, although performance on complex MV skills was suboptimal. The use of virtual simulators for teaching and assessment are valuable new tools for teaching MV.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"202-216"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Artificial Intelligence and Medical Education: Navigating the Alignment Paradox.","authors":"Laurah Turner, Michelle I Knopp, Eneida A Mendonca, Sanjay Desai","doi":"10.34197/ats-scholar.2024-0086PS","DOIUrl":"10.34197/ats-scholar.2024-0086PS","url":null,"abstract":"<p><p>The integration of artificial intelligence (AI) into medical education presents both unprecedented opportunities and significant challenges, epitomized by the \"alignment paradox.\" This paradox asks: How do we ensure AI systems remain aligned with our educational goals? For instance, AI could create highly personalized learning pathways, but this might conflict with educators' intentions for structured skill development. This paper proposes a framework to address this paradox, focusing on four key principles: ethics, robustness, interpretability, and scalable oversight. We examine the current landscape of AI in medical education, highlighting its potential to enhance learning experiences, improve clinical decision making, and personalize education. We review ethical considerations, emphasize the importance of robustness across diverse healthcare settings, and present interpretability as crucial for effective human-AI collaboration. For example, AI-based feedback systems like i-SIDRA enable real-time, actionable feedback, enhancing interpretability while reducing cognitive overload. The concept of scalable oversight is introduced to maintain human control while leveraging AI's autonomy. We outline strategies for implementing this oversight, including directable behaviors and human-AI collaboration techniques. With this road map, we aim to support the medical education community in responsibly harnessing AI's power in its educational systems.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"135-148"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Interventional Pulmonology Fellowships on Pulmonary Critical Care Fellows' Core Bronchoscopy Competencies.","authors":"Samiksha Gupta, Christopher Ghiathi, David DiBardino, Enambir S Josan, Bertin D Salguero, Udit Chaddha, Max T Wayne, Jose De Cardenas, Maroun Matta, Benjamin Young, Andrew Dunatchik, Christopher Di Felice, Sameer K Avasarala","doi":"10.34197/ats-scholar.2024-0079OC","DOIUrl":"10.34197/ats-scholar.2024-0079OC","url":null,"abstract":"<p><p><b>Background:</b> Currently, there is significant variability in bronchoscopy training across pulmonary and critical care medicine (PCCM) programs nationwide, including procedural volume and exposure to simulation training. Despite the increased number of interventional pulmonology (IP) fellowship programs in the United States, their direct educational impact on PCCM fellows' bronchoscopy training is unknown. <b>Objective:</b> To identify and quantify the differences in flexible bronchoscopy competency among PCCM fellows from institutes with IP fellowships compared with those without IP fellowships. <b>Methods:</b> This multicenter, prospective cohort study included the assessment of PCCM fellows from two groups, using the Ontario Bronchoscopy Assessment Tool (OBAT): <i>1</i>) PCCM fellowships with a coexistent IP fellowship program and <i>2</i>) PCCM fellowships without an IP fellowship program. The primary outcome was the difference in mean score between the two groups; secondary outcomes included the mean OBAT score of first, second, and third-year (or above) fellows in the two groups and the percentage of fellows in the two groups who were capable of independently performing the procedure. <b>Results:</b> There were five participating training sites: two with IP fellowships and three without IP fellowships. A total of 50 OBAT assessments were performed (25 in each group) by the supervising attending physician. The mean OBAT score was 3.58 ± 0.65 in the IP group compared with 4.33 ± 0.61 in the non-IP group (<i>P</i> < 0.001). The mean (standard deviation) OBAT scores of the first, second, and third-year (or above) fellows were 3.36 (0.5), 3.48 (0.4), and 4.53 (0.5) in the IP group and 3.75 (0.8), 4.25 (0.5), and 4.7 (0.3) in the non-IP group, respectively. The mean OBAT score was directly proportional to the number of procedures done by the fellows. <b>Conclusion:</b> There was a statistically significant difference in the mean OBAT scores between the two groups; the mean OBAT score was higher in the non-IP fellowship group. Although a more comprehensive study is needed to fully account for the various factors that can impact bronchoscopy training, this study highlights a key difference in basic bronchoscopy training among PCCM trainees. The presence of IP fellowship is one of the many factors that can affect the basic bronchoscopy skills of PCCM fellows.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"179-190"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchoscopic Lung Volume Reduction with Endobronchial Valves for Emphysema.","authors":"Yaron B Gesthalter, Julia Maheshwari","doi":"10.34197/ats-scholar.2024-0078PE","DOIUrl":"10.34197/ats-scholar.2024-0078PE","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"252-254"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}