Beckman, Thomas J.

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

The body and mind are instruments that, through the senses, provide a gateway to conscious experience. One could reduce the totality of human existence to the body and mind alone, yet superficial appearances can be misleading. According to the yogic system, humans are comprised progressively subtle sheaths or koshas, ranging from the physical to the mind, energy, intellect, and bliss body. Furthermore, harnessing the intellect brings a level of control over energy, thoughts, behaviors, and quality of life. This understanding reorients the traditional, allopathic approach, which tends to emphasize the physical body in terms of anatomy, physiology, and clinical pathology. Recognizing deeper layers of self reminds physicians to see patients more holistically, while empowering patients to have greater authority over their own health outcomes.

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.

Background: The impact of computer ECG interpretation (CEI) on medical professionals’ performance is understudied. This study aims to assess the interpretation proficiency of diverse medical professionals with and without access to CEI reports. Methods: Medical professionals from diverse backgrounds interpreted 60 12-lead ECGs with urgent and non-urgent findings. The interpretation process involved two interpretation phases: (i) 30 ECGs with clinical statements and (ii) the same 30 ECGs and clinical statements in random order along with a CEI report. Diagnostic performance was evaluated based on interpretation accuracy, time per ECG, and self-reported confidence (rated 0 [not confident], 1 [somewhat confident], or 2 [confident]). Results: Among 892 participants, there were 44 (4.9%) primary care physicians, 123 (13.8%) cardiology fellows-in-training, 259 (29.0%) resident physicians, 137 (15.4%) medical students, 56 (6.3%) advanced practice providers, 82 (9.2%) nurses, and 191 (21.4%) allied health professionals. The inclusion of the CEI significantly improved interpretation accuracy by 15.1% (95% CI, 14.3 to 16.0; P<0.001), reduced interpretation time by 52 seconds (95% CI, -56 to -48; P<0.001), and increased confidence by 0.06 (95% CI, 0.03 to 0.09; P=0.003) (Table 1) . Conclusions: CEI integration improves ECG interpretation accuracy, efficiency, and confidence across medical professionals. Nevertheless, even with CEI, significant gaps in ECG interpretation proficiency remain.

Background: Accurate ECG interpretation is vital, but variations in skills exist among healthcare professionals. This study aims to identify factors contributing to ECG interpretation proficiency. Methods: Survey data and ECG test scores from participants in the EDUCATE Trial were analyzed. The dependent variable was the test score for interpreting 30 12-lead ECGs. Independent variables included non-modifiable factors (physician status, clinical experience, patient care impact) and modifiable factors (weekly interpretations, training hours, expert supervision frequency). Bivariate and multivariate analyses generated the Comprehensive Model (all factors) and Actionable Model (modifiable factors only). Results: Among 1206 participants, there were 72 (6.0%) primary care physicians, 146 (12.1%) cardiology fellows-in-training, 353 (29.3%) resident physicians, 182 (15.1%) medical students, 84 (7.0%) advanced practice providers, 120 (9.9%) nurses, and 249 (20.7%) allied health professionals. Physicians accounted for 571 (47.3%) of participants, while 453 (37.6%) were non-physicians. Bivariate analysis showed associations between test scores and multiple variables (Table 1) . In the Comprehensive Model, scores were independently associated with weekly interpretations (9.9 score increase; 95% CI 7.9-11.8; P<0.001), physician status (9.0 score increase; 95% CI 7.2-10.8; P<0.001), and training hours (5.7 score increase; 95% CI 3.7-7.6; P<0.001). In the Actionable Model, scores were independently associated with weekly interpretations (12.0 score increase; 95% CI, 10.0-14.0; P<0.001) and training hours (4.7 score increase; 95% CI 2.6-6.7; P<0.001). The Comprehensive and Actionable Models accounted for 18.7% and 12.3% of the variance in test scores, respectively. Conclusions: Being a physician is a non-modifiable predictor, while training and regular practice are modifiable predictors of ECG interpretation performance.

