Kelm, Diana J.

Abstract Background Central venous catheterization (CVC) is a fundamental procedural competency in pulmonary and critical care medicine (PCCM). Although commercially available task trainers are effective for teaching CVC placement, their high cost and logistical requirements can limit access to repeated practice. Objective To evaluate learner and faculty perceptions and usability of a newly developed CVC simulation model compared with a standard commercial task trainer and detail the technical report of the novel model’s construction. Methods We conducted a prospective educational evaluation during the PCCM CVC workshop. Participants practiced CVC placement with both the standard commercial trainer and a locally constructed simulation model developed at our institution. Teaching faculty were asked to evaluate both models from an instructional standpoint. Results Eighteen participants (15 PCCM 1st year fellows and 3 faculty instructors) evaluated the novel CVC simulation model. All fellows (n = 15, 100%) preferred the new model over a standard commercial model, with 14 (93%) reporting improved understanding of CVC insertion steps and 11 (73%) noting ease of ultrasound landmark identification. All fellows (n = 15, 100%) endorsed inclusion of the model in future workshops. Additionally, faculty instructors preferred the novel model for teaching (n = 3, 100%). All faculty supported future use of the model. The initial model development cost was approximately $288.96 with most materials’ reusable. Conclusions The novel task-aligned CVC simulation model offers a realistic, reusable, and cost-effective alternative to commercial simulators, with high learner and faculty preference and strong educational value. Its functional alignment supports integration into fellowship training, with future studies needed to assess objective skill acquisition and retention.

Abstract Rationale Teaching invasive bedside procedures is a core responsibility of critical care physicians, yet few validated tools exist to evaluate teaching effectiveness in this high-stakes environment. Building on prior qualitative work identifying key traits and behaviors of effective IBP teachers, we aimed to develop and validate the Invasive Bedside Procedure Teacher Effectiveness Scale (IBP-TES) to advance assessment and faculty development in procedural education. Methods This multicenter validation study recruited internal medicine residents and PCCM fellows from two academic institutions (Oregon Health & Science University (OHSU) and Mayo Clinic) in which each learner reviewed two standardized videos of simulated ultrasound-guided central venous catheter insertions supervised by critical care physicians. Learners rated supervising teachers using the eight-item IBP-TES, derived from prior qualitative themes of effective procedural teaching. Factor analysis using generalized estimating equations accounted for repeated measures, and orthogonal rotation was applied for factor extraction. The number of factors retained was determined using the minimal proportion criterion and visual inspection of the scree plot. Cronbach’s α assessed internal consistency reliability. Analyses were performed in SAS v9.4. Results Thirty-eight learners (63% OHSU, 37% Mayo Clinic) completed 76 IBP-TES evaluations of supervising physicians. Factor analysis identified two underlying domains accounting for most of the variance: (1) Procedural Teaching Behaviors—pre-briefing, communication, feedback, environmental control, and procedural expertise (Cronbach’s α = 0.80); and (2) Interpersonal Traits—calmness, adaptability, and learner autonomy (α = 0.72). Overall reliability was strong (α = 0.80), and findings were consistent in sensitivity analyses unadjusted for repeated measures. These domains collectively reflect that effective IBP supervision integrates both structured teaching behaviors and interpersonal qualities that foster learner engagement and safety. No significant associations were observed between IBP-TES scores and learner demographics or postgraduate year. Conclusions The IBP-TES demonstrated strong internal consistency and a reproducible two-factor structure encompassing procedural teaching behaviors and interpersonal traits. This validated tool provides a structured framework for assessing procedural teaching effectiveness and guiding faculty development. Future work will evaluate its use in real-world ICU settings to further improve procedural supervision and patient safety. This abstract is funded by: None

Abstract Introduction Emergent endotracheal intubation in the intensive care unit (ICU) is a high-risk, time-sensitive procedure performed to maintain airway patency and ensure adequate oxygenation and ventilation, often complicated by hypotension, hypoxemia, or cardiac arrest. Successful outcomes depend on precise team coordination, communication, and situational awareness. Drawing inspiration from the demonstrated benefits of simulation-based cardiopulmonary resuscitation training in enhancing team performance, this study examines the feasibility of implementing in situ “mock intubation” in the ICU. The objective is to determine whether this approach can be seamlessly integrated into routine practice to improve teamwork, procedural readiness, and patient safety. Methodology A prospective interventional study was conducted in the medical ICU at Mayo Clinic Rochester over two months. ICU staff—including physicians, advanced practice providers (APP), nurses, and respiratory therapists—participated in eight scheduled 45-minute in situ mock intubation sessions integrated into routine clinical hours. Each session included five participants (one physician faculty, one physician trainee/APP, two nurses, and one respiratory therapist) and incorporated case-based scenarios requiring completion of the intubation and management of post-procedural complications. Structured debriefings followed each session to identify performance gaps, enhance team communication, and assess the educational value and feasibility of incorporating mock intubation into routine ICU practice. Results A total of eight mock intubations were conducted with 40 participants. Sessions were seamlessly integrated into the routine clinical workflow without disruption. Participants reported high satisfaction, unanimously agreeing that the sessions were valuable and should be continued. Feedback emphasized psychological safety and realism: “This offered a safe space to communicate,” one noted; another stated, “It’s important to practice where it’s easy to make mistakes,” and a third remarked, “Real-life experiences were brought into simulations.” These themes underscore participants’ desire for ongoing sessions and their perceived real-world relevance. Conclusion Mock intubation using in situ simulation provides a practical approach to training for emergent endotracheal intubation, enhancing team communication, coordination, and situational awareness in the ICU. This on-site format eliminates the need for off-unit scheduling and was well received by staff. The potential of in situ mock intubation to mirror the success of simulated cardiopulmonary resuscitation training highlights the importance of team-based procedural preparation in high-acuity environments. The intervention fosters procedural readiness, teamwork, and a culture of safety. Given its feasibility, clinical relevance, and positive reception, in situ mock intubation should be integrated into routine ICU practice as a team training tool for high-risk procedures. This abstract is funded by: None

