Bergl Paul A, Franco Rose M, Patel Jayshil J, Khan Marium, Fletcher Kathlyn E, Nanchal Rahul S
Division of Pulmonary, Critical Care, and Sleep Medicine at the Medical College of Wisconsin, Milwaukee, WI.
Internal Medicine Residency Program, Medical College of Wisconsin, Milwaukee, WI.
Crit Care Explor. 2020 Oct 19;2(10):e0235. doi: 10.1097/CCE.0000000000000235. eCollection 2020 Oct.
During training, fellows serve as teachers and role models for junior colleagues. Fellows-as-teachers curricula may support these roles, but little is known about their effectiveness and durability. We sought to measure the long-term effects on ICU rounds after administering fellows-as-teachers workshops.
Prospective pre-/postintervention observational study of ICU rounds.
Tertiary-care medical ICU with both pulmonary critical care and critical care medicine fellowships.
ICU teaching teams.
Fellows attended immersive workshops on promoting clinical reasoning, managing the learning environment, teaching bedside skills, and developing situational awareness on ICU rounds. After the workshops, faculty physicians were encouraged to have fellows routinely lead afternoon rounds.
We gathered data from direct observations of ICU rounding activities, residents' evaluations of rounds from surveys, and faculty physicians' written comments on fellows' performance in the ICU from end-of-rotation evaluations. Data were analyzed using descriptive statistics, nonparametric comparative tests, and chi-square tests for categorical data. A total of 61 ICU rounding sessions were observed with 501 discrete provider-patient interactions. Survey responses were collected from a total of 53 residents preintervention and 34 residents postintervention. We reviewed 72 open-ended faculty comments on fellows' end-of-rotation evaluations, with 22 occurring postintervention. During the postintervention period, fellows were significantly more likely to make clinical decisions, explain their reasoning, provide teaching points, and ask questions on rounds. Additionally, we observed significantly higher quality written feedback on end-of-rotation evaluations by faculty physicians. However, residents generally harbored neutral or negative perceptions about the educational value of fellow-led rounds postintervention.
Fellows' contributions to patient care and teaching on ICU rounds increased for several months after our fellows-as-teachers workshops. Despite limitations and contamination in our design, our data suggest that similarly designed curricula may promote fellow engagement, possibly at the expense of residents' education.
在培训期间，研究员担任初级同事的教师和榜样。以研究员为教师的课程可能有助于这些角色的发挥，但对其有效性和持久性知之甚少。我们试图通过举办以研究员为教师的研讨会来衡量其对重症监护病房查房的长期影响。
对重症监护病房查房进行前瞻性干预前/干预后观察性研究。
设有肺部重症监护和重症医学研究员培训项目的三级医疗重症监护病房。
重症监护病房教学团队。
研究员参加了关于促进临床推理、管理学习环境、教授床边技能以及在重症监护病房查房时培养情境意识的沉浸式研讨会。研讨会结束后，鼓励指导医师让研究员定期主持下午的查房。
我们收集了重症监护病房查房活动的直接观察数据、住院医师对查房的调查评估以及指导医师在轮转结束评估中对研究员在重症监护病房表现的书面评价。使用描述性统计、非参数比较检验和分类数据的卡方检验对数据进行分析。共观察了61次重症监护病房查房，有501次离散的医护人员与患者互动。干预前共收集了53名住院医师的调查回复，干预后收集了34名住院医师的回复。我们审查了72条指导医师对研究员轮转结束评估的开放式评论，其中22条是干预后出现的。在干预后期间，研究员在查房时做出临床决策、解释推理过程、提供教学要点和提问的可能性显著增加。此外，表示更高质量书面反馈的指导医师在轮转结束评估中的比例显著增加。然而，住院医师对干预后研究员主持查房的教育价值普遍持中立或负面看法。
在我们举办以研究员为教师的研讨会后的几个月里，研究员对重症监护病房患者护理和教学的贡献有所增加。尽管我们的设计存在局限性和干扰因素，但我们的数据表明，类似设计的课程可能会促进研究员的参与度，这可能是以牺牲住院医师的教育为代价的。
