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John MM, Starks H, Allam JS, Moore J, Frank JA, Bosslet GT, Burkart KM, Çoruh B. Variable Practice, Variable Results: Impact of Postinterview Communication Practices Among Critical Care Medicine/Pulmonary and Critical Care Medicine Fellowship Applicants and Program Directors. Chest 2024; 165:1186-1197. [PMID: 37977268 DOI: 10.1016/j.chest.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Although postinterview communication (PIC) guidelines exist, adherence is voluntary. There are no studies of PIC practices in critical care medicine (CCM) and pulmonary and critical care medicine (PCCM) fellowship recruitment. RESEARCH QUESTION What is the frequency, format, goals, and content of PIC between CCM/PCCM applicants and program directors? What is the impact of PIC on applicant and program rank order lists (ROLs)? STUDY DESIGN AND METHODS CCM/PCCM applicants and program directors were separately surveyed after the 2022-2023 National Resident Matching Program Specialty Match. Surveys included multiple-choice, Likert-scale, and two free text questions. Thematic content analysis of free text responses was performed. RESULTS One-third of eligible participants responded (applicants: n = 373 [34%]; program directors: n = 86 [32%]). Applicant respondents applied to CCM (19%), PCCM (69%), or both (12%). Program directors represented CCM (17%), PCCM (57%), or both (26%) programs. Applicant (66%) and program director (49%) respondents reported initiating PIC. PIC did not impact ROL decision for most applicants (73%) or program directors (83%), though 21% of applicants and 17% of program directors moved programs or applicants up on their ROL in response to PIC. One-quarter (23%) of applicants strongly agreed or agreed that PIC was helpful in creating their ROL, 27% strongly disagreed or disagreed, and 29% were neutral. PIC challenges identified by both groups included time; lack of uniformity; peer pressure; misleading language; and uncertainty about motives, rules, and response protocols. INTERPRETATION PIC is common among CCM/PCCM applicants and program directors. About 50% of applicants and 20% of program directors share ranking intentions via PIC. Although PIC did not impact ROL for most applicants and program directors, a minority of applicants and program directors moved programs up on their ROL after receiving PIC from the other party. Applicants have mixed perspectives on PIC value. Applicants and program directors alike desire clear guidance on PIC to minimize ambiguous and misleading communication.
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Affiliation(s)
- Mira M John
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Helene Starks
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA
| | - J Shirine Allam
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jason Moore
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - James A Frank
- Division of Pulmonary and Critical Care, University of California San Francisco School of Medicine, San Francisco, CA
| | - Gabriel T Bosslet
- Division of Pulmonary, Critical Care, Allergy, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Kristin M Burkart
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving School of Medicine, New York, NY
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA
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Stiller RH, Luks AM, Çoruh B. All That Raises Lactate Is Not Sepsis. ATS Sch 2023; 4:385-386. [PMID: 37795127 PMCID: PMC10547029 DOI: 10.34197/ats-scholar.2023-0032ot] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/11/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Robin H Stiller
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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Holmberg MH, Çoruh B, Sanghavi SF. Bridging the Gap: A Practical Approach to Discussing eGFR and Race with Medical Students. Clin J Am Soc Nephrol 2023; 18:1095-1097. [PMID: 36723344 PMCID: PMC10564359 DOI: 10.2215/cjn.0000000000000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/02/2023]
Affiliation(s)
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Sarah F. Sanghavi
- Division of Nephrology, Department of Medicine, VA Puget Sound Health Care System, Seattle, Washington
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Lee AG, Maley J, Hibbert K, Akgün KM, Hauschildt KE, Law A, Kaminski N, Hayes M, Gesthalter Y, Bosslet GT, Santhosh L, Witkin A, Hills-Dunlap K, Çoruh B, Gershengorn HB, Hardin CC. Medical Societies Must Choose Professional Meeting Locations Responsibly in a Post- Roe World. Ann Am Thorac Soc 2023; 20:781-784. [PMID: 36812378 PMCID: PMC10257035 DOI: 10.1513/annalsats.202211-928ip] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- Alison G. Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason Maley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kathryn Hibbert
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kathleen M. Akgün
- Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Katrina E. Hauschildt
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anica Law
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Naftali Kaminski