Abstract Background In the United States, a growing number of lung transplants are performed each year, necessitating an increased number of general and transplant pulmonologists skilled in the care of these complex patients. However, pulmonary and critical care medicine (PCCM) fellowships across the country do not universally have dedicated lung transplantation curricula, and there is scarce literature in this area. We describe the generation of a content outline for curriculum development created through modified electronic Delphi methodology. Objective To identify “must know” topics in lung transplantation for a graduating PCCM fellows. Methods We developed expert consensus on “must know” lung transplant topics and subtopics (“items”) for a graduating fellow through three survey rounds from July 2023 to October 2023. Thirty-three panelists were asked to rank author-provided items as “must know,” “nice to know,” or “not necessary to know” and to generate new items in round 1 to be submitted for ranking in subsequent rounds. “Must know consensus” was defined as ≥50% must know responses. Results Survey response and completion rates across rounds were 58–70% and 96–100%, respectively. In round 1, panelists were provided eight topics and 30 subtopics for initial ranking. Panelists generated 82 new items in this round, of which 19 were included in round 2 for ranking after author review, together with one item from round 1 that required reranking. From round 2, only two items required reranking, and these items comprised round 3. Seven topics were identified as “must know”: transplant immunology, evaluation of a lung transplant candidate, surgical and peri/postoperative management, rejection, immunosuppression, infections, and other complications, together with 36 subtopics. Conclusion Self-identified lung transplantation experts obtained consensus on seven “must know” topics and 36 subtopics in lung transplantation for graduating PCCM fellows. The findings serve as a starting point for future curriculum development.

Abstract Large language models are becoming ubiquitous in the editing and generation of written content and are actively being explored for their use in medical education. The use of artificial intelligence (AI) engines to generate content in academic spaces is controversial and has been meet with swift responses and guidance from academic journals and publishers regarding the appropriate use or disclosure of use of AI engines in professional writing. To date, there is no guidance to applicants of graduate medical education programs in using AI engines to generate application content—primarily personal statements and letters of recommendation. In this Perspective, we review perceptions of using AI to generate application content, considerations for the impact of AI in holistic application review, ethical challenges regarding plagiarism, and AI text classifiers. Finally, included are recommendations to the graduate medical education community to provide guidance on use of AI engines in applications to maintain the integrity of the application process in graduate medical education.

Abstract Rationale Endotracheal intubation is the third most common bedside procedure in U.S. hospitals. In over 40% of intubations, preventable complications attributable to human factors occur. A better understanding of team dynamics during intubation may improve patient safety. Objectives To explore team dynamics and safety-related actions during emergent endotracheal intubations in the emergency department and intensive care unit and to engage members of the care team in reflection for process improvement through a novel video-based team debriefing technique. Methods Video-reflexive ethnography involves in situ video recording and reflexive discussions with practitioners to scrutinize behaviors and to identify opportunities for improvement. In this study, real-time intubations were recorded in the emergency department and intensive care unit at Mayo Clinic Rochester, and facilitated video-reflexive sessions were conducted with the multidisciplinary procedural teams. Themes about team dynamics and safety-related action were identified inductively from transcriptions of recorded sessions. Results Between December 2022 and January 2023, eight video-reflexive sessions were conducted with a total of 78 participants. Multidisciplinary members included nurses (n = 23), respiratory therapists (n = 16), pharmacists (n = 7), advanced practitioners (n = 5), and physicians (n = 26). In video-reflexive discussions, major safety gaps were identified and several solutions were proposed related to the use of a multidisciplinary intubation checklist, standardized communication and team positioning, developing a culture of safety, and routinely debriefing after the procedure. Conclusions The findings of this study may inform the development of a team supervision model for emergent endotracheal intubations. This approach could integrate key components such as a multidisciplinary intubation checklist, standardized communication and team positioning, a culture of safety, and debriefing as part of the procedure itself.