ATS scholar最新文献

{"title":"Management of Leukostasis in Acute Myeloid Leukemia.","authors":"Kalaila L Pais, Jenna Spring, Margaret M Hayes","doi":"10.34197/ats-scholar.2025-0039OT","DOIUrl":"10.34197/ats-scholar.2025-0039OT","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"512-514"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453614","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":"Cognitive Task Analysis to Understand and Overcome Heuristics in Medical Residents: Even More Relevant in the Era of Artificial Intelligence.","authors":"Sandra Zaeh","doi":"10.34197/ats-scholar.2025-0149ED","DOIUrl":"10.34197/ats-scholar.2025-0149ED","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"6 4","pages":"389-391"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859568","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":"Cognitive Task Analysis to Evaluate Resident Physician Decision Making in the Intensive Care Unit.","authors":"Jason N Mansoori, Stephanie Gravitz, Kathryne D Reed, Jennifer K Taylor, Edward P Havranek, Jodi S Holtrop, Ivor S Douglas","doi":"10.34197/ats-scholar.2025-0009OC","DOIUrl":"10.34197/ats-scholar.2025-0009OC","url":null,"abstract":"<p><p><b>Background:</b> Heuristics are commonplace among novices and experts making clinical decisions, often guided by clinical intuition when there is diagnostic or therapeutic uncertainty. Compared with more experienced clinicians, trainees may lack the knowledge, insight, and intuition needed to appropriately select and apply heuristics and clinical decision rules. An improved understanding of the mental models and contextual factors that predispose trainees to misapplied heuristics, cognitive biases, and other decision-making errors is needed. <b>Objectives:</b> To test the use of cognitive task analysis for examining how trainees make high-risk decisions in complex, dynamic, and real-world practice environments. <b>Methods:</b> We conducted semistructured interviews between September 2019 and March 2020 using a cognitive task analysis technique called the critical decision method. Participants were third-year internal medicine resident physicians rotating in the medical intensive care unit at a major safety-net academic hospital. Interviews focused on fluid-resuscitation decisions for actual patients with septic shock. Data were coded and analyzed using a template approach with the Recognition-Primed Decision model as the guiding framework. <b>Results:</b> Eleven of 23 eligible residents completed a full interview. The median time from initial sepsis care to interview was 7 days (interquartile range, 6.5-11 d). Seven key domains related to fluid-resuscitation decisions were identified: cues, information, decision making, decision alternatives, analogs, expected outcomes, and goals. In addition to objective clinical data (e.g., serum lactate concentration), fluid-resuscitation decisions were most significantly influenced by clinical intuition, other nonphysiological contextual factors, and volume-based heuristics. For example, residents frequently prescribed fluid dependent on the total volume already administered. They assumed that patients receiving more than 3-5 L would not benefit from additional resuscitation, while using the same heuristic to disregard evidence-based predictors of fluid responsiveness. Evidence of related cognitive biases was also found, including premature closure, confirmation bias, and status quo (or default) bias. <b>Conclusions:</b> Cognitive task analysis is a promising tool for examining how trainees make high-risk clinical decisions. Better understanding the nature of trainees' heuristics and cognitive biases has implications for designing educational and training strategies that improve their clinical reasoning.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"448-463"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509790","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":"Failure to Thrive.","authors":"Anna K Brady","doi":"10.34197/ats-scholar.2025-0014SN","DOIUrl":"10.34197/ats-scholar.2025-0014SN","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"515-517"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762467","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":"Did COVID-19 Curb Residents' Enthusiasm for Pulmonary Disease and Critical Care Medicine/Critical Care Medicine Fellowships?","authors":"Zachary B Strumpf, Maroun Matta","doi":"10.34197/ats-scholar.2024-0121CM","DOIUrl":"10.34197/ats-scholar.2024-0121CM","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"402-406"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202254","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":"Pulmonary Hypertension Associated with Interstitial Lung Disease: Screening and Epidemiology.","authors":"Cedric Rutland, Chase S Hall, Nicholas A Kolaitis, Tejaswini Kulkarni, Lisa H Lancaster, Manisit Das, Eric Shen, Brittany N J Davis, Steven D Nathan","doi":"10.34197/ats-scholar.2024-0135VO","DOIUrl":"10.34197/ats-scholar.2024-0135VO","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"521-522"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202215","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 Tenuous Future of Our Next Generation of Physician-Scientists.","authors":"David A Schwartz","doi":"10.34197/ats-scholar.2025-0078CM","DOIUrl":"10.34197/ats-scholar.2025-0078CM","url":null,"abstract":"","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"6 4","pages":"395-397"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859565","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":"Leaning into Necessary Discomforts: Striving for Clinical Excellence While Maintaining Wellness.","authors":"Hitesh H Patel, Erica Lin","doi":"10.34197/ats-scholar.2025-0033PS","DOIUrl":"10.34197/ats-scholar.2025-0033PS","url":null,"abstract":"<p><p>Medical education is redefining clinical excellence in