ATS scholar最新文献

{"title":"What is an Intensive Care Unit? Video Script.","authors":"Catherine Chen, Marianna Sockrider","doi":"10.1093/atsscholar/aapag052","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag052","url":null,"abstract":"","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":"148868094","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":"Palliative Care in the Intensive Care Unit Patient Fact Sheet.","authors":"Lauren Ward, Padmaja G Reddy, Catherine Chen","doi":"10.1093/atsscholar/aapag056","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag056","url":null,"abstract":"","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":"148868158","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 in Critical Spaces: Qualitative Analysis of Medical Students' Reflections in the ICU.","authors":"Esther Etchinson, Brooke Hirsch, Kathryn M Pendleton, Molly Kessler, Ben Trappey, Ronald A Reilkoff","doi":"10.1093/atsscholar/aapag053","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag053","url":null,"abstract":"<p><strong>Background: </strong>Research on ICU experiences from medical students' perspectives and their impact on professional development is limited. Reflective practices like storytelling enhance wellness and cultivate empathy among medical professionals, yet student involvement remains limited.</p><p><strong>Objective: </strong>To qualitatively analyze fourth-year medical student reflections from a required critical care clerkship, identify key themes, and suggest curricular improvements.</p><p><strong>Methods: </strong>Inductive qualitative methods were employed to develop a codebook through thematic analysis with consensus building and inter-rater reliability testing (Cohen's kappa ≥0.65). Frequency and collocation analyses identified patterns and contextual relationships.</p><p><strong>Results: </strong>Fifty-four percent of students participated, yielding 119 coded reflections. Six themes and 15 elements emerged, with top themes being \"communicating with patient, family, or care team\" (36.1%), \"grappling with end-of-life, death, or dying\" (26.1%), and \"witnessing role modeling\" (10.1%). Leading elements included \"humanity\" (44.5%), \"professional development\" (35.3%), \"teamwork\" (33.6%), and \"duty\" (32.8%). Reflections emphasized complex patient interactions, moral ambiguity, and personal growth over medical knowledge acquisition.</p><p><strong>Conclusion: </strong>The Critical Care Sub-Internship is a formative experience in which fourth-year medical students not only learn clinical medicine but also engage in professional identity formation. Qualitative analysis of student reflections identified six dominant themes: navigating social challenges; addressing ethical dilemmas; observing role modeling; communicating with patients, families, and interprofessional teams; grappling with end-of-life care; and coping with emotional distress. Findings support targeted curricular enhancements including structured education in serious illness communication and end-of-life care, and intentional faculty development for positive role modeling.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842363","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":"Structured Debriefing After Adult ICU Intubation: A Narrative Review and Implementation Framework.","authors":"Salem Harry-Hernandez, Akhil Khosla, Shyoko Honiden, Christopher T Erb, Ryan J J Buckley","doi":"10.1093/atsscholar/aapag050","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag050","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation in the intensive care unit (ICU) carries substantial risk, with adverse events such as hypoxia and hemodynamic instability occurring in up to 40% of critically ill patients. These events affect not only patient safety but also team learning and trainee development. Structured debriefing, defined as brief, reflective discussion following a critical event, represents a potential strategy to mitigate risks and strengthen team performance in high acuity environments.</p><p><strong>Objective: </strong>To synthesize theoretical and empirical literature on structured debriefing after ICU intubation and identify barriers and facilitators to implementation. We propose an adult ICU-focused, pragmatic framework that uses brief post-intubation hot debriefing with selective escalation to cold debriefing, linking airway events to measurable learning and safety processes.</p><p><strong>Methods: </strong>We conducted a narrative review informed by a comprehensive search of PubMed, Scopus, Ovid MEDLINE, and Google Scholar (1999-2026). Eligible sources included peer-reviewed studies and high-quality reviews addressing debriefing in acute and critical care contexts, evaluation of debriefing tools, and theoretical frameworks related to psychological safety and team learning. Simulation-only studies were excluded unless they informed clinical translation or implementation-relevant debriefing frameworks.</p><p><strong>Results: </strong>Evidence from perioperative, trauma, and emergency medicine demonstrates that structured debriefing is feasible, valued, and effective in surfacing latent safety threats, enhancing communication, and promoting psychological safety. Early ICU applications confirm feasibility but expose barriers, including competing clinical demands, hierarchical culture, and varied faculty training. Adaptations, such as embedding debriefing into airway safety bundles, training fellows to lead discussions, and incorporating digital or hybrid approaches show promise. However, most studies focus on feasibility and perceptions rather than patient-level (or team-level) outcomes.