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Margaret Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Yaron Gesthalter
- Division of Pulmonary, Critical Care, Allergy and Sleep, University of San Francisco, San Francisco, California
| | - Gabriel T. Bosslet
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lekshmi Santhosh
- Division of Pulmonary, Critical Care, Allergy and Sleep, University of San Francisco, San Francisco, California
| | - Alison Witkin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kelsey Hills-Dunlap
- Pulmonary Sciences and Critical Care, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Hayley B. Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida; and
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - C. Corey Hardin
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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5
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Byrd KM, Jain S, Choudhuri I, Çoruh B, McSparron JI, Viglianti EM. Differences in international medical graduates' letters of recommendation by gender in pulmonary and critical care medicine: a cohort analysis. BMC Med Educ 2023; 23:58. [PMID: 36694194 PMCID: PMC9875522 DOI: 10.1186/s12909-023-04042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/18/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND International Medical Graduates (IMGs) encounter barriers as they seek to match into fellowship programs in the United States (US). This study's objective is to determine if there are differences in letters of recommendation written for IMGs compared to U.S. Medical Graduates (USMGs) applying to pulmonary and critical care medicine (PCCM) fellowship programs. METHODS All applications submitted to a PCCM fellowship program in 2021 were included in this study. The applicant demographics and accomplishments were mined from applications. The gender of letter writers was identified by the author's pronouns on professional websites. Word count and language differences in the letters were analyzed for each applicant using the Linguistic Inquiry and Word Count (LWIC2015) program. Multivariable linear regressions were performed controlling for applicant characteristics to identify if IMG status was associated with total word count and degree of support, measured by a composite outcome encompassing several categories of adjectives, compared to USMG status. RESULTS Of the 573 applications, most of the applicants were USMGs (72%, N = 334/573). When adjusting for applicant characteristics, IMG applicants had shorter letters of recommendation (87.81 total words shorter 95% CI: - 118.61, - 57.00, p-value < 0.01) and less supportive letters (4.79 composite words shorter 95% CI: - 6.61, - 2.97, p-value < 0.01), as compared to USMG applicants. Notably, female IMG applicants had the biggest difference in their word counts compared to USMG applicants when the letter writer was a man. CONCLUSIONS IMG applicants to a PCCM fellowship received shorter and less supportive letters of recommendation compared to USMG applicants.
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Affiliation(s)
- Kaitland M Byrd
- Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, 2800 Plymouth Road, NCRC building 16, Ann Arbor, MI, 48109, USA.
| | - Snigdha Jain
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Irada Choudhuri
- Internal Medicine Resident in the Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Jakob I McSparron
- Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, 2800 Plymouth Road, NCRC building 16, Ann Arbor, MI, 48109, USA
| | - Elizabeth M Viglianti
- Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, 2800 Plymouth Road, NCRC building 16, Ann Arbor, MI, 48109, USA
- Veterans Affairs Center for Clinical Management Research, HSR&D Center for Innovation, Ann Arbor, MI, USA
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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6
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Singer BD, Chotirmall SH, Leither LM, Meldrum OW, Joudi AM, Seam N, Brown SM, Çoruh B. Selected Bibliography of Recent Research in COVID-19. Am J Respir Crit Care Med 2022; 206:1548-1562. [PMID: 35442171 PMCID: PMC9757093 DOI: 10.1164/rccm.202202-0277up] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Benjamin D. Singer
- Department of Medicine, Division of Pulmonary and Critical Care Medicine,,Department of Biochemistry and Molecular Genetics,,Canning Thoracic Institute, and,Simpson Querrey Institute for Epigenetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjay H. Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore;,Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Lindsay M. Leither
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah;,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Oliver W. Meldrum
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Anthony M. Joudi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine,,Canning Thoracic Institute, and
| | - Nitin Seam
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland; and
| | - Samuel M. Brown
