ATS scholar最新文献

{"title":"An Attending-Directed Intervention to Enhance Interprofessional Teaching on ICU Rounds.","authors":"Camille R Petri, Atulita Punnamaraju, Christine P Beltran, Amy M Sullivan, Amy P Cohen, Jacqueline FitzGerald, Asha M Anandaiah","doi":"10.1093/atsscholar/aapag060","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag060","url":null,"abstract":"<p><strong>Introduction: </strong>Interprofessional teaching (IPT) during rounds may enhance teamwork and collaborative patient care, but previous studies have shown low rates of IPT during intensive care unit (ICU) rounds. We designed a study to explore contributions by interprofessional providers (IPPs) during ICU rounds and an attending-targeted intervention to promote IPT.</p><p><strong>Methods: </strong>Using a novel observation tool, we collected details regarding contributions made by IPPs during rounds in two ICUs at an academic medical center. A study team member conducted observations for six weeks before and after implementation of an attending-directed intervention. Comparisons were made between pre- and post-intervention data.</p><p><strong>Results: </strong>Before the intervention, six attendings were observed for 59 patient-rounds with 309 contributions recorded, and after, eleven attendings were observed for 94 patient-rounds with 512 contributions recorded. The majority of contributions from IPPs were classified as \"reporting\" (pre/post: 42.7% vs. 43.6%) and \"observing\" (pre/post: 29.1% vs. 29.7%). \"Teaching\" contributions were rare, but increased from 3.9% (12/309) to 4.7% (24/512) of all contributions (p > 0.05). The mean number of contributions per patient did not change after the intervention (5.24 vs. 5.45), and the types of contributions were similar across different attendings. When an IPP spontaneously provided a recommendation (pre: 33, post: 55), the contribution often changed the care plan (pre/post: 97.0% (32/33), 83.6% (46/55)).</p><p><strong>Conclusions: </strong>IPPs predominantly contribute to rounds by reporting data and providing observations. An intervention to improve attending facilitation of IPT did not affect rates of teaching. However, recommendations made by IPPs consistently impacted the patient care plan.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229533","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":"Educational Priorities in Oncologic Critical Care: A Modified Delphi Study.","authors":"Kristina Montemayor, Rupali Sood, Tom Di Vitantonio, Ben B Claxton, Justin Choi, Meehir Shah, Mary Elizabeth Card, Eli Salzberg, Kristen A Marrone, Margaret M Hayes, Michelle N Eakin, R Scott Stephens","doi":"10.1093/atsscholar/aapag064","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag064","url":null,"abstract":"<p><strong>Background: </strong>Advances in cancer diagnosis and treatment have prolonged survival, expanded therapeutic options, and introduced novel treatment-related toxicities. Patients with cancer now account for more than 20% of ICU admissions, exposing intensivists to increasingly complex clinical scenarios. Despite this evolving landscape, oncologic critical care education within PCCM fellowship training remains unstructured, with no consensus on educational priorities or expectations for trainee practice.</p><p><strong>Objectives: </strong>To define consensus-based educational priorities in oncologic critical care for PCCM fellowship training and clarify expectations regarding trainee management responsibility.</p><p><strong>Methods: </strong>We conducted a modified Delphi study between October and December 2025. Expert panelists were purposively recruited based on clinical or educational expertise in PCCM, hematology, oncology, and fellowship education. Using a REDCap-based survey, panelists rated 47 proposed topics across 11 oncologic critical care domains for importance to graduating PCCM fellows without additional sub-specialty training. Topics were rated using a four-point scale, with consensus defined a priori as ≥ 70% \"Must Know\" ratings. Open-ended feedback informed addition of a secondary rating scale in Round 2 assessing expected management responsibility (independent management vs. co-management with Hematology/Oncology). Responses were analyzed descriptively and in aggregate.