</p><p><strong>Conclusion: </strong>This review proposes a pragmatic, adult ICU-focused framework that translates existing debriefing tools into a testable model for improving team learning, psychological safety, and system-level safety processes following adult ICU intubation.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808897","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":"Federal Administration '25-'26 and its Impact on the Medical Workforce.","authors":"Debasree Banerjee","doi":"10.1093/atsscholar/aapag051","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag051","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802320","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":"From Adoption to Optimization: APCCMPD Recommendations for PCCM Program Signaling.","authors":"Stella B Ogake, Kristina Montemayor, Erin J Covert, Kathleen Doo, Sherie A Gause, Van K Holden, Mira M John, Edward Kilb Iii, Angela Love, Anna T Neumeier, Radhika M Shah, J Shirine Allam","doi":"10.1093/atsscholar/aapag049","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag049","url":null,"abstract":"<p><p>Program signaling was introduced to address application inflation in graduate medical education (GME) by providing applicants with a structured mechanism to express genuine program interest. While signaling has been widely adopted across specialties, evidence-based guidance specific to fellowship recruitment in Pulmonary and Critical Care Medicine (PCCM), Critical Care Medicine (CCM), and Pulmonary Medicine is lacking. The Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD) Recruitment Committee developed specialty-specific signaling recommendations, drawing on a comprehensive literature review, a national benchmarking survey of program directors (n=108), and through consultation with ERAS representatives. Our literature review confirmed that signaling increases interview yield across specialties, with the strongest gains observed among MD graduates compared with DO and international medical graduate (IMG) applicants. The benchmarking survey revealed that 92.8% of programs participated in signaling, over half reported reduced application review time, and most programs used gold and silver signals identically. Key deliberative considerations included the unique cross-applicant dynamics among PCCM, CCM, and Pulmonary pathways, the structural inability of ERAS to distinguish CCM tracks within PCCM programs, equity implications for IMG applicants, and the relationship between signal number and signal value. Based on these findings, we recommend transitioning to a non-tiered signaling system, allocating 15 signals for PCCM, 10 for CCM, and 2 for Pulmonary, and maintaining separate signal pools with continued monitoring. We also provide specific guidance for both applicants and programs to promote transparency, equity, and holistic review. These recommendations will be reviewed iteratively as applicant behaviors and match outcome data evolve.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763424","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":"The Subspecialty APD: A New Framework for Fellowship Advising and Career Identity.","authors":"Robin H Stiller, Radhika R Narla","doi":"10.1093/atsscholar/aapag047","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag047","url":null,"abstract":"<p><p>The Internal Medicine (IM) Match into subspecialty fellowship has grown in complexity and competitiveness with record numbers of applicants and applications submitted, evolving specialty-specific expectations, and introduction of preference signaling among contributing factors. Insufficient available positions relative to interest already leave many qualified candidates unmatched and Graduate Medical Education reform needed to confront the looming physician deficit in the face of an aging, medically complex general population may further destabilize the fellowship Match process. Advising has historically occurred through informal networks exacerbating uncertainty and inequities, and potentially contributing to reactive application strategies rather than deliberate pursuit of program alignment. These factors threaten the future availability of subspecialists to partner with generalist colleagues in care delivery; and may jeopardize patients' access care. We advocate for formalization of an Associate (or Assistant) Program Director for Subspecialty Medicine to provide structured, longitudinal subspecialty-specific guidance for fellowship-bound residents. This role provides support through three critical phases: 1: Early conversations about goals, diverse career options, and mentorship connections for equitable access to opportunities; 2: Elective and scholarly experiences planning to deepen engagement in the preferred field and build cohesive portfolios; 3: Application preparation emphasizing program alignment and delineation of support networks irrespective of outcome. The role can be adapted depending on programmatic characteristics, and regional collaborations can broaden the reach of mentorship resources. Embedding subspecialty-informed advising within residency infrastructure facilitates proactive, equitable and intentional mentorship for residents as their professional identities are evolving and formalizes faculty effort toward the development of a well-rounded subspecialty workforce.