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah;,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Başak Çoruh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
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7
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Burns KEA, Moss M, Lorens E, Jose EKA, Martin CM, Viglianti EM, Fox-Robichaud A, Mathews KS, Akgun K, Jain S, Gershengorn H, Mehta S, Han JE, Martin GS, Liebler JM, Stapleton RD, Trachuk P, Vranas KC, Chua A, Herridge MS, Tsang JLY, Biehl M, Burnham EL, Chen JT, Attia EF, Mohamed A, Harkins MS, Soriano SM, Maddux A, West JC, Badke AR, Bagshaw SM, Binnie A, Carlos WG, Çoruh B, Crothers K, D'Aragon F, Denson JL, Drover JW, Eschun G, Geagea A, Griesdale D, Hadler R, Hancock J, Hasmatali J, Kaul B, Kerlin MP, Kohn R, Kutsogiannis DJ, Matson SM, Morris PE, Paunovic B, Peltan ID, Piquette D, Pirzadeh M, Pulchan K, Schnapp LM, Sessler CN, Smith H, Sy E, Thirugnanam S, McDonald RK, McPherson KA, Kraft M, Spiegel M, Dodek PM. Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey. Crit Care Med 2022; 50:1689-1700. [PMID: 36300945 PMCID: PMC9668381 DOI: 10.1097/ccm.0000000000005674] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. DESIGN Cross-sectional survey using four validated instruments. SETTING Sixty-two sites in Canada and the United States. SUBJECTS Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. CONCLUSIONS Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.
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Affiliation(s)
- Karen E A Burns
- Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Marc Moss
- University of Colorado - Anschutz Medical Campus and Children's Hospital of Colorado, Aurora, CO
| | - Edmund Lorens
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Claudio M Martin
- Division of Critical Care, London Health Sciences, London Health Sciences Centre, London, ON, Canada
| | - Elizabeth M Viglianti
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Alison Fox-Robichaud
- Division of Critical Care, McMaster University, Department of Medicine, Hamilton, ON, Canada
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kathleen Akgun
- Section of Pulmonary, Critical Care & Sleep Medicine, VA Connecticut Healthcare System, West Haven, CT
| | - Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Hayley Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Sangeeta Mehta
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Sinai Health, Toronto, ON, Canada
| | - Jenny E Han
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Gregory S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Janice M Liebler
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, Los Angeles, CA
| | - Renee D Stapleton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Polina Trachuk
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, New York University Langone Health, New York, NY
| | - Kelly C Vranas
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, OR
| | | | - Margaret S Herridge
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, ON, Canada
| | | | - Michelle Biehl
- Departments of Critical Care Medicine and Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Ellen L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Jen-Ting Chen
- Harborview Medical Center, University of Washington, Seattle, WA
| | - Engi F Attia
- Division of Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Amira Mohamed
- Division of Pulmonary, Critical Care and Sleep, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY
| | - Michelle S Harkins
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of New Mexico, Albuquerque, NM
| | - Sheryll M Soriano
- OSF Medical Group Pulmonary and Critical Care Division, Order of St Francis (OSF) Healthcare, Peoria, IL
| | - Aline Maddux
- University of Colorado - Anschutz Medical Campus and Children's Hospital of Colorado, Aurora, CO
| | - Julia C West
- Department of Pediatrics, Section of Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Andrew R Badke
- Pulmonary and Critical Care, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexandra Binnie
- Department of Critical Care Medicine at William Osler Health System, William Osler Health System, Toronto, ON, Canada
| | - W Graham Carlos
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Affairs Puget Sound Health Care, Seattle, WA
| | - Frederick D'Aragon
- Department of Anesthesia, University de Sherbrooke, Sherbrooke, QC, Canada
| | - Joshua Lee Denson
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA
| | - John W Drover
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Gregg Eschun
- Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
| | - Anna Geagea
- Division of Critical Care, Department of Medicine, North York General Hospital, Toronto, ON, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia. Vancouver, BC, Canada
| | - Rachel Hadler
- Department of Anesthesia, University of Iowa Hospital and Clinics, Iowa City, IA
| | | | - Jovan Hasmatali
- Department of Critical Care, Health Sciences Centre, Winnipeg, MB, Canada
| | - Bhavika Kaul
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA
| | - Meeta Prasad Kerlin
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Rachel Kohn
