ATS scholar最新文献

{"title":"Conducting Prospective Research as a Trainee: Experiences with the DRIVE-SAFE Study.","authors":"Michael Mikhaeil,&nbsp;Malik Farooqi,&nbsp;Hameid Alenazy,&nbsp;Kimberley Lewis,&nbsp;Bram Rochwerg","doi":"10.34197/ats-scholar.2022-0130PS","DOIUrl":"10.34197/ats-scholar.2022-0130PS","url":null,"abstract":"<p><p>Conducting clinical research during a 2-year critical care fellowship is a challenging endeavor. Fellows are often met with multiple barriers when considering clinical research projects during fellowship, including time, mentorship, resources, and clinical support. This paper presents the perspective and experiences of a group of critical care fellows who conducted the DRIVE-SAFE (Driving Pressure in Assisted Ventilation as a Predictor for Successful Liberation from Invasive Mechanical Ventilation) feasibility study, which aimed to determine measurable physiological variables that could be associated with lung injury and affect duration of mechanical ventilation. This paper provides a guide for trainees on how to conduct prospective clinical research at the bedside. We describe three key steps, including formulating a research question, developing appropriate methodology, and establishing outcomes. We also present the challenges that trainees may encounter when conducting prospective studies and how to overcome these challenges with proper mentorship, training, and collaboration with key stakeholders. These perspectives may provide useful guidance for current and future trainees interested in conducting prospective clinical research at the bedside.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/a4/ats-scholar.2022-0130PS.PMC10547036.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157349","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":"Mechanical Ventilation Training Curriculum for Pulmonary Critical Care Fellows during the COVID-19 Pandemic.","authors":"Aryan Shiari,&nbsp;Divya Venkat,&nbsp;Abdelaziz Mohamed,&nbsp;Sarah J Lee,&nbsp;Abdulghani Sankari","doi":"10.34197/ats-scholar.2022-0048IN","DOIUrl":"10.34197/ats-scholar.2022-0048IN","url":null,"abstract":"<p><strong>Background: </strong>Mechanical ventilation (MV) management is an essential skill for pulmonary and critical care medicine (PCCM) fellows to master during training. The unprecedented emergence of the coronavirus disease (COVID-19) pandemic highlighted the need for advanced operator competency in MV to improve patients' outcomes.</p><p><strong>Objective: </strong>We aimed to create a standardized case-based curriculum using a blended approach of high-fidelity simulation, rapid-cycle deliberate practice, video didactics, and hands-on small group sessions for rapid accumulation of knowledge and hands-on skills for PCCM fellows before caring for critically ill patients during the COVID-19 pandemic.</p><p><strong>Methods: </strong>The MV curriculum consisted of the following steps: <i>1</i>) baseline written knowledge test with 15 multiple-choice questions covering MV, the latest evidence-based practices, and pathophysiology of COVID-19; <i>2</i>) baseline confidence survey using a 5-point Likert scale; <i>3</i>) a one-on-one session using a high-fidelity simulation manikin, a lung simulator, and a mechanical ventilator to test baseline competencies; <i>4</i>) a structured debriefing tailored per fellow's 50-point competency assessment checklist from the simulation using rapid-cycle deliberate practice; <i>5</i>) video didactics; <i>6</i>) a hands-on session in small groups for basic knobology, waveforms, and modes of MV; <i>7</i>) a one-on-one simulation reassessment session; <i>8</i>) a written knowledge posttest; and <i>9</i>) a post-training confidence survey using a 5-point Likert scale.</p><p><strong>Results: </strong>Eight PCCM fellows completed the training. The mean multiple-choice question score increased from 7.4 ± 2.9 to 10.4 ± 2.4 (<i>P</i> < 0.05), and the simulation scores increased from 17.1 ± 4.4 to 30.8 ± 3.7 (<i>P</i> < 0.05). Comparing the simulation reassessment to the baseline, fellows showed significant improvement (<i>P</i> < 0.05) in assessing indications for MV; implementing rapid sequence intubation for patients with COVID-19; initiating MV and ventilator bundle per best practices; recognizing and managing mucous plugging, ventilator dyssynchrony, and evidence-based treatments for acute respiratory distress syndrome; and developing a care plan for proning. The post-training survey revealed improved learner confidence in all competencies.</p><p><strong>Conclusion: </strong>This pilot MV curriculum using a blended approach was feasible and allowed PCCM fellows to significantly improve their knowledge and hands-on skills, allowing for the appropriate use of MV during the pandemic. Self-reported improvement scores further reinforced this. The emergent need for novice learners may again be necessary for future pandemic settings where standard training models requiring extensive training time are limited.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f4/6e/ats-scholar.2022-0048IN.PMC10547087.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173886","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":"Better Together: Development and Implementation of Fellow Group Evaluations of Faculty.","authors":"Zachary A Reese,&nbsp;Jessica T Lee,&nbsp;Caitlin Clancy","doi":"10.34197/ats-scholar.2023-0023IN","DOIUrl":"https://doi.org/10.34197/ats-scholar.2023-0023IN","url":null,"abstract":"<p><strong>Background: </strong>High-quality trainee evaluations of faculty are essential for meaningful faculty development and for improving the clinical learning environment. However, concerns about anonymity can limit usefulness of trainee evaluations, particularly in smaller programs, such as subspecialty fellowships.