ATS scholar最新文献

{"title":"Ventilator Training through International Telesimulation in Sierra Leone.","authors":"Oluwakemi Tomobi, Howard Nelson-Williams, Adam Laytin, Christaphine Bob-Ray, Ifeoma Ekwere, Michael C Banks, Elizabeth David, Christelle D K Samen, Joseph Edwin Kanu, John B Sampson","doi":"10.34197/ats-scholar.2022-0084OC","DOIUrl":"10.34197/ats-scholar.2022-0084OC","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease (COVID-19) pandemic resulted in an increased need for medical professionals with expertise in managing patients with acute hypoxemic respiratory failure, overwhelming the existing critical care workforce in many low-resource countries.</p><p><strong>Objective: </strong>To address this need in Sierra Leone, we developed, piloted, and evaluated a synchronous simulation-based tele-education workshop for healthcare providers on the fundamental principles of intensive care unit (ICU) management of the COVID-19 patient in a low-resource setting.</p><p><strong>Methods: </strong>Thirteen 2-day virtual workshops were implemented between April and July 2020 with frontline Sierra Leone physicians and nurses for potential ICU patients in hospitals throughout Sierra Leone. Although all training sessions took place at the 34 Military Hospital (a national COVID-19 center) in Freetown, participants were drawn from hospitals in each of the provinces of Sierra Leone. The workshops included synchronous tele-education-directed medical simulation didactic sessions about COVID-19, hypoxemia management, and hands-on simulation training about mechanical ventilation. Measures included pre and postworkshop knowledge tests, simulation checklists, and a posttest survey. Test results were analyzed with a paired sample <i>t</i> test; Likert-scale survey responses were reported using descriptive statistics; and open-ended responses were analyzed using thematic analysis.</p><p><strong>Results: </strong>Seventy-five participants enrolled in the program. On average, participants showed 20.8% improvement (a score difference of 4.00 out of a maximum total score of 20) in scores between pre and postworkshop knowledge tests (<i>P</i> = 0.004). Participants reported satisfaction with training (96%; <i>n</i> = 73), achieved 100% of simulation checklist objectives, and increased confidence with ventilator skills (96%; <i>n</i> = 73). Themes from the participants' feedback included increased readiness to train colleagues on critical care ventilators at their hospitals, the need for longer and more frequent training, and a need to have access to critical care ventilators at their hospitals.</p><p><strong>Conclusion: </strong>This synchronous tele-education-directed medical simulation workshop implemented through partnerships between U.S. physicians and Sierra Leone healthcare providers was a feasible, acceptable, and effective means of providing training about COVID-19, hypoxemia management, and mechanical ventilation. Future ICU ventilator training opportunities may consider increasing the length of training beyond 2 days to allow more time for the hands-on simulation scenarios using the ICU ventilator and assessing knowledge application in long-term follow-up.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48245608","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":"Implementation of a Near-Peer Support Program to Improve Trainee Well-Being after Patient Safety Events.","authors":"Kevin P Seitz, Nikita V Baclig, Robin Stiller, Anders Chen","doi":"10.34197/ats-scholar.2023-0011PS","DOIUrl":"10.34197/ats-scholar.2023-0011PS","url":null,"abstract":"<p><p>Adverse events can take an emotional toll on physicians, which, left unprocessed, can have negative impacts on well-being, including burnout and depression. Peer support can help mitigate these negative effects. Structured programs train physicians to aid colleagues in processing work-related experiences and emotions such as guilt and self-doubt. Although such programs are common for faculty, peer support for resident physicians has not been adequately addressed, and few programs have been described in the literature. Residency is a vulnerable time of professional identity formation, and providing support has specific challenges. The power dynamics and distance between lived experiences limit the utility of faculty peer support programs. Some institutions have trained residents to provide peer support, but widespread implementation may be difficult because of limited resident time and comfort in providing support. Chief residents (CRs), however, are close to residents in training yet experienced enough to afford perspective and are uniquely situated to provide \"near-peer\" support. We describe the implementation of a CR near-peer support program in which an established peer support framework was adapted to add elements specific to resident stressors and CR-resident relationships. One faculty member and two outgoing CRs lead a 2-hour workshop that is built into existing CR onboarding to ensure sustainability. The workshop combines large-group didactics and small-group breakouts, using clinical vignettes and simulated near-peer support conversations. To date, 36 CRs have been trained. CR near-peer support can serve as a model for programs in which true resident peer support is not feasible.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46504988","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":"Implementing Holistic Review Practices in a Pulmonary and Critical Care Fellowship.","authors":"Jacob Bailey, Brinda Desai, Angela Wang, Bernie Sunwoo, Kim Kerr, Jess Mandel, Daniel R Crouch, Laura E Crotty Alexander","doi":"10.34197/ats-scholar.2022-0108IN","DOIUrl":"10.34197/ats-scholar.2022-0108IN","url":null,"abstract":"<p><strong>Background: </strong>Medical schools have used holistic review in admissions to increase mission-aligned enrollment of students from backgrounds underrepresented in medicine. Graduate medical education programs have increasingly followed suit. However, there is a paucity of literature regarding holistic review at the fellowship level.