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D James Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Scott M Matson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Peter E Morris
- University of Kentucky College of Medicine, Lexington, KY
| | - Bojan Paunovic
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ithan D Peltan
- Division of Pulmonary/Critical Care Medicine, Department of Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mina Pirzadeh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Krishna Pulchan
- Division of Critical Care Medicine, Horizon Health Network, Fredericton, NB, Canada
| | - Lynn M Schnapp
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Curtis N Sessler
- Department of Medicine, Section of Critical Care, Virginia Commonwealth University Health System, Richmond, VA
| | | | - Eric Sy
- Regina General Hospital, Regina, SK, Canada
| | | | | | - Katie A McPherson
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Monica Kraft
- University of Arizona College of Medicine, Tucson, AZ
| | - Michelle Spiegel
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC
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Lobo SM, Creutzfeldt CJ, Maia IS, Town JA, Amorim E, Kross EK, Çoruh B, Patel PV, Jannotta GE, Lewis A, Greer DM, Curtis JR, Sharma M, Wahlster S. Perceptions of Critical Care Shortages, Resource Use, and Provider Well-being During the COVID-19 Pandemic: A Survey of 1,985 Health Care Providers in Brazil. Chest 2022; 161:1526-1542. [PMID: 35150658 PMCID: PMC8828383 DOI: 10.1016/j.chest.2022.01.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Brazil has been disproportionately affected by COVID-19, placing a high burden on ICUs. RESEARCH QUESTION Are perceptions of ICU resource availability associated with end-of-life decisions and burnout among health care providers (HCPs) during COVID-19 surges in Brazil? STUDY DESIGN AND METHODS We electronically administered a survey to multidisciplinary ICU HCPs during two 2-week periods (in June 2020 and March 2021) coinciding with COVID-19 surges. We examined responses across geographical regions and performed multivariate regressions to explore factors associated with reports of: (1) families being allowed less input in decisions about maintaining life-sustaining treatments for patients with COVID-19 and (2) emotional distress and burnout. RESULTS We included 1,985 respondents (57% physicians, 14% nurses, 12% respiratory therapists, 16% other HCPs). More respondents reported shortages during the second surge compared with the first (P < .05 for all comparisons), including lower availability of intensivists (66% vs 42%), ICU nurses (53% vs 36%), ICU beds (68% vs 22%), and ventilators for patients with COVID-19 (80% vs 70%); shortages were highest in the North. One-quarter of HCPs reported that families were allowed less input in decisions about maintaining life-sustaining treatments for patients with COVID-19, which was associated with lack of intensivists (adjusted relative risk [aRR], 1.37; 95% CI, 1.05-1.80) and ICU beds (aRR, 1.71; 95% CI, 1.16-2.62) during the first surge and lack of N95 masks (aRR, 1.43; 95% CI, 1.10-1.85), noninvasive positive pressure ventilation (aRR, 1.56; 95% CI, 1.18-2.07), and oxygen concentrators (aRR, 1.50; 95% CI, 1.13-2.00) during the second surge. Burnout was higher during the second surge (60% vs 71%; P < .001), associated with witnessing colleagues at one's hospital contract COVID-19 during both surges (aRR, 1.55 [95% CI, 1.25-1.93] and 1.31 [95% CI, 1.11-1.55], respectively), as well as worries about finances (aRR, 1.28; 95% CI, 1.02-1.61) and lack of ICU nurses (aRR, 1.25; 95% CI, 1.02-1.53) during the first surge. INTERPRETATION During the COVID-19 pandemic, ICU HCPs in Brazil experienced substantial resource shortages, health care disparities between regions, changes in end-of-life care associated with resource shortages, and high proportions of burnout.
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Affiliation(s)
- Suzana M Lobo
- Intensive Care Department, Hospital de Base, São José do Rio Preto, São Paulo, Brazil; Associação de Medicina Intensiva Brasileira, Florianópolis, Santa Catarina, Brazil
| | - Claire J Creutzfeldt
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA
| | - Israel S Maia
- Department of Intensive Care Medicine, Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil
| | - James A Town
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Edilberto Amorim
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Erin K Kross
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Pratik V Patel
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Gemi E Jannotta
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Ariane Lewis
- Departments of Neurology and Neurosurgery, New York University, New York, NY
| | - David M Greer
- Department of Neurology, Boston University, Boston, MA
| | - J Randall Curtis
- Department of Intensive Care Medicine, Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil; Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA
| | - Sarah Wahlster
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA; Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA.