</p><p><strong>Results: </strong>Of 58 invited experts, 41 (70%) completed Round 1. All Round 1 respondents were invited to participate in Round 2, of whom 32 (78%) completed the survey. Panelists represented diverse disciplines, geographic regions, and levels of experience. Of the 47 topics presented in Round 1, 33 met consensus criteria. Three topics close to consensus were carried forward based on panelist feedback. Five new topics were introduced in Round 2, three of which achieved consensus. In total, 39 topics were retained across both Delphi rounds. Consensus items emphasized core principles of oncologic critical care including ICU triage, procedural safety, management of infectious, metabolic, neurologic and oncologic emergencies, respiratory failure and therapy-related complications. Management-responsibility ratings differentiated topics appropriate for independent PCCM management from those requiring co-management with hematology/oncology.</p><p><strong>Conclusion: </strong>This study defines consensus-based educational priorities in oncologic critical care and clarifies expectations for trainee management and interdisciplinary collaboration, providing a practical framework to align PCCM fellowship training with contemporary ICU practice.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119170","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":"ATS Core Curriculum 2026 Adult Pulmonary Medicine: Pulmonary Hypertension Diagnosis and Management.","authors":"Josalyn L Cho, Erin Camac, Roberto J Bernardo, Hugo Carmona, Kathryn T Del Valle, Lindsay M Forbes, Nicholas A Kolaitis, Susan K Mathai, Stephanie I Maximous, Kathryn H Melamed, Tyler J Peck, Morgan Soffler, Trevor C Steinbach, Jenny Z Yang, Diana J Kelm, Garth W Garrison","doi":"10.1093/atsscholar/aapag062","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag062","url":null,"abstract":"<p><p>The American Thoracic Society Core Curriculum provides an update in adult and pediatric pulmonary disease, medical critical care, and sleep medicine at the annual International Conference. The 2026 Adult Pulmonary Core Curriculum focuses on pulmonary hypertension. Pulmonary hypertension is a complex and multifactorial condition requiring a systematic and nuanced approach to diagnosis and management. This clinical review provides a comprehensive overview of contemporary practices in adult pulmonary hypertension. Key topics include the role of right heart catheterization in definitive diagnosis, the application of validated risk stratification tools, and evolving treatment paradigms for pulmonary arterial hypertension. The curriculum also highlights the importance of recognizing and managing specific subgroups of patients with pulmonary hypertension, including chronic thromboembolic pulmonary hypertension, heritable PAH, and porto-pulmonary hypertension, as well as addressing critical considerations in patients of childbearing potential. In addition, the review underscores the role of supportive therapies and multidisciplinary care in optimizing patient outcomes. Educational Value: This review serves as a practical and evidence-based guide for clinicians managing pulmonary hypertension patients, integrating foundational principles with up-to-date clinical guidelines and emerging evidence in pulmonary hypertension. By addressing both common and specialized aspects of PH care, this resource will support learners across training levels, fostering improved clinical reasoning, decision-making, and evidence-based practice, and enhancing learners' ability to apply knowledge directly to patient care.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013300","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":"\"Learning Happens When Thinking Is Shared\": A Qualitative Exploration of Resident-Fellow Relationships on Inpatient Pulmonary Specialist Teams.","authors":"Erik Way, Bailey Ray, Josh Hayes, Haying Long, Scott M Matson, Sahil M Pandya","doi":"10.1093/atsscholar/aapag061","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag061","url":null,"abstract":"<p><strong>Background: </strong>Inpatient specialist teams present opportunities for clinical learning and professional development. These teams are comprised of both residents and fellows that work together to provide comprehensive patient care. Despite the complexity of these roles, dedicated focus on understanding perceptions of the resident-fellow relationship remains limited. Surgical and pediatric literature has demonstrated the variable impacts of fellows on inpatient teams; however limited data exists on the nature of the resident-fellow relationship in the context of pulmonary specialist teams. Understanding perceptions of these relationships may assist in clarifying expectations and roles and in optimizing learning experiences.</p><p><strong>Objectives: </strong>We aimed to understand resident perceptions of fellows and fellow perceptions of residents within the inpatient pulmonary specialist team. By doing so, we hope to understand the perceptions of joint team dynamics and collaborative qualities within these supervisory relationships.