</p><p><strong>Objective: </strong>Here, we share our experience implementing the Association of American Medical Colleges core principles of holistic review during the 2021 recruitment cycle.</p><p><strong>Methods: </strong>We used a partially asynchronous and online learning strategy to train division members on the principles of holistic review. Following the match, we conducted a survey of faculty members and fellows to understand their opinions on our holistic review training and implementation.</p><p><strong>Results: </strong>Although few of our colleagues clearly understood holistic review before the training, they were able to identify broad-based criteria that aligned with our division's mission and balanced applicants' experiences, attributes, competencies, and metrics. These were viewed as better selection criteria than traditional measures and were incorporated into the individualized consideration of applicants. Our survey had a 41.5% response rate, with 10 of 22 fellows and 24 of 60 faculty members responding. Most faculty members and fellows agreed that holistic review decreases socioeconomic disparities in fellowship recruitment (79.2% and 80.0%, respectively) and promotes inclusion and diversity (83.3% and 90.0%, respectively). Faculty members appeared more confident than fellows that our training efforts had influenced recruitment. All respondents agreed that it would be critical for such training to be repeated yearly.</p><p><strong>Conclusion: </strong>Although this was a single-institution experience, implementing holistic review was feasible and well received by faculty and fellows.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41443851","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":"Keeping Cardiac Arrest Documentation Alive in the Electronic Medical Record.","authors":"Pallavi Sharma, Gavriella Pora, Paarth Sharma, Frank J Jacono, Maroun Matta, Simran Singh, Matthew J Stull","doi":"10.34197/ats-scholar.2023-0031BR","DOIUrl":"10.34197/ats-scholar.2023-0031BR","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46429779","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":"The Influence of Stress on Student Performance during Simulation-based Learning: A Pilot Randomized Trial.","authors":"Rocco Cavaleri, Alexia Withington, K Jane Chalmers, Felicity Blackstock","doi":"10.34197/ats-scholar.2022-0042OC","DOIUrl":"10.34197/ats-scholar.2022-0042OC","url":null,"abstract":"<p><strong>Background: </strong>Simulation-based learning is an important educational medium that is being implemented increasingly for the purpose of improved patient care and safety. However, there is evidence to suggest that simulation-based education (SBE) may increase anxiety, as illustrated through self-reporting and physiological responses. Despite such data, no studies have investigated whether anxiety and stress can be manipulated through SBE scenario design and delivery to facilitate optimal learning conditions.</p><p><strong>Objective: </strong>This pilot study examined perceived anxiety and physiological stress experienced by entry-level physiotherapy students while learning a skill using SBE and the relationship between this anxiety and their subsequent skill performance.</p><p><strong>Methods: </strong>Final-year physiotherapy students were randomly allocated to one of three SBE experiences: low, medium, or high stress. The experiences were designed to induce increasing levels of stress and anxiety. Performance of the learned skill (endotracheal airway suctioning) was measured after the SBE using a bespoke assessment form. Cortisol levels, heart rate, and perceived anxiety measurements (State-Trait Anxiety Inventory and visual analog scale) were also collected.</p><p><strong>Results: </strong>Twenty-seven participants completed the trial. There were significant differences in perceived stress and physiological response between the groups. The low-stress group demonstrated significantly better performance of airway suctioning than the higher-stress groups (<i>P</i> = 0.02). Higher anxiety was correlated with poorer skill performance (<i>r</i> = -0.410).</p><p><strong>Conclusions: </strong>Students report SBE to be stressful, and scenarios themselves can influence the stress and anxiety experienced. Greater stress is associated with poor learning outcomes during SBE. Healthcare educators involved in SBE scenario design need to consider the stress levels experienced. Future research to determine optimal stress and embed measurement of stress in SBE experiences is warranted.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45002744","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 Novel Provider Education Module to Enhance Detection of Alpha-1 Antitrypsin Deficiency.","authors":"Ross C Schumacher, Chia-Ying Chiu, Jovana Lubarda, Pakinam Aboulsaoud, Jennifer Bomberger, J Michael Wells","doi":"10.34197/ats-scholar.2023-0028OC","DOIUrl":"10.34197/ats-scholar.2023-0028OC","url":null,"abstract":"<p><strong>Background: </strong>Alpha-1 antitrypsin deficiency (AATD) is the most common genetic risk factor for early-onset emphysema. However, AATD continues to be underrecognized and underdiagnosed. Provider awareness about AATD, concerns with testing costs, and limited understanding about therapeutic options contribute to its underdiagnosis. We hypothesized that provider education would improve awareness of AATD and improve screening.</p><p><strong>Objective: </strong>To evaluate the impact of a targeted provider education module on AATD screening.</p><p><strong>Methods: </strong>We developed a web-based education module to address barriers to screening for AATD, deployed the education module using the Medscape Education platform, assessed perceived healthcare provider confidence in AATD screening, and conducted a prospective pre and postintervention study of AATD testing practices at a high-volume academic outpatient subspecialty pulmonary clinic.