BackgroundCritical care trainees were integral in the coronavirus disease (COVID-19)pandemic response. Several perspective pieces have provided insight into thepandemic’s impact on critical care training. Surveys of programdirectors and critical care trainees have focused on curricular impact.There is a lack of data from the trainee perspective on curricularenhancements, career development, and emotional and well-being needs tosucceed in a critical care career in the ongoing COVID-19 pandemic.ObjectiveOur objective was to elicit perspectives from critical care trainees on theirpersonal and professional needs as they continue to serve in the COVID-19pandemic.MethodsThis was a hypothesis-generating qualitative study. Individuals in a U.S.critical care training program during the COVID-19 pandemic participated ineither focus groups or semistructured interviews. Interviews were conductedbetween July 2020 and March 2021 until data saturation was achieved. Audiorecordings were professionally transcribed and analyzed using qualitativecontent analysis. A codebook was generated by two independent coders, with athird investigator reconciling codes when there were discrepancies. Themesand subthemes were identified from these codes.ResultsThirteen participants were interviewed. The major themes identified were asfollows: 1) Curricular adaptation is necessary to addressevolving changes in trainee needs; 2) COVID-19 impactedcareer development and highlighted that trainees need individualized help tomeet their goals; 3) receiving social support at work frompeers and leaders is vital for the sustained well-being of trainees;4) fostering and maintaining a sense of meaning andhumanity in one’s work is important; and 5) traineesdesire assistance and support to process their emotions and experiences.ConclusionThe needs expressed by critical care trainees are only partially captured inconceptual models of physician well-being. The need for multilevel workplacesocial networks and identifying meaning in one’s work have beenmagnified in this pandemic. The themes discussing curricular gaps, careerdevelopment needs, and skills to process work-related trauma are less wellcaptured in preexisting conceptual models and point to areas where furtherresearch and intervention development are needed.

BackgroundOral case presentation is a crucial skill of physicians and a key componentof team-based care. However, consistent and objective assessment andfeedback on presentations during training are infrequent.ObjectiveTo determine the potential value of applying natural language processing,computer software that extracts meaning from text, to transcripts of oralcase presentations as a strategy to assess their quality automatically andobjectively.MethodsWe transcribed a collection of simulated oral case presentations. Thepresentations were from eight critical care fellows and one critical careattending. They were instructed to review the medical charts of 11 realintensive care unit patient cases and to audio record themselves, presentingeach case as if they were doing so on morning rounds. We then used naturallanguage processing to convert the transcripts from human-readable text intomachine-readable numbers. These numbers represent details of thepresentation style and content. The distance between the numericrepresentation of two different transcripts negatively correlates with thesimilarity of those two transcripts. We ranked fellows on the basis of howsimilar their presentations were to the attending’spresentations.ResultsThe 99 presentations included 260 minutes of audio (mean length:2.6 ± 1.24 min per case). On average,23.88 ± 2.65 sentences were spoken, and each sentencehad 14.10 ± 0.67 words,3.62 ± 0.15 medical concepts, and0.75 ± 0.09 medical adjectives. When ranking fellows onthe basis of how similar their presentations were to the attending’spresentation, we found a gap between the five fellows with the most similarpresentations and the three fellows with the least similar presentations(average group similarity scores of 0.62 ± 0.01 and0.53 ± 0.01, respectively). Rankings were sensitive towhether presentation style or content information were weighted more heavilywhen calculating transcript similarity.ConclusionNatural language processing enabled the ranking of case presentations on thebasis of how similar they were to a reference presentation. Althoughadditional work is needed to convert these rankings, and underlyingsimilarity scores, into actionable feedback for trainees, these methods maysupport new tools for improving medical education.