</p><p><strong>Methods: </strong>We conducted virtual, individual, qualitative, semi-structured interviews of learners at a single academic health system. Pulmonary critical care fellows (n = 10) and internal medicine residents (n = 10) were included. Responses were transcribed, compiled, and coded thematically to identify perceived characteristics of near-peer relationships and shared stressors.</p><p><strong>Results: </strong>From the fellow perspective, five qualities were identified when describing collaborative residents on inpatient specialist teams: engaged, intellectually curious, accountable, proactive, and independent thinkers. From resident interviews, four recurring characteristics emerged describing fellow counterparts: proactive communication, availability/accessibility, mutual respect, and ability to provide coaching/guidance. Fellow-to-resident feedback was viewed as mutually beneficial but infrequently practiced (requested or received). Both learner types (resident and fellow) described overlapping challenges in the resident-fellow relationship including unclear expectations, unpredictable workload, undefined student roles, and inconsistent feedback.</p><p><strong>Conclusion: </strong>Our findings suggest that both residents and fellows value specific behaviors from each other on inpatient pulmonary specialist teams. Both learner types have unique perceptions, and shared stressors that may be utilized to optimize the learning environment.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013289","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 Basics of Mechanical Ventilation.","authors":"Khaled M Abdullah, Elio Junior Feghali, Luis Sanchez-Ato, Guramrinder Thind, Deepa B Gotur","doi":"10.1093/atsscholar/aapag055","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag055","url":null,"abstract":"<p><p>Mechanical ventilation is a fundamental intervention in the management of the critically ill. Ventilator strategies and delivery of safe mechanical ventilation can significantly impact patient outcomes. Despite its clinical significance, mechanical ventilation training and curriculum for the graduate medical education trainees are lacking in standardization. This issue is further compounded by inconsistencies in the terminology used among critical care specialists, as well as differences in the proprietary names for similar ventilator modes by various ventilator models. Simplifying these issues into a basic understanding of pressure-, flow-, and volume-time scalars, followed by the introduction of advanced concepts in a constructivist approach, allows learners to build a knowledge scaffold that can help guide clinical decision-making in the intensive care unit. In this article, we focus on incorporating a standardized approach to explain the basics of mechanical ventilation. We created our curriculum based on Kolb's experiential learning theory. We planned our didactic sessions into interactive classroom-based discussions using teaching props and hands-on simulation with case-based learning.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992723","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":"Prioritizing Global Health Education in Pulmonary and Critical Care Fellowships: An Applicant Survey.","authors":"Maria L Srour, Varun U Shetty, Addison E Montroy, J Shirine Allam, Engi F Attia, Kristin M Burkart, Katerina L Byanova, Başak Çoruh, Laurence Huang, Jason E Moore, Neelima Navuluri, Crystal M North, Max R O'Donnell, Alfred C Papali, Kristina E Rudd, Trishul Siddarthan, Gabriel T Bosslet","doi":"10.1093/atsscholar/aapag059","DOIUrl":"10.1093/atsscholar/aapag059","url":null,"abstract":"<p><strong>Background: </strong>Global Health (GH) is expanding, offering an increasing number of opportunities for engagement to trainees in medical schools and residency programs. This expansion of opportunities has not yet reached those at the fellowship level, particularly in Critical Care Medicine (CCM), Pulmonary and Critical Care Medicine (PCCM), and Pulmonary Medicine (PM) fellowships (collectively termed PCCM).</p><p><strong>Objective: </strong>We surveyed applicants to US adult PCCM fellowship programs regarding interest in GH training and the influence of GH tracks and related opportunities on applicants' rank list decisions.</p><p><strong>Methods: </strong>We developed a survey to assess applicants' demographics, prior GH experience, interest in pursuing GH experiences during and after fellowship, and preferences regarding GH opportunities within fellowship programs. Survey questions included multiple choice, Likert scale, and free text questions. After initial pilot testing, the survey was sent to 1,024 applicants applying to PCCM programs through the National Resident Matching Program match during the 2025 appointment year. Both univariate and multivariate regression models were built to identify predictors of GH interest.