</p><p><strong>Objective: </strong>To develop and implement a fellow-driven group evaluation process to enhance trainee confidentiality and generate high-quality feedback for pulmonary and critical care medicine faculty.</p><p><strong>Methods: </strong>A novel process was developed for faculty evaluation and feedback consisting of quarterly, structured, fellow-led group evaluation sessions focused on collecting confidential, behaviorally oriented, actionable feedback for faculty. Upper-year fellow moderators utilized a standard format to structure discussion, generating strengths and areas for growth for each faculty member while explicitly asking for input from fellows with divergent perspectives. Moderators compiled anonymized session notes for the program director, who delivered feedback to individual faculty. After the first six sessions, an electronic survey was distributed to assess fellow perceptions of the group evaluation model.</p><p><strong>Results: </strong>Thirty-seven faculty members were evaluated in 11 group sessions over 42 months. Fellows rated group-generated feedback as more confidential, more specific, more accurate, more efficient, more actionable, and less biased when compared with individual written evaluations (<i>P</i> < 0.01 for all categories).</p><p><strong>Conclusion: </strong>The authors successfully developed and implemented a process for fellow-led group evaluation of faculty, designed to facilitate fellow confidentiality and enrich the quality of feedback. Fellows preferred the group evaluation process and perceived group-generated feedback more favorably compared with individual written evaluations.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/55/ats-scholar.2023-0023IN.PMC10547107.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161039","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":"Development and Implementation of an Escalation Protocol for Internal Medicine Trainees.","authors":"Seda Babroudi, Sharanya Mohanty, Aliysa Rajwani, Leidy Guzman, Langley Topper, Samantha Asber, Karen Freund, Sucharita Kher","doi":"10.34197/ats-scholar.2023-0009IN","DOIUrl":"10.34197/ats-scholar.2023-0009IN","url":null,"abstract":"<p><strong>Background: </strong>Overnight, physicians in training receive less direct supervision. Decreased direct supervision requires trainees to appropriately assess patients at risk of clinical deterioration and escalate to supervising physicians. Failure of trainees to escalate contributes to adverse patient safety events.</p><p><strong>Objective: </strong>To standardize the evaluation of patients at risk of deterioration overnight by internal medicine residents, increase communication between residents and supervising physicians, and improve perceptions of patient safety at a tertiary academic medical center.</p><p><strong>Methods: </strong>A multidisciplinary stakeholder team developed an overnight escalation-of-care protocol for residents. The protocol was implemented with badge buddies and an educational campaign targeted at residents, supervising physicians, and nursing staff. Residents and supervising physicians completed anonymous surveys to assess the use of the protocol; the frequency of overnight communication between residents and supervising physicians; and perceptions of escalation and patient safety before, immediately after (\"early postintervention\"), and 8 months after (\"delayed postintervention\") the intervention.</p><p><strong>Results: </strong>Seventy-five (100%) residents participated in the intervention, and 57-89% of those invited to complete surveys at the various time points responded. After the intervention, 82% of residents reported using the protocol, though no change was observed in the frequency of communication between residents and supervising physicians. After the implementation, residents perceived that patient care was safer (early postintervention, 47%; delayed postintervention, 72%; <i>P</i> = 0.02), and interns expressed decreased fear of waking and being criticized by supervising physicians.</p><p><strong>Conclusion: </strong>An escalation-of-care protocol was developed and successfully implemented using a multimodal approach. The implementation and dissemination of the protocol standardized resident escalation overnight and improved resident-perceived patient safety and interns' comfort with escalation.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48616874","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":"Who Is Teaching Residents in the Intensive Care Unit? Perceptions of Interprofessional Teaching at an Academic Medical Center.","authors":"Camille R Petri,&nbsp;Christine P Beltran,&nbsp;Amy M Sullivan,&nbsp;Asha Anandaiah","doi":"10.34197/ats-scholar.2023-0008OC","DOIUrl":"10.34197/ats-scholar.2023-0008OC","url":null,"abstract":"<p><strong>Background: </strong>Teamwork is essential for high-quality care in the intensive care unit (ICU). Interprofessional education has been widely endorsed as a way of promoting collaborative practice. Interprofessional providers (IPPs), including nurses, pharmacists, and respiratory therapists (RTs), routinely participate in multidisciplinary rounds in the ICU, but their role in teaching residents at academic medical centers has yet to be characterized.