Abstract Identification and management of patient-ventilator asynchronies is a fundamental skill for the management of mechanical ventilation and often requires interpretation of mechanical ventilation waveform scalars. However, teaching mechanical ventilation waveform analysis can be challenging for educators due to the complexity of the material. In this entry of “How I Teach”, we provide an approach to teaching the concept of “normal” mechanical ventilator waveforms as an introduction to the broader topic of patient-ventilator asynchronies. We stress that intimate knowledge of normal mechanical ventilator appearance and physiology is vital prior to tackling the concepts of abnormal mechanical ventilator waveforms. We offer a framework to present this material in a classroom or small group setting, summarize key concepts and provide concrete examples of the educational techniques we utilize.

The high-acuity environment of the intensive care unit (ICU) has the potential to erode the humanistic connection between clinicians and critically ill patients. Admission to an ICU places patients at risk for dehumanization-treating a person as if they do not possess the attributes of human beings. Physician trainees, while developing skills in professionalism and communication, may be especially vulnerable to losing sight of their patients' personhood amid the cognitive demands of ICU care. Humanizing interventions offer a feasible way to re‑center personhood and connection. The 'Get to Know Me Board' (GTKMB) is a narrative-informed intervention that helps clinicians understand the individual behind the illness. In this manuscript, we synthesize the existing literature on GTKMBs and describe our own implementation in a New York City ICU during the COVID‑19 pandemic. We qualitatively explored how residents perceived the impact of the GTKMBs on their engagement with patients, families, and their own sense of meaning in ICU work. Trainees self-reported that the GTKMB helped them connect more deeply with patients, strengthened their sense of responsibility for patient welfare, and increased their fulfillment from work. Implementation was feasible but required intentional coordination and a reliable GTKMB champion. Our findings highlight the potential role of narrative‑informed, humanizing practices in supporting trainee development and fostering a culture of dignity and respect in the ICU. We discuss opportunities for integrating GTKMBs into competency‑based medical education frameworks and outline future directions for evaluating their impact on trainee well‑being, communication, and patient‑ and family‑centered outcomes.

A minority of Pulmonary and Critical Care Medicine (PCCM) graduates pursue careers in academic medicine. Although compensation is only a portion of the career decision, job negotiations remain shrouded in ambiguity and inconsistency. Additionally, while role-level salary tables exist through the Association of American Medical Colleges (AAMC), to our knowledge there is no resource that includes important non-salary. We sought to describe key components of first PCCM academic job offers for both physician scientists and clinician educators, including salary, start-up packages, non-clinical full-time equivalent (FTE) breakdown, and bonus ranges. An electronic survey was distributed via a snowball sampling method between May - June 2025. PCCM graduates between 2020-2025 who accepted a job in academic medicine were included. Mann-Whitney Wilcoxon tests were used for ordinal comparisons. Qualitative analysis of free text responses was performed with a social cognitive career theory framework. There were 60 respondents who provided information about 103 job offers, with 50% (14/28) of physician-scientists and 66% (21/32) of clinician-educators reporting more than one job offer. Physician-scientists received lower salary offers compared to clinician-educators (respective median ranges: $150,000-$199,999 vs $250,000-$299,999, p < 0.001). Only 35.7% of physician-scientists (10/28) received a career development award prior to negotiation, which was associated with a higher start-up package offer (p < 0.05). For all clinician-educator jobs (n = 59), 42.4% had non-clinical FTE in the initial offer. Many respondents commented on the lack of negotiating power. PCCM physician-scientists and clinician-educators experience wide variability in their initial job offers. Recognizing differences is essential to improve transparency in job negotiations in academic medicine.