Background: Gaps in ECG interpretation competency among medical professionals exist, with a need for practical, evidence-based, and accessible learning solutions. We conducted an international, prospective, randomized controlled trial to assess the effectiveness of web-based, self-directed ECG learning. Methods: A total of 1206 diverse medical learners and professionals underwent an initial test, followed by random assignment to one of four groups: (i) online question-bank (questions), (ii) online lectures (lectures), (iii) online, question-bank and lectures (hybrid), or (iv) no resources (control). After 4 months, a post-test was administered to evaluate the overall change in performance. Results: Of all participants, 863 (72%) completed the trial. After the 4-month follow-up, all three online, self-directed intervention groups (questions, lectures, and hybrid) showed significant improvement in overall performance (P<0.001), while the control group did not (P=0.544). The questions, lectures, and hybrid interventions demonstrated score improvements of +11.4% (95% CI, 9.1-13.7; P<0.001), +9.8% (95% CI, 7.8-11.9; P<0.001), and +11.0% (95% CI, 9.2-12.9; P<0.001) respectively, compared to +0.8% (95% CI, -1.2-2.8; P=0.544) for the control group. These improvements were consistent across medical professional groups (Figure 1) . Conclusions: Web-based, self-directed learning resources effectively improved ECG interpretation proficiency for diverse medical learners and professionals.

Background: ECG interpretation is crucial in medical practice, but professionals struggle with achieving and maintaining competency. Identifying proficiency gaps aids in designing educational interventions. Methods: Medical professionals from various disciplines interpreted 30 12-lead ECGs containing commonly taught urgent and non-urgent findings. Performance metrics evaluated were overall adjusted score (% of correctly identified findings using a point-value score based on clinical relevance), unadjusted score (% of correctly identified findings), interpretation time per ECG, and self-reported confidence (rated on an ordinal scale of 0 [not confident], 1 [somewhat confident], or 2 [confident]). Results: Among 1206 participants, there were 72 (6%) primary care physicians (PCPs), 146 (12%) cardiology fellows-in-training (FIT), 353 (29%) resident physicians, 182 (15%) medical students, 84 (7%) advanced practice providers (APPs), 120 (10%) nurses, 249 (21%) allied health professionals, 571 (47%) physicians, and 453 (38%) non-physicians. Participants had a mean adjusted score of 46.9% (± 15.9%), unadjusted score of 56.4% (± 17.2%), interpretation time of 142 seconds (± 67 seconds), and confidence of 0.83 (± 0.53) (Table 1) . Performance varied across groups; cardiology FIT had superior performance in all metrics. Physicians generally outperformed non-physicians, with higher overall adjusted score (52% vs. 43%; p<0.01), unadjusted score (62% vs. 52%; p<0.01), and confidence (0.91 vs. 0.80; p<0.01). Unadjusted score for PCPs was higher than nurses and APPs (58% vs. 47% and 51%; p<0.01) but lower than resident physicians (58% vs. 60%; p<0.01). Allied health professionals outperformed nurses and APPs and closely matched resident physicians and PCPs. Conclusions: Significant gaps in ECG interpretation proficiency exist, emphasizing the need for comprehensive, scalable, and accessible educational tools.

Dieulafoy lesions are a rare but life-threatening cause of gastrointestinal bleeding. Colonic Dieulafoy lesions are exceptionally rare, comprising only 2% of these lesions. We present a case of cecal Dieulafoy lesion as an unusual cause of lower gastrointestinal bleeding—along with hemoptysis. An 81-year-old male with pulmonary hypertension presented with a one-day history of hematochezia. He subsequently developed new small-volume hemoptysis/hematemesis with increasing oxygen requirements. Bronchoscopy revealed old blood in the left lower lobe, with no active bleeding. The hemoptysis was attributed to severe pulmonary hypertension. Colonoscopy revealed a 2-mm cecal Dieulafoy lesion with spurting bleeding, which was clipped. We report a rare case of cecal Dieulafoy lesion with only 13 other published cases. Our case was complicated by hemoptysis creating an interesting diagnostic dilemma. In patients bleeding from both oral and anal orifices, a brisk upper gastrointestinal bleed—as well as independent causes involving the gastrointestinal and respiratory tracts—should be considered.