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Holmberg MH, dela Cruz E, Longino A, Longino N, Çoruh B, Merel SE. Development of a Single-Institution Virtual Internal Medicine Subinternship With Near-Peer Teaching in Response to the COVID-19 Pandemic. Acad Med 2021; 96:1706-1710. [PMID: 34192717 PMCID: PMC8603430 DOI: 10.1097/acm.0000000000004219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PROBLEM In March 2020, medical students at the University of Washington School of Medicine were removed from clinical settings in response to the COVID-19 pandemic. As subinternships are required for graduation and an important way to prepare for internship, a virtual subinternship was created to include practical elements of in-person learning and to address limited teaching faculty from COVID-19 inpatient surges. APPROACH A virtual, interactive subinternship was developed with case-based teaching sessions, communication and critical literature evaluation skill building, professional development, and creation of independent learning plans. Near-peer teachers (NPTs) were selected from graduating senior medical students who matched into internal medicine. In addition to teaching topics from the Clerkship Directors of Internal Medicine curriculum, NPTs engaged in course development, recruited teaching faculty, gathered feedback, and facilitated small groups. Participating students completed pre- and postcourse surveys. OUTCOMES The 10 students (100%) enrolled in the course who completed both surveys indicated significant improvement in mean scores across 4 domains: evaluating medical literature (3.1/5 to 4.5/5; +1.4, P < .001); developing individual learning plans (3.6/5 to 4.7/5; +1.1, P = .001); perceived ability to efficiently evaluate patients with common internal medicine concerns (3.7/5 to 4.6/5; +0.9, P = .004); and formulating initial diagnostic and therapeutic plans (3.6/5 to 4.6/5; +1.0, P < .001). Themes extracted from open-ended responses included initial skepticism of an online format, the course exceeding expectations, and feeling prepared for internship. NEXT STEPS Although a virtual subinternship lacks direct patient care, students reported improvement in all 4 domains studied. Future courses would benefit from greater use of simulation and role-playing scenarios for practical skills. The experience with NPTs was encouraging, aiding in the success of the subinternship. The role of NPTs should be cultivated to fill gaps in content delivery and enhance the development of students as educators.
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Affiliation(s)
- Mackenzie H. Holmberg
- M.H. Holmberg is a resident physician, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Erin dela Cruz
- E. dela Cruz is a resident physician, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - August Longino
- A. Longino is a resident physician, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Natalie Longino
- N. Longino is a resident physician, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Başak Çoruh
- B. Çoruh is associate professor, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Susan E. Merel
- S.E. Merel is associate professor, Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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10
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Çoruh B. Rebuttal From Dr Çoruh. Chest 2021; 160:1189-1190. [PMID: 34625172 DOI: 10.1016/j.chest.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Başak Çoruh
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
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11
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Affiliation(s)
- Başak Çoruh
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
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12
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Garrison GW, Cho JL, Deng JC, Camac E, Oh S, Sundar K, Baptiste JV, Cheng GS, De Cardenas J, Fitzgerald C, Garfield J, Ha NT, Holden VK, O’Corragain O, Patel S, Wayne MT, McSparron JI, Wang T, Çoruh B, Hayes MM, Guzman E, Channick CL. ATS Core Curriculum 2021. Adult Pulmonary Medicine: Thoracic Oncology. ATS Sch 2021; 2:468-483. [PMID: 34667994 PMCID: PMC8518653 DOI: 10.34197/ats-scholar.2021-0032re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine at the annual international conference. The 2021 Pulmonary Core Curriculum focuses on lung cancer and include risks and prevention, screening, nodules, therapeutics and associated pulmonary toxicities, and malignant pleural effusions. Although tobacco smoking remains the primary risk factor for developing lung cancer, exposure to other environmental and occupational substances, including asbestos, radon, and burned biomass, contribute to the global burden of disease. Randomized studies have demonstrated that routine screening of high-risk smokers with low-dose chest computed tomography results in detection at an earlier stage and reduction in lung cancer mortality. On the basis of these trials and other lung cancer risk tools, screening recommendations have been developed. When evaluating lung nodules, clinical and radiographic features are used to estimate the probability of cancer. Management guidelines take into account the nodule size and cancer risk estimates to provide recommendations at evaluation. Newer lung cancer therapies, including immune checkpoint inhibitors and molecular therapies, cause pulmonary toxicity more frequently than conventional chemotherapy. Treatment-related toxicity should be suspected in patients receiving these medications who present with respiratory symptoms. Evaluation is aimed at excluding other etiologies, and treatment is based on the severity of symptoms. Malignant pleural effusions can be debilitating. The diagnosis is made by using simple pleural drainage and/or pleural biopsies. Management depends on the clinical scenario and the patient's preferences and includes the use of serial thoracentesis, a tunneled pleural catheter, or pleurodesis.