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708631","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":"Air Pollution Education: A Novel Curriculum for Pulmonary Fellows.","authors":"Rachel M Wojcik, Gillian C Goobie, Franziska Rosser, Patrick Campbell, Stephanie I Maximous","doi":"10.1093/atsscholar/aapag039","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag039","url":null,"abstract":"<p><strong>Background: </strong>Air pollution plays a significant role in human health, impacting respiratory outcomes. Despite decades of evidence detailing these health consequences as a result of both short and long-term air pollution exposure, the harms of air pollution exposure are infrequently taught at the graduate medical education level, particularly at the level of pulmonary fellowship. As the climate changes and air pollution increases, patients are becoming increasingly aware of how these changes affect their health, but do not routinely receive guidance from their pulmonologist, in part due to limited healthcare provider knowledge.</p><p><strong>Objective: </strong>We developed an air pollution curriculum to increase fellow knowledge about air pollution and its health impacts by focusing on the question \"what do pulmonologists need to know about air pollution?\"</p><p><strong>Methods: </strong>Using Kern's six steps for curriculum development, we developed an air pollution and health impact curriculum. Following identification of the five domains of focus (composition, health effects, monitoring, risk mitigation, and environmental justice) by a panel of content experts, a 20-item knowledge scale was developed via a modified Delphi process to deliver as both a pre- and post-curriculum assessment. By delivering it over the course of the year and infusing it with interactive components, the curriculum allowed for implementation of spaced repetition, active recall, and reinforcement of key air pollution topics to facilitate learning a novel topic within the constraints of an existing educational program's structure.</p><p><strong>Results: </strong>Fellows demonstrated an increase in knowledge in all five domains of the air pollution curriculum when comparing pre- and post-course assessments (p < 0.001). The curriculum was well-received with requests for both repetition of the curriculum and expansion to other climate-related topics.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility and effective implementation of an air pollution curriculum for pulmonary and critical care trainees that increases knowledge of this critical environmental exposure.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698511","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 ICU Triage: A Three-Column Framework for Premorbid, Morbid, and Postmorbid Assessment.","authors":"Albert Teng, Yi Hern Tan","doi":"10.1093/atsscholar/aapag048","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag048","url":null,"abstract":"<p><p>Intensive care unit (ICU) triage is a cognitively complex and emotionally charged task that challenges clinicians across training levels. Although trainees may recognise prognostic factors and ethical principles, many lack a coherent structure to integrate these elements into a defensible real-time assessment. We describe a three-domain triage framework - Premorbid, Morbid, and Postmorbid - designed to support structured reasoning during ICU triage, particularly for on-call senior residents and clinicians who do not practice critical care routinely. The framework is taught through case-based discussions embedded in routine clinical care within a high-volume medical ICU at a large tertiary hospital. The Premorbid domain considers baseline physiologic reserve, including functional status, prolonged hospitalization, nutritional state, and irreversible comorbidities. The Morbid domain focuses on the present illness, emphasizing etiologic diagnosis and recoverability, and the burden of ICU syndromes such as shock, respiratory failure, and acute kidney injury. The Postmorbid domain guides learners to translate these assessments into a set of realistic outcome trajectories, supporting clearer prognostication and communication. By providing a shared language for discussions among senior residents, intensivists, and referring teams, the framework offers a practical cognitive scaffold for organizing complex information under pressure. Rather than eliminating uncertainty, the Premorbid-Morbid-Postmorbid framework provides trainees with a reproducible method to reason through uncertainty, communicate transparently and approach ICU triage with greater clarity and confidence.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698506","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":"Reply to Scherzer and colleagues: Bridging Perspectives: Rebalancing Learner-Educator Dynamics in Modern Medical Education.","authors":"John A Rankin","doi":"10.1093/atsscholar/aapag044","DOIUrl":"https://doi.org/10.1093/atsscholar/aapag044","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698255","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}