</p><p><strong>Objective: </strong>To characterize perceptions of interprofessional teaching during and outside of rounds in the ICU.</p><p><strong>Methods: </strong>The authors conducted a cross-sectional survey of critical care physicians, internal medicine residents, nurses, pharmacists, and RTs across three ICUs at a tertiary academic medical center from September 2019 to March 2020. The frequency of different types of rounds contributions was rated on a Likert scale. Means and medians were compared across groups.</p><p><strong>Results: </strong>A total of 221 of 285 participants completed the survey (78% response rate). All IPPs described that they report data, provide clinical observations, and make recommendations frequently during ICU rounds, but teaching occurred infrequently (mean values, nurses = 2.9; pharmacists = 3.5; RTs = 3.7; 1 = not at all; 5 = always). Nurses were least likely to report teaching (<i>P</i> = 0.0017). From residents' and attendings' perspectives, pharmacists taught most frequently (mean values, 3.7 and 3.4, respectively). RTs self-report of teaching was higher than physicians' reports of RT teaching (<i>P</i> < 0.0001). Outside of rounds, residents reported a low frequency of teaching by nurses and RTs (means, nurses = 3.1; RTs = 3.1), but they reported a high rate of teaching by pharmacists (mean, 4.4).</p><p><strong>Conclusion: </strong>Nonphysician IPPs routinely participate in ICU rounds but teach medical trainees infrequently. Physicians' perception of IPP teaching frequency was generally lower than self-reports by IPPs. Exploring modifiers of interprofessional teaching may enhance education and collaboration.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/65/39/ats-scholar.2023-0008OC.PMC10547100.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157080","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":"Use of a Novel Three-Dimensional Model to Teach Ultrasound-guided Subclavian Vein Cannulation.","authors":"Jaya Tanwani,&nbsp;Sabine Nabecker,&nbsp;Joshua Qua Hiansen,&nbsp;Azad Mashari,&nbsp;Naveed Siddiqui,&nbsp;Cristian Arzola,&nbsp;Alberto Goffi,&nbsp;Sharon Peacock","doi":"10.34197/ats-scholar.2022-0104IN","DOIUrl":"https://doi.org/10.34197/ats-scholar.2022-0104IN","url":null,"abstract":"<p><strong>Background: </strong>Central venous cannulation is an essential skill in perioperative and critical care medicine. Ultrasound guidance is the standard of care for femoral and internal jugular vein access, with the subclavian vein being perceived to be less amenable to ultrasound-guided (UG) insertion, resulting in a lack of procedural competency and low cannulation rate. There is a paucity of resources and a lack of experience among staff physicians to effectively instruct trainees. Simulation-based medical education has the potential to help maintain high-stakes, infrequently performed skills and counteract possible unrecognized skill decline. We aimed to create a novel, low-cost, high-fidelity three-dimensional (3D) model for UG subclavian vein (UG-SCV) access with an accompanying curriculum to improve this important skill.</p><p><strong>Methods: </strong>A curriculum was created consisting of preparatory material reviewing UG-SCV access, followed by an in-person didactic lecture focusing on ultrasound use and management of complications and a deliberate practice session scanning volunteers and practicing UG vascular puncture on a 3D model. A qualitative usability test design was used to assess the validity of the curriculum in trainees with advanced vascular access skills (anesthesiologists). Participants were second-year anesthesia residents, anesthesia fellows, and staff physicians. Focus groups conducted after each session explored the face validity of the model and curriculum. By applying a usability design, the curriculum was optimized and finalized.</p><p><strong>Results: </strong>Between September 2020 and February 2021, 28 participants tested the curriculum. The focus groups ensured that the curriculum achieved its objective, with iterative changes made after each session in a quality improvement framework Plan-Do-Study-Act approach. After the third cycle, minimal changes were suggested, and the curriculum and 3D model were finalized. An additional group of participants was used to ensure that no new input would help improve the curriculum further.</p><p><strong>Conclusions: </strong>A focused curriculum for enhancing skills in UG-SCV cannulation using a novel 3D model was successfully implemented and validated through a usability test design. This curriculum is better targeted for practitioners experienced in central venous access to master a subclavian approach and maintain their skill level.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/fe/ats-scholar.2022-0104IN.PMC10547090.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41142050","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":"Nurses' Perceptions of Intensive Care Unit Orientation Patient Education Pamphlet.","authors":"Daniel S Livingston,&nbsp;Vidya Krishnan","doi":"10.34197/ats-scholar.2022-0142OC","DOIUrl":"10.34197/ats-scholar.2022-0142OC","url":null,"abstract":"<p><strong>Background: </strong>Critical illness is a stressful time for patients and their support networks. Although patient-directed educational material to improve the understanding of critical illness exists, both patients and staff members are often unaware of these resources or how to find them.