</p><p><strong>Results: </strong>Of the 325 applicants who completed the survey (31.7% response rate), 51% stated the GH was at least slightly important when ranking a given fellowship program. According to the surveyed applicants, the most important GH program elements were faculty mentors with GH experience within the division, opportunities for GH-related clinical service in the US, and established partnerships outside the US where fellows could rotate. Perceived barriers to a career in GH included lack of protected time for international work, family obligations, and lack of institutional funding. We also found a significant association on multivariate analysis between prior GH work and interest in pursuing it at the fellowship level (OR 2.76, 95% CI 1.04-5.49, p = 0.04).</p><p><strong>Conclusion: </strong>Applicants to US PCCM fellowship programs with prior GH experience are most likely to have a significant interest in pursuing GH work at the fellowship level. Important elements to a GH program within PCCM include faculty mentorship, opportunities for GH-related clinical service in the US, and established partnerships outside the US.</p><p><strong>Funding: </strong>MLS completed this work while supported on grant 5T32HL091816 from the National Heart, Lung, and Blood Institute.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978869","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":"Immune Toxicities After CAR-T and Bispecific T-Cell Engager Therapies.","authors":"Julia Carter, Jonaphine Mata, Thomas A Di Vitantonio, Rupali Sood, R Scott Stephens, Kristina Montemayor","doi":"10.1093/atsscholar/aapag058","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag058","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957172","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":"Virtual reality simulation for tracheostomy emergencies: a randomized educational intervention.","authors":"Jordan W Talan, Mark H Adelman, Molly Forster, Brian Reuland, Brian Kaufman, Ali Hafiz, Sunil S Nair, Violet E Kramer, Jonathan S Mendelson, Anthony Andriotis","doi":"10.1093/atsscholar/aapag023","DOIUrl":"10.1093/atsscholar/aapag023","url":null,"abstract":"<p><strong>Background: </strong>Despite a high incidence of tracheostomy-related airway complications with potentially life-threatening implications, nonsurgical tracheostomy first responders receive limited formal education on the management of tracheostomy emergencies. While the United Kingdom has developed multidisciplinary guidelines and education for tracheostomy emergencies, such programs have not been widely implemented in the United States.</p><p><strong>Objective: </strong>We evaluated the feasibility and effectiveness of an immersive virtual reality (VR) simulation training as a potential generalizable and scalable approach to tracheostomy-related emergency training.</p><p><strong>Methods: </strong>Over the academic year 2023-2024, critical care fellows were randomly assigned to participate in tracheostomy emergency training either via immersive VR simulation or via small group discussion sessions facilitated by expert faculty. After each case-based educational intervention, participants were asked to manage 4 simulated tracheostomy-related emergencies involving common tracheostomy complications. Fellow performance was evaluated using a purpose-built task trainer. Three independent and blinded graders completed fellow scoring using a checklist assessment for which validation evidence was also collected. Fellows received pre- and postintervention surveys to measure attitudes toward VR training.</p><p><strong>Results: </strong>Of 27 eligible fellows, 19 participated in the study, managing 76 simulated tracheostomy emergencies. There were 10 fellows in the VR arm and 9 fellows in the small group arm. Of a total possible 26 points on the checklist assessment, fellows in the VR group scored an average (SD) of 18.03 (3.39) compared to the small group score of 16.96 (4.41) (P = .558). Surveys indicated improvements in fellow confidence after the training and high levels of acceptance of the VR curriculum.</p><p><strong>Conclusions: </strong>An immersive VR educational intervention for the management of tracheostomy-related emergencies was feasible and well received by learners. There was no significant difference in post-training checklist assessment scores between the VR and small group participants, suggesting noninferiority of the VR intervention and contributing validation evidence to our task trainer simulation assessment.