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Affiliation(s)
- Garth W. Garrison
- Divison of Pulmonary Disease and Critical Care Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Josalyn L. Cho
- Division of Pulmonary, Critical Care and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Jane C. Deng
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Erin Camac
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Scott Oh
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Krishna Sundar
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Janelle V. Baptiste
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center–Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Guang-Shing Cheng
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Jose De Cardenas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
- Section of Thoracic Surgery, Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Codi Fitzgerald
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Jamie Garfield
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Ngoc-Tram Ha
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; and
| | - Van K. Holden
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; and
| | - Oisin O’Corragain
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sahil Patel
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center–Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Max T. Wayne
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Jakob I. McSparron
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Tisha Wang
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Margaret M. Hayes
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center–Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Colleen L. Channick
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Affiliation(s)
- Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lindsay M Leither
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, Utah.,Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Louisa L Y Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Anthony M Joudi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, Utah.,Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Benjamin D Singer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine.,Department of Biochemistry and Molecular Genetics, and.,Simpson Querrey Institute for Epigenetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Nitin Seam
- Critical Care Medicine Department, NIH, Bethesda, Maryland
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Keller JM, Steinbach TC, Adamson R, Carlbom DJ, Johnson NJ, Clark J, Kritek PA, Çoruh B. ICU Emergencies Simulation Curriculum for Critical Care Fellows: Neurologic Emergencies. MedEdPORTAL 2019; 15:10813. [PMID: 31139732 PMCID: PMC6489375 DOI: 10.15766/mep_2374-8265.10813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The management of neurologic emergencies is an important component of critical care fellowship training. Additional training in neurocritical care has been demonstrated to improve clinical outcomes, though exposure to these emergencies during training can be limited. METHODS Three simulation cases are presented as part of a comprehensive neurologic emergencies curriculum for critical care trainees. The cases represent neurologic catastrophes encountered in the intensive care unit consisting of symptomatic hyponatremia, severe alcohol withdrawal syndrome, and brain herniation syndrome. The case descriptions are complete with learning objectives, critical actions checklists, and debriefing material for facilitators, as well as all necessary personnel briefs and required equipment. RESULTS The scenarios were completed over the course of the 2016-2017 academic year by first-year critical care fellows. Following curriculum implementation, there was an improvement in self-perceived confidence of fellows in neurologic emergency management skills. DISCUSSION The cases were felt to be realistic and beneficial and led to perceived improvement in management of neurologic emergencies and leadership during clinical crises.