BackgroundDespite a recent rise in publications describing extracorporeal membrane oxygenation (ECMO) education, the scope and quality of ECMO educational research and curricular assessments have not previously been evaluated.ObjectiveThe purposes of this study are 1) to categorize published ECMO educational scholarship according to Bloom’s educational domains, learner groups, and content delivery methods; 2) to assess ECMO educational scholarship quality; and 3) to identify areas of focus for future curricular development and educational research.MethodsA multidisciplinary research team conducted a scoping review of ECMO literature published between January 2009 and October 2021 using established frameworks. The Medical Education Research Study Quality Instrument (MERSQI) was applied to assess quality.ResultsA total of 1,028 references were retrieved; 36 were selected for review. ECMO education studies frequently targeted the cognitive domain (78%), with 17% of studies targeting the psychomotor domain alone and 33% of studies targeting combinations of the cognitive, psychomotor, and affective domains. Thirty-three studies qualified for MERSQI scoring, with a median score of 11 (interquartile range, 4; possible range, 5–18). Simulation-based training was used in 97%, with 50% of studies targeting physicians and one other discipline.ConclusionECMO education frequently incorporates simulation and spans all domains of Bloom’s taxonomy. Overall, MERSQI scores for ECMO education studies are similar to those for other simulation-based medical education studies. However, developing assessment tools with multisource validity evidence and conducting multienvironment studies would strengthen future work. The creation of a collaborative ECMO educational network would increase standardization and reproducibility in ECMO training, ultimately improving patient outcomes.

BackgroundStructural health inequities and racism adversely affect patient health andthe culture of academic medicine. Formal training to educate fellows andfaculty on antiracism is lacking.ObjectiveOur objective was to design, implement, and assess the feasibility andpreliminary efficacy of a year-long antiracism curriculum within apulmonary, critical care, and sleep medicine division.MethodsThis was a pre- and postintervention observational study conducted betweenJuly 2020 and June 2021. The curriculum was offered during an allottededucational meeting time slot at a single-center pulmonary, critical care,and sleep medicine division at a large academic institution to fellows andfaculty. The curriculum consisted of 13 1-hour virtual interactive workshopsdelivered by local experts in diversity, equity, and inclusion topics.Surveys assessed knowledge on racism in medicine; opinions, understanding,and comfort surrounding race and racism in medicine; as well as additionalquestions to solicit feedback on the curriculum itself via visual analogscale and write-in comments.ResultsBefore initiating the curriculum, 74%(n = 28) of respondents reportedinterest in an antiracism curriculum, and the majority (95%,n = 36) believed thatdiscrimination affects medical staff and patients. Respondents reported onlymoderate comfort in talking about race (median, 58; interquartile range41–70 on visual analog scale 0–100, where 100 is stronglyagree with “I feel comfortable talking about race”). Thepostintervention survey demonstrated stability of the belief of the presenceof racial discrimination and a 15% increase in self-directed learningabout related topics. Although knowledge related to the use of race inmedical algorithms improved, 14% fewer participants reported interestin continuing to engage in a division-wide structured antiracismcurriculum.ConclusionImplementation of a curriculum on justice, equity, diversity, and inclusionwithin a fellowship program is feasible and addresses an unmet need withingraduate medical education.

Medical learners are vital to the care of critically ill patients in the intensive care unit (ICU). Although these learners are exposed to the challenges and stresses of acute ICU management, they do not typically experience the benefits of following ICU patients and families longitudinally after their ICU rotation. Post-ICU clinics and recovery programs may fill this crucial gap in trainee education. These clinics have emerged as an appealing approach to potentially support patient recovery, enhance provider satisfaction, and provide feedback on vital lessons learned in long-term follow-up to improve the quality of ICU care. Notably, the effect of such a program on trainee education has not been explored. In this article, we propose a framework for medical learner participation in post-ICU follow-up based on the Accreditation Council for Graduate Medical Education milestones and discuss the potential benefits, including: education about post-ICU recovery, including post–intensive care syndrome and post–intensive care syndrome–family; experience in quality improvement to enhance ICU care by understanding long-term outcomes; engagement in reflection; and mitigation of compassion fatigue and burnout.