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"210-216"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in employment opportunities for critical care physicians from non-pulmonary training backgrounds: a nationwide cross-sectional study.","authors":"Katerina M Flamm, Farha K Khan, Zachary J Smith, Alexis Brengartner, Gregory J Eisinger","doi":"10.1093/atsscholar/aapag054","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag054","url":null,"abstract":"<p><strong>Background: </strong>Multiple physician training pathways exist for critical care medicine. Prior research has demonstrated an increased perception of barriers to employment for non-pulmonary trained intensivists, but none have examined the landscape of current job openings.</p><p><strong>Objective: </strong>This study sought to describe characteristics of publicly posted critical care job opportunities for physicians with different training backgrounds.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of job postings for adult critical care physicians on four popular databases between April and July 2024. The primary outcome was the availability of each position to physicians trained in each critical care specialty. Secondary outcomes included characteristics of the job setting. When key data were not contained within the posting, recruiters were contacted to provide additional information.</p><p><strong>Results: </strong>A total of 223 job postings across 41 states were included. Most openings were at non-university-affiliated academic centers (51.2%) or non-academic hospitals (26.5%), with only 8.6% representing tertiary care centers. A higher percentage of positions were available to pulmonary-trained intensivists (84.8%) than those without pulmonary training (30.5%; OR 4.6 95% Confidence Interval [CI] 3.1 to 6.8; P < .001). The number of positions available to each non-pulmonary specialty was similar except neurocritical care, which had fewer opportunities. Significant differences in hospital size (P < .001) and academic designation (P = .002) were observed that appeared to be driven by higher percentages of positions open to non-pulmonary specialties being at medium to very large hospitals and at tertiary care centers, while pulmonary-only positions were more commonly at small and non-academic hospitals. Differences in metropolitan setting approached significance (P = .059), with non-pulmonary positions more common in large urban cities. No significant differences in regional distribution were noted.</p><p><strong>Conclusion: </strong>In this cross-sectional study, publicly posted critical care positions were much less likely to be available to intensivists without pulmonary training. Positions open to non-pulmonary physicians were more commonly at larger, academic hospitals located in bigger cities.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868133","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":"7 Fellows, 7 Fellowships: Why N = 1 Matters in Program Evaluation.","authors":"Timothy G Dyster","doi":"10.1093/atsscholar/aapag057","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag057","url":null,"abstract":"<p><p>Program evaluation data collected from learners are widely used in medical education for quality improvement, accountability, and accreditation. Generally, success entails high response rates and mean item scores above predetermined thresholds. Although pragmatic, these practices assume when data from multiple learners are aggregated, they converge on a more accurate representation of a single educational object, such as a training program, and reduce the influence of misrepresentative, outlying data. Drawing on Communities of Practice and the professional identity formation literature, this Perspective argues learner-completed program evaluations are better understood as traces of learner-program interactions, shaped by each learner's experience of socializing into a community of practice. Because trainees enter programs with pre-existing personal and professional identities, participation in training is never fully identical from one learner to the next. Rather than capturing multiple data points about a \"single\" program, evaluation responses describe multiple fellowships, each of which emerged through the interaction between a particular learner and the program's design. This reconceptualization has important implications for the interpretation of isolated (\"N of 1\") findings. Outliers, especially when they suggest a negative experience, should not be dismissed merely as a minority view, as they capture meaningful experiences obscured by aggregate reporting. This requires reconsideration of how educational data are interpreted, how evaluation systems preserve variation, and how curricula are designed and delivered.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868141","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}