Technology-driven intensive care unit (ICU) environments can be dehumanizing for critically ill patients, their families, and team members who care for them. Prior educational efforts to humanize the ICU have focused on training clinicians to provide human-centered care for patients and families, with relatively little attention on promoting human-centered environments for team members. We used the framework of team coaching to develop an interprofessional educational program focused on humanizing the ICU. We sought to evaluate whether this program improves participants' perceived capability to promote a human-centered environment for the ICU team. We conducted a 3-year, mixed methods evaluation of a novel interprofessional ICU team coaching program in a medical/surgical/trauma ICU within an academic medical center. The 3-session program is led by a certified coach and annual cohorts are a subset of the ICU team. Session topics are: role identification, end-of-life care, and practices of dignity and respect. We conducted pre- and post-coaching participant surveys and qualitative content analysis of coaching reflections, open-ended survey responses, and an audio-recorded debriefing session. Over 3 years, 43 ICU team members representing 7 professional roles (advanced practice providers, attending physicians, chaplains, fellow physicians, nurses, respiratory therapists, social workers) participated. The overall session attendance rate was 70%. Before participation, most reported a need for training to promote a human-centered environment for patients (78.1%), families (81.3%) and other members of the team (81.3%). After coaching, this unmet need decreased to 28.6% for patients (p < 0.01), 42.9% for families (p < 0.01), and 33.3% for team members (p < 0.01). Participants' self-reported ability to provide optimal human-centered care was similar pre-(84.4%) and post-coaching (81.8%; p = 0.80). Participants' scores on the interprofessional Consultation and Relational Empathy (CARE) measure improved from 37.1 (95% CI 34.3-39.9) pre-coaching to 40.7 post-coaching (95% CI 38.8-42.6;p = 0.047). Qualitative analysis revealed commitment to growth in interprofessional relationships among participants and a desire to expand the program's reach. Our findings confirm an unmet need among ICU team members for training in how to promote human-centered ICU environments and suggest that interprofessional team coaching is a promising tool to help meet this need.

Coaching for professional development contributes to improved performance, personal satisfaction, and well-being. Although coaching programs have been widely introduced at the undergraduate medical education level and in certain residency programs, coaching programs targeting the unique experiences of fellows are less well described. Given high rates of burnout, pulmonary and critical care medicine (PCCM) fellows may benefit from professional development coaching. To design, implement, and evaluate an individual coaching program for PCCM fellows. Alumni surveys and trainee and faculty focus groups identified key needs of a coaching program. Coaches received salary support and were trained in competencies including positive psychology, learner engagement, and communication. Starting in 2019, three coaches were assigned seven fellows each, spanning the three Accreditation Council of Graduate Medical Education (ACGME) years. The program was evaluated through ACGME surveys, Likert scale-based end-of-year surveys, and qualitative analysis of fellows' written feedback. Coaching was associated with improved overall training program satisfaction (ACGME survey overall satisfaction (survey range 1-5 with 5 highest) was 4.2, 3.9, 4.3 in the three years pre-intervention, and 4.6, 4.6, 4.6 in the three years post-intervention). Compliant responses in the ACGME survey domain of Evaluation increased above our program benchmark of 90% from a baseline of 75%. Fellow well-being demonstrated slight improvements through the evaluation period (2018-2022). Fellows rated the coaching program highly, especially in support and well-being, feedback, and goal-setting. Only 66% reported a direct impact on choosing a specific career path. Implementation of this fellowship coaching program was associated with improvements in fellows' satisfaction with the training experience, evaluation and feedback, career development, and well-being, despite the added challenges of the COVID-19 pandemic. Future directions include standardizing coaching frameworks, exploring long-term impacts on career trajectories, and evaluating coaches' satisfaction with the program.

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.

BackgroundOutside of the operating room airway management (OOORAM) poses unique challenges and is associated with increased complications when compared with routine operative airway management. Approaches to airway management between healthcare systems is variable in terms of operator training and expertise and may be associated with adverse patient outcomes. In response to this, the Veterans Health Administration created a mandatory standardized OOORAM training program in 2013.ObjectiveWe sought to evaluate the effect that introduction of the OOORAM training program had on first-pass laryngoscopy success.MethodsThis is a retrospective cross-sectional study of out-of-operating room endotracheal intubations performed at a single academically affiliated tertiary care center from June 2008 through June 2018. The study interval is 5 years before and after the introduction of the OOORAM program in 2013. Data were extracted from standardized intubation notes for all patients undergoing out-of-operating room intubation from the electronic medical system. The primary outcome was first-pass laryngoscopy success, defined as successful intubation with a single insertion of the laryngoscope. A secondary analysis restricted the cohort to experienced providers to evaluate the effect of OOORAM training in this group.ResultsThe overall rate of successful laryngoscopy improved from 73.0% to 78.2% (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.06–1.75) after the introduction of the OOORAM program. Similarly, overall first-pass intubation success rates showed a trend toward improvement, rising from a baseline of 77.2–83.1%, but did not reach statistical significance (OR, 1.17; 95% CI, 0.88–1.55). The rate of esophageal intubation decreased after OOORAM training from 9.6% to 5.1% (P = 0.001). The use of video laryngoscopy was not associated with a significant difference in first-pass laryngoscopy (P = 0.586) or first-pass intubation (P = 0.375). There was no improvement in first-pass laryngoscopy or intubation success after introduction of the training program in the experienced provider cohort.ConclusionWe have shown that a limited duration, facility-wide training intervention OOORAM is associated with improved first-pass laryngoscopy success and reduced rates of esophageal intubation.

