University of Michigan
Ann Arbor, MI
Program Director: Kevin Chan
Program Type: Pulmonary/Critical Care
Abstract Authors: Dru D. Claar, Jakob I. McSparron, Ivan Co, Anthony J. Courey, Niket Nathani, Rommel Sagana, Kevin M. Chan
Description of Fellowship Program: Academic training program with both PCCM and CCM fellows.
Abstract
Introduction
The medical ICU is a high intensity setting with diverse educational stakeholders. Attending physicians must balance teaching responsibilities for multiple learner levels with other clinical, administrative, and research obligations within and outside of the ICU. These competing responsibilities are often a barrier to delivering education specifically to fellows, who have a broad array of skill domains to master and apply in the ICU. In addition, the shift to competency-based assessment through milestones and entrustable professional activities necessitates direct observation of fellows, presenting another challenge for the busy faculty member. To address concerns about insufficient fellow-specific education in the ICU, we implemented a pilot ICU Teaching Attending (TA) program within our fellowship to improve fellow-level teaching and competency assessment practices.
Methods
The ICU TA program was implemented for the first 3 months of the current academic year and consisted of teaching sessions conducted by a TA. Sessions were 2-3 hours and scheduled several afternoons a week. TAs were chosen from a pool of procedural and critical care skilled faculty educators. The sessions specifically targeted the non-call ICU fellow. Educational topics were chosen at the time of teaching based on fellow request, attending expertise, and clinical scenarios present in the ICU. Data was collected using a mixed-methods approach with surveys, structured interviews, and focus groups of fellows, TAs, and primary ICU attendings.
Results
Five first-year fellows and two second-year fellows participated in this program. Fellows attended 17 sessions, and each fellow participated in an average of 2.4 sessions (range 1 - 5 sessions). Topics covered included right ventricular physiology, bedside echocardiography, thoracic ultrasound, ventilator management, tracheostomy, lung transplant, and extracorporeal membrane oxygenation. 86% of fellows rated the program as at least moderately important to their critical care education, and all fellows felt the program should be continued in the future. A majority of the primary ICU attendings did not feel that the TAs impacted their role as attending of record. Full qualitative analysis is ongoing; major themes expressed by learners included appreciation of fellow-level teaching, importance of bedside teaching, skill of dedicated teaching faculty, and standardization of educational topics. Conclusions An ICU TA program is feasible and well-received in the ICU. This pilot program improved fellows’ educational experience in the ICU, and may provide an important platform for competency-based assessment in the future. Full qualitative data analysis of this program is ongoing.