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Affiliation(s)
- Jonathan M. Keller
- Fellow, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Trevor C. Steinbach
- Fellow, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Rosemary Adamson
- Assistant Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
- Staff Physician, Pulmonary and Critical Care Medicine, Veterans Affairs Puget Sound Health Care System
| | - David J. Carlbom
- Associate Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Nicholas J. Johnson
- Assistant Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
- Assistant Professor, Department of Emergency Medicine, University of Washington School of Medicine
| | - Jennifer Clark
- Respiratory Therapist, Department of Respiratory Therapy, Harborview Medical Center
| | - Patricia A. Kritek
- Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Başak Çoruh
- Assistant Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
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Keller JM, Steinbach TC, Adamson R, Carlbom DJ, Johnson NJ, Clark J, Kritek PA, Çoruh B. ICU Emergencies Simulation Curriculum for Critical Care Fellows: The Difficult Airway. MedEdPORTAL 2018; 14:10744. [PMID: 30800944 PMCID: PMC6346282 DOI: 10.15766/mep_2374-8265.10744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/26/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Management of airway emergencies is a core skill for critical care fellows. There is no standardized training mechanism for difficult airway management among critical care fellowships, although fellows frequently cite management of airway catastrophes as an area of educational need. METHODS Three simulation cases that are each approximately 15 minutes in length are presented. The cases represent airway emergencies encountered in the intensive care unit consisting of angioedema, endotracheal tube dislodgement, and endotracheal tube occlusion. Incorporated into the scenarios are planned incidents of interpersonal conflict requiring negotiation by the learner during a crisis event. The case descriptions are complete, with learning objectives and critical actions as well as all necessary personnel briefs and required equipment. RESULTS The cases were completed over multiple simulation sessions on different days by 11 first-year critical care fellows during the 2016-2017 academic year. All participants demonstrated improvement in self-perceived confidence in airway management skills. DISCUSSION The cases were felt to be realistic and beneficial and led to perceived improvement in management of airway emergencies and leadership during crisis scenarios.
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Affiliation(s)
- Jonathan M. Keller
- Fellow, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Trevor C. Steinbach
- Fellow, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Rosemary Adamson
- Assistant Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
- Staff Physician, Pulmonary and Critical Care Medicine, Veterans Affairs Puget Sound Health Care System
| | - David J. Carlbom
- Associate Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Nicholas J. Johnson
- Assistant Professor, Department of Emergency Medicine, University of Washington School of Medicine
| | - Jennifer Clark
- Respiratory Therapist, Department of Respiratory Therapy, Harborview Medical Center
| | - Patricia A. Kritek
- Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Başak Çoruh
- Assistant Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
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Cook MR, Badulak J, Çoruh B, Kiraly LN, Zonies D, Cuschieri J, Bulger EM. Fellowship training in extracorporeal life support: Characterization and educational needs assessment. J Crit Care 2018; 46:159-161. [PMID: 29606413 DOI: 10.1016/j.jcrc.2018.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/22/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Adult Extracorporeal Life Support (ECLS) use is rapidly increasing. The structure of fellowship ECLS education is unknown. We sought to define current ECLS education and identify curricular needs. MATERIALS AND METHODS An anonymous survey with Likert, binary and free response questions was sent to Critical Care Program Directors (CCPDs). RESULTS A total of 103 CCPDs responded, a response rate of 31. ECLS training was provided by 64% (66/103) of fellowships. Importantly, 50% (52/103) of CCPDs agreed or strongly agreed that fellows should be competent in ECLS and 70% (72/103) agreed or strongly agreed that ECLS will be an important part of critical care in the next 10years. Only 28% (29/103) and 37% (38/103) of CCPDs agreed or strongly agreed their fellows could independently manage veno-arterial or veno-venous ECLS, respectively. Formal ECLS education was 5h or less in 85% (88/103) of programs. Desired curricular improvements were: simulation 50% (51/103), patient volume 47% (48/103), and didactics 44% (45/103). CONCLUSIONS CCPDs identified ECLS as a critical care skill, but believe that a minority of fellows are prepared for independent practice. Simulation, formal didactics and clinical volume are key needs. These data will guide the development of ECLS curriculum.