</p><p><strong>Objectives: </strong>We aimed to evaluate the impact of the implementation of the American Thoracic Society's (ATS) \"Managing the Intensive Care Unity (ICU) Experience: A Proactive Guide for Patients and Families\", an ICU orientation pamphlet, on nurses' perceptions of the availability and effectiveness of patient and family educational resources.</p><p><strong>Methods: </strong>In a safety-net urban institution, we surveyed medical ICU (MICU) nurses in February 2021 regarding their perceptions of the availability of patient and family educational materials and the time and quality of communication with families of critically ill patients. We then introduced the MICU nurses to the ATS ICU orientation pamphlet to complement patient and family education. Quick response (QR) codes were created, linking to the online versions of the ICU pamphlet, and made available in waiting rooms. Printed copies of the pamphlet were provided to families in the ICU introductory packet upon patient MICU admission. We informed nurses regarding the pamphlet content, website, and QR codes. A postintervention survey was administered 11 months after the initial survey. Changes between pre and postintervention responses were analyzed for significant differences. Debriefing sessions with the MICU nurses were conducted, and subsequent discussions identified opportunities to improve the available educational resources.</p><p><strong>Results: </strong>At baseline, 28 of 67 (42%) MICU nurses responded to the survey. Although all nurses provided verbal education to patients and families, only 18% reported knowing about and using additional resources to supplement this education. The postintervention survey was completed by 39% of nurses; 39% of them reported using additional materials to supplement patient and family education. Reported awareness of the ATS ICU pamphlet increased from 4% before implementation to 23% after implementation (<i>P</i> = 0.04). MICU nurses offered suggestions to improve the pamphlet, which thematically fell into three categories: <i>1</i>) opportunities to alter the ICU pamphlet, <i>2</i>) opportunities to provide the pamphlet in varied formats, and <i>3</i>) opportunities to add additional education topics.</p><p><strong>Conclusions: </strong>Informing nurses about the ICU pamphlet improved the acceptance and use of the materials, but it was still not accepted by many nurses. Barriers to ICU nurses using patient education resources should be explored to facilitate quality materials reaching patients and complementing patient communication. QR codes may have offered a way to disseminate educational materials to patients and families in a m","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/9a/ats-scholar.2022-0142OC.PMC10547037.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41124309","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":"A Learner's Perspective on Educating Trainees in Quality, Safety, and Implementation Science.","authors":"Elaine M Griffeth,&nbsp;Kannan Ramar","doi":"10.34197/ats-scholar.2023-0017VL","DOIUrl":"10.34197/ats-scholar.2023-0017VL","url":null,"abstract":"Experiential learning forms the foundation of residency and fellowship training. We learn to provide high-quality patient care through studying, deliberate practice (simulation), performing clinical duties with faculty feedback and learning from mistakes (1). Growth as a physician is important, but trainees must also understand the larger healthcare context and drivers of patient outcomes. This requires effort to break down silos separating healthcare roles and promote interprofessional collaboration early in training. Quality improvement (QI), patient safety, and implementation science are important aspects of achieving these goals","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/7e/ats-scholar.2023-0017VL.PMC10547035.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41143399","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":"There Are No Bad Days, Only Bad Moments: The Lessons We Can Only Learn from Experience.","authors":"Edan Zitelny,&nbsp;Catherine Auriemma","doi":"10.34197/ats-scholar.2022-0119VL","DOIUrl":"https://doi.org/10.34197/ats-scholar.2022-0119VL","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/49/ats-scholar.2022-0119VL.PMC10547027.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162541","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":"How I Teach: Liberation from Mechanical Ventilation.","authors":"Michael C Ferrera,&nbsp;Margaret M Hayes","doi":"10.34197/ats-scholar.2023-0037HT","DOIUrl":"https://doi.org/10.34197/ats-scholar.2023-0037HT","url":null,"abstract":"<p><p>Liberation from mechanical ventilation is one of the most important decisions in the intensive care unit (ICU), as extubation failure is associated with worse outcomes. Determining readiness to extubate can be challenging in complex patients and lead to provider stress. Here, we provide our approach to teaching liberation from mechanical ventilation for learners in the ICU. We use a case-based didactic session that purposefully introduces ambiguous cases without a clear answer, utilizing aspects of both cognitive load theory and adult learning theories.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/50/ats-scholar.2023-0037HT.PMC10547038.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157065","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}