the face of high learner (medical student and house staff) burnout rates, exposing a dichotomy between clinical rigor and well-being. Endurance-based traditions that once equated long hours with competence persist, yet contemporary evidence shows that effective learning environments, grounded in psychological safety and timely bidirectional feedback, improve both performance and well-being. Through the lens of early career clinician educators, we trace the origins of hardship-driven training, review data linking burnout to impaired clinical performance, and describe how competency-based medical education, anchored in entrustable professional activities and qualitative milestones, shifts success metrics from hours logged to skills demonstrated. We explore generational shifts that intensify the need for transparent discussions of expectations between learners and educators. We advocate for a culture in which mistakes are viewed as learning opportunities rather than failures. Finally, we argue that educational reforms must undergo rigorous, longitudinal evaluation before widespread implementation to ensure that they enhance competence, reduce burnout, and maximize patient safety. Clarifying which stressors cultivate mastery and which merely exhaust will allow us to produce physicians who learn more effectively, care for patients more safely, and remain in the profession longer. By cocreating psychologically safe, data-driven training models that retain \"necessary discomforts\" while eliminating \"unnecessary harms,\" medical education can reconcile its dual obligations to clinical excellence and learner well-being.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":"6 4","pages":"420-431"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859587","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":"Multidisciplinary Videoconferencing for Physician Education and Remote Management of Interstitial Lung Disease.","authors":"Sarah Pankovitch, Shane Shapera, Lee Fidler, Micheal McInnis, Jolene H Fisher","doi":"10.34197/ats-scholar.2024-0136OC","DOIUrl":"10.34197/ats-scholar.2024-0136OC","url":null,"abstract":"<p><p><b>Background:</b> The gold standard for interstitial lung disease (ILD) diagnosis is multidisciplinary discussion (MDD); however, access is often limited by geographic barriers, time constraints, and the number of centers with ILD expertise. <b>Objective:</b> To assess the educational and clinical impact of a novel videoconferencing MDD program for the diagnosis and management of ILD. <b>Methods:</b> We performed a retrospective observational study of the Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely (MILDDER) program, a videoconferencing MDD platform initiated by the Toronto General Hospital in Toronto, Canada. We used anonymized survey data from attendees (trainees and practicing physicians) and referring physicians who attended MILDDER between 2018 and 2023. Self-reported ILD confidence before and after MILDDER participation and general program satisfaction were assessed using a 10-point Likert scale. ILD confidence questions were stratified by clinical practice experience. Wilcoxon signed-rank testing for paired data was used to determine statistical significance in the subgroup that completed a MILDDER semester (bimonthly sessions for 6 mo). Written survey responses were assessed qualitatively and grouped by theme. Clinical outcomes, including patient characteristics, new or changed ILD diagnoses, new investigations requests, and new treatment suggestions, were assessed. <b>Results:</b> Three hundred seventeen attendees and referring physicians completed pre-MILDDER questionnaires. Overall, they reported low confidence in their ability to diagnose and manage ILD. After they attended a MILDDER semester ILD, their confidence increased by a median of 3 to 4 points in the overall group. Among respondents with ⩾5 years of clinical practice experience, there was no change in ILD diagnostic confidence after MILDDER; however, management confidence increased by a median of 2 points. A statistically significant increase in all areas of ILD confidence assessed was noted in the subgroup of 70 participants with complete pre- and post-MILDDER semester surveys. Respondents were generally very satisfied with MILDDER. New or changed ILD diagnoses occurred in 86 (50.6%) presented cases, new investigation requests occurred in 40 (22.7%) cases, and new medications were recommended for 30 (17%) cases. <b>Conclusion:</b> Videoconferencing MDD platforms such as MILDDER are feasible and can be used as a tool for physician education and remote management of ILD.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"475-487"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765853","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":"Final Acts of Love.","authors":"Kalaila L Pais","doi":"10.34197/ats-scholar.2025-0001VL","DOIUrl":"10.34197/ats-scholar.2025-0001VL","url":null,"abstract":"<p><p>Discussions and acts surrounding end-of-life care are a daily occurrence in the intensive care unit (ICU) and are influenced by cultural, spiritual, and socioeconomic factors. This reflective essay explores the complexities of providing end-of-life care through my experience as an Indian immigrant, medical student at a historically Black university, and resident physician in a large quaternary medical center. It examines the disparities and cultural dissonance that currently exist in end-of-life care with regard to ethnic minority patients and families. The essay advocates for improved cultural sensitivity among healthcare providers and concludes with a call for initiatives that bridge respect for diverse perspectives on life and death.</p>","PeriodicalId":72330,"journal":{"name":"ATS scholar","volume":" ","pages":"398-401"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710024","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}