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Affiliation(s)
- Mackenzie R Cook
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Jenelle Badulak
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, 1959, NE Pacific St, Seattle, WA 98195, USA
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, 1959, NE Pacific St, Seattle, WA 98195, USA
| | - Laszlo N Kiraly
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - David Zonies
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Joseph Cuschieri
- Division of Trauma, Burn & Critical Care Surgery, 4, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, USA
| | - Eileen M Bulger
- Division of Trauma, Burn & Critical Care Surgery, 4, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, USA
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Michaud GC, Channick CL, Law AC, McCannon JB, Antkowiak M, Garrison G, Sayah D, Huynh RH, Brady AK, Adamson R, DuBrock H, Akuthota P, Marion C, Dela Cruz C, Town JA, Çoruh B, Thomson CC. ATS Core Curriculum 2016. Part IV. Adult Pulmonary Medicine Core Curriculum. Ann Am Thorac Soc 2016; 13:1160-9. [PMID: 27388404 PMCID: PMC6138058 DOI: 10.1513/annalsats.201601-060cme] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/28/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- Gaëtane C Michaud
- 1 Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York
| | - Colleen L Channick
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anica C Law
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica B McCannon
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - MaryEllen Antkowiak
- 3 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Garth Garrison
- 3 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - David Sayah
- 4 Pulmonary and Critical Care Medicine, University of California, Los Angeles, Los Angeles, California
| | - Richard H Huynh
- 4 Pulmonary and Critical Care Medicine, University of California, Los Angeles, Los Angeles, California
| | - Anna K Brady
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Rosemary Adamson
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Hilary DuBrock
- 6 Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Praveen Akuthota
- 6 Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Chad Marion
- 7 Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Charles Dela Cruz
- 7 Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - James A Town
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Başak Çoruh
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Carey C Thomson
- 8 Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
Aspiration of foreign bodies during dental procedures is a rare but potentially serious complication. We present a case of a 75-year-old man who aspirated a dental crown requiring flexible bronchoscopic retrieval. We discuss the risk factors for aspiration, the radiographic features of diagnosis, and the techniques for management and retrieval.
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Affiliation(s)
- Nicholas M Mark
- Division of Pulmonary and Critical Care, University of Washington, Box 356522, Seattle, WA 98195, USA
| | - Juan N Lessing
- Hospital Medicine Section, Department of Medicine, University of Colorado, Mail Stop F782, 12401 E. 17th Avenue, Aurora, CO 80045, USA
| | - Başak Çoruh
- Division of Pulmonary and Critical Care, University of Washington, Box 356522, Seattle, WA 98195, USA
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Çoruh B, Roberson-Wiley G, Wright CH, Kritek PA. A Collaborative Critical Care Preceptorship for APRN Students. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Advanced practice registered nurses (APRNs) increasingly are caring for critically ill patients as a part of interprofessional teams, but new APRNs may have limited critical care exposure in their training. We created a 12-week critical care preceptorship for APRN students as well as a curriculum composed of daily case-based teaching. Student assessment methods included direct observation, pretests and posttests of critical care knowledge, and presurveys and postsurveys of perceptions about critical care skills. The average score on the knowledge pretest was 50% and increased to 74% on the posttest (N = 10). Students reported increased comfort in several aspects of managing critically ill patients after the preceptorship. Descriptive feedback noted that the preceptorship is distinctive, comprehensive, and focused on student education. The evolving intensive care unit will have increasing numbers of APRNs, and a collaborative preceptorship can improve critical care knowledge and perceptions of critical care skills in APRN students.
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Affiliation(s)
- Başak Çoruh
- Başak Çoruh is Assistant Professor, Division of Pulmonary and Critical Care Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA 98195
| | - Gayle Roberson-Wiley
- Gayle Roberson-Wiley is Teaching Associate, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle
| | - Cameron H. Wright
- Cameron H. Wright is Teaching Associate, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle
| | - Patricia A. Kritek
- Patricia A. Kritek is Associate Professor, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle
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Affiliation(s)
- Başak Çoruh
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA.
| | - Mark R Tonelli
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA
| | - David R Park
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA
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Abstract
Fentanyl and other opiates used in procedural sedation and analgesia are associated with several well-known complications. We report the case of a man who developed the uncommon complication of chest wall rigidity and ineffective spontaneous ventilation following the administration of fentanyl during an elective bronchoscopy. His ventilation was assisted and the condition was reversed with naloxone. Although this complication is better described in pediatric patients and with anesthetic doses, chest wall rigidity can occur with analgesic doses of fentanyl and related compounds. Management includes ventilatory support and reversal with either naloxone or a short-acting neuromuscular blocking agent. This reaction does not appear to be a contraindication to future use of fentanyl or related compounds. Chest wall rigidity causing respiratory compromise should be readily recognized and treated by bronchoscopists.
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Affiliation(s)
- Başak Çoruh
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA.
| | - Mark R Tonelli
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA
| | - David R Park
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA
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