Point-of-care ultrasound (POCUS) is a powerful diagnostic tool that combines image acquisition with bedside interpretation, enabling physicians to make rapid diagnoses at the bedside (1). Over the last decade, the popularity of POCUS has surged because of its versatility and the immediate insights it provides in clinical decision making (1). However, basic POCUS does not provide important hemodynamic information, such as intracardiac pressures, stroke volume, or valvular regurgitation assessment. Critical care echocardiography (CCE) becomes indispensable as a specialized application of POCUS focused on using Doppler techniques to provide detailed hemodynamic assessments in critically ill patients (2). Teaching hemodynamic evaluation in CCE, such as estimating right ventricular systolic pressure (RVSP), is a challenging yet essential aspect of modern critical care education. RVSP is used to assess the presence of pathologic elevation in right ventricular afterload, which has significant clinical implications for critically ill patients. Deriving RVSP requires understanding ultrasound physics, fluid mechanics, and Doppler techniques and mastery of cardiac image acquisition (3–4). These complex skills are not just important but crucial for effectively managing critically ill patients in the intensive care unit (ICU). In this edition of “How I Teach,” we introduce our methodology for instructing learners in our ICU on RVSP estimation using CCE. We use hands-on ultrasound training and e-learning strategies to optimize knowledge retention, ensure accurate interpretation, and promote practical application.

BackgroundCurrently, there is significant variability in bronchoscopy training across pulmonary and critical care medicine (PCCM) programs nationwide, including procedural volume and exposure to simulation training. Despite the increased number of interventional pulmonology (IP) fellowship programs in the United States, their direct educational impact on PCCM fellows’ bronchoscopy training is unknown.ObjectiveTo identify and quantify the differences in flexible bronchoscopy competency among PCCM fellows from institutes with IP fellowships compared with those without IP fellowships.MethodsThis multicenter, prospective cohort study included the assessment of PCCM fellows from two groups, using the Ontario Bronchoscopy Assessment Tool (OBAT): 1) PCCM fellowships with a coexistent IP fellowship program and 2) PCCM fellowships without an IP fellowship program. The primary outcome was the difference in mean score between the two groups; secondary outcomes included the mean OBAT score of first, second, and third-year (or above) fellows in the two groups and the percentage of fellows in the two groups who were capable of independently performing the procedure.ResultsThere were five participating training sites: two with IP fellowships and three without IP fellowships. A total of 50 OBAT assessments were performed (25 in each group) by the supervising attending physician. The mean OBAT score was 3.58 ± 0.65 in the IP group compared with 4.33 ± 0.61 in the non-IP group (P < 0.001). The mean (standard deviation) OBAT scores of the first, second, and third-year (or above) fellows were 3.36 (0.5), 3.48 (0.4), and 4.53 (0.5) in the IP group and 3.75 (0.8), 4.25 (0.5), and 4.7 (0.3) in the non-IP group, respectively. The mean OBAT score was directly proportional to the number of procedures done by the fellows.ConclusionThere was a statistically significant difference in the mean OBAT scores between the two groups; the mean OBAT score was higher in the non-IP fellowship group. Although a more comprehensive study is needed to fully account for the various factors that can impact bronchoscopy training, this study highlights a key difference in basic bronchoscopy training among PCCM trainees. The presence of IP fellowship is one of the many factors that can affect the basic bronchoscopy skills of PCCM fellows.