</p><p><strong>Results: </strong>A total of 11,385 healthcare providers, including eight pulmonologists at our institution, completed the web-based education module. Confidence in identifying patients at high risk for AATD improved after completing the module (\"not confident\" in AATD screening was 7.7% postintervention compared with 19.4% preintervention). The rate of screening patients at high risk for AATD improved more than twofold (AATD screening rate 9.7% preintervention vs. 20.4% postintervention; <i>P</i> = 0.004). Among patients screened for AATD in our cohort, 27.2% had a genotype/phenotype or low alpha-1 antitrypsin concentration consistent with AATD.</p><p><strong>Conclusion: </strong>Targeted healthcare provider education can improve the confidence in testing for AATD. Improvements in provider confidence corresponded to improvements in AATD screening in a subspecialty pulmonary clinic. More than one-fourth of screening tests suggested AATD, underpinning the value of testing in high-risk individuals.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46221339","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":"Mind the Gap: A Single-Site, 12-Year Analysis of Trends in Medicine Residents Taking Gap Years before Fellowship.","authors":"Lekshmi Santhosh,&nbsp;Megan K McGrath,&nbsp;Jennifer M Babik","doi":"10.34197/ats-scholar.2022-0137BR","DOIUrl":"10.34197/ats-scholar.2022-0137BR","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/d6/ats-scholar.2022-0137BR.PMC10547094.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162875","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":"Trainees' Experience of Family Presence during Intensive Care Unit Procedures.","authors":"Benjamin R E Harris, Allison Butler, Eliotte L Hirshberg, Ramona O Hopkins, Jorie Butler, James Orme, Samuel M Brown, Sarah J Beesley","doi":"10.34197/ats-scholar.2023-0065BR","DOIUrl":"10.34197/ats-scholar.2023-0065BR","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48210321","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 Leadership Pathway in Patient Safety and Quality Improvement for Trainees.","authors":"Blaine Kenaa, Leena Ramadan, Mary J Njoku, Van K Holden, Mangla Gulati","doi":"10.34197/ats-scholar.2023-0019PS","DOIUrl":"10.34197/ats-scholar.2023-0019PS","url":null,"abstract":"<p><p>Training house staff in patient safety and quality improvement (PSQI) requires multidisciplinary collaboration between program directors, graduate medical education, and hospital safety and quality leadership. A heavy clinical workload and limited protected time hinder trainees from engaging in a meaningful PSQI experience during their years of post-graduate training. This is further exacerbated by the lack of subject experts who are available to mentor young physicians. For pulmonary and critical care trainees who are actively involved in the management and care coordination of high-acuity patients, this lack of experience adds undue burden. The role of house officer for patient safety and quality improvement was implemented to engage those currently in training who have an interest in PSQI. Under the supervision of the hospital PSQI leaders, they are given optimal, purposeful immersion without impacting their primary training specialty. This skill set can then be incorporated into their future careers. In this review, we provide perspective on how this can be accomplished and provide a framework that can be expanded.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46303421","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 Quality Improvement Approach to Modification of a Point-of-Care Ultrasound Curriculum.","authors":"Tiffany A Gardner, Elizabeth K Breitbach, Julia E Limes, Geoffrey R Connors, Andrew R Berry, August A Longino, Sneha Shah, Brandon Fainstad, Tyler M Miller, Carolina Ortiz-Lopez, Michelle Fleshner","doi":"10.34197/ats-scholar.2023-0018IN","DOIUrl":"10.34197/ats-scholar.2023-0018IN","url":null,"abstract":"<p><strong>Background: </strong>There is increasing emphasis on resident involvement in quality improvement (QI) efforts, yet resident engagement in QI has remained low for many reasons. Although QI methods are classically applied to clinical processes, there are many opportunities to incorporate QI principles into curricular design and implementation.</p><p><strong>Objective: </strong>Demonstrate the utility of QI methods when applied to curricular design and the implementation of a novel point-of-care ultrasound portfolio development and quality assurance program at a large internal medicine residency program.</p><p><strong>Methods: </strong>We applied foundational QI methods, including process mapping, plan-do-study-act (PDSA) cycles, time-trap identification, run-chart analysis, and qualitative interviews throughout the curricular design and implementation phases to rapidly identify areas for improvement and perform timely tests of change.</p><p><strong>Results: </strong>Fifty-one interns participated in the curriculum, submitting 731 images in the first trimester. Process mapping and submission review revealed that 29% of images were saved to the incorrect digital archive. Resident-reviewer interpretation concordance was present in 80.7% of submissions. In 95.2% of completed quality assurance cards, the same information was provided in the commentary feedback and the evaluator's checklists, representing a time trap. Interventions included restricting access to image archives and removing redundant fields from quality assurance cards. The time to feedback fell from 69.5 to 6.5 days, demonstrating nonrandom variation via run-chart analysis.</p><p><strong>Conclusion: </strong>This pilot study demonstrates the successful application of QI methods to a novel point-of-care ultrasound curriculum. The systematic use of these methodologies in curricular design and implementation allows expeditious curricular improvement. Emphasizing the relevance of QI methods to subject matter beyond clinical processes may increase resident engagement in QI efforts.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43612142","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}