A GLOBAL REMOTE QUALITY IMPROVEMENT INITIATIVE: NEEDS ASSESSMENT FROM INTERPROFESSIONAL CRITICAL CARE PROVIDERS FROM BOSNIA AND HERZEGOVINA

IMPLEMENTATION OF A GLOBAL REMOTE INTERPROFESSIONAL QUALITY IMPROVEMENT INITIATIVE: RESULTS OF A NEEDS ASSESSMENT CONDUCTED FOR A BALKAN LEARNING COLLABORATIVE

FEASIBILITY, DELIVERY, AND IMPLEMENTATION OF A REMOTE CRITICAL CARE TRAINING PROGRAM IN CHINA: THE CERTAIN APPROACH

Entrustable Professional Activities: Reflecting on Where We Are to Define a Path for the Next Decade.

HEART RATE VARIABILITY ON 10-SECOND ECG AND RISK OF ACUTE EXACERBATIONS OF COPD: A SECONDARY ANALYSIS OF BLOCK COPD

FIRST PASS SUCCESS DURING AIRWAY MANAGEMENT BY CRITICAL CARE PHYSICIANS OUTSIDE OF AN ICU

Order entry, entrustable professional activity (EPA) 4, is one of several EPAs that residency program directors identify as a weakness for PGY 1 residents. A multispecialty survey of program directors indicated that only 69% of interns could be trusted to enter and discuss orders and prescriptions without supervision. To address this gap, we developed a formative workshop for fourth-year medical students. Prior to the start of their subinternships, 366 fourth-year medical students engaged in an order entry workshop. Students performed chart reviews on electronic standardized patients within an educational electronic health record (EHR), placed admission orders, customized order sets, responded to safety alerts, utilized decision support tools, and incorporated high-value care considerations. Students used expert-validated rubrics to assess the quality of their admission orders and participated in a facilitated group discussion on key learning points. Finally, students participated in order entry, with all orders requiring cosignature by a supervising physician, during their clinical rotations. Students reported their confidence with order entry before and after the workshop and after the clinical rotation. One hundred seventeen students completed the pre- and postworkshop surveys, and 99 went on to complete the postcourse evaluation. Students showed a statistically significant increase in their confidence level following the workshop. Order entry is a critical, complex skill that requires deliberate instruction. This curriculum, which leverages the features of an educational EHR, can facilitate instruction, practice, and confidence gains regarding order entry prior to further application of these skills in the clinical environment.

Entrustable professional activities (EPAs) are units of concrete daily clinical tasks that trainee physicians should be able to handle with increasing autonomy during their postgraduate training. EPAs are gaining international recognition as an essential component of competency-based medical training programmes. The process of developing EPAs for a nationwide training programme is complex and requires an in-depth understanding of EPAs as a concept and good knowledge of appropriate development processes. This article provides a detailed description of the methodology and results of a multi-step approach for developing a list of candidate EPAs for Switzerland's postgraduate training programme in general internal medicine (GIM). We took a multi-step approach including a systematic review of international literature, four national focus groups, a national consensus process using a RAND appropriateness method, and a quality check of the selected candidate EPAs using EQual criteria. These steps generated a final list of 247 candidate EPAs in general internal medicine that were submitted for the national consensus process. After two rounds of rating, experts agreed on the appropriateness for general internal medicine postgraduate training of 225 candidate EPAs. Twenty-two were deemed inappropriate, and disagreement persisted only for two EPAs. This multi-step programme is one of the few describing in detail the process of developing a list of EPAs and providing evidence of validity at each step. The clinical breadth of our candidate EPAs, together with the detailed description of our methodology, could serve as a useful starting point from which medical education specialists or clinicians could develop or revise applicable lists of EPAs, particularly for postgraduate training programmes in either general internal medicine or family medicine.

IMPACT OF CHANGES IN THE 2019 GINA TREATMENT CLASSIFICATION: ASSESSMENT IN A REAL-WORLD SETTING

OUTCOMES OF ATYPICAL CELLS ON BRONCHOSCOPY FOR MALIGNANCY

RAPID RESPONSE TEAMS (RRTS) IN FIVE US STATES

To develop a set of pediatric neurocritical care (PNCC) entrustable professional activities (EPAs) for pediatric critical care medicine (PCCM). Survey and Delphi methodology in a panel of experts from the Pediatric Neurocritical Care Research Group (PNCRG) and the Education in Pediatric Intensive Care (EPIC) Research Collaborative. Interprofessional local focus group, national focus group, and subsequent national multi-institutional, multidisciplinary expert panel in the United States. The interprofessional local group of 23 members carried out work March 2022 to June 2022 and the national group of 19 members October 2022 to November 2022. Subsequently, 38 physicians from the PNCRG and EPIC networks carried out work December 2022 to August 2024. None. First, a preliminary set of 15 PNCC EPAs was developed by two local and national interprofessional groups. The EPAs were based on the American Board of Pediatrics (ABP) practice analysis for PCCM, the ABP PCCM content outline, and stakeholder opinion. Next, a panel of critical care, neurology, and education experts used Delphi methodology to generate consensus, edit, and finalize the EPAs, with content validity. All EPAs were edited; two were deemed non-essential and not included in the final set of 13 EPAs. The EPAs fit three categories: general management and principles; disease-specific management; and neuroprognostication and end-of-life care. Consensus was reached after three Delphi rounds, with response rates of 31 of 38, 29 of 31, and 29 of 31, respectively. The final set of EPAs was approved by 30 respondents (response rate 30/31), with content validity indices 0.81-1.00. The 2024 set of 13 EPAs are intended to be a valuable framework for competency-based curriculum and assessment to ensure consistent PCCM proficiency in the provision of neurocritical care while also promoting standardization in curriculum development for PCCM fellowship trainees.

Artificial Intelligence (AI) is transforming the delivery of patient-centred healthcare in Canada and around the globe. As the next generation of healthcare providers completes their medical education, it is critical to equip them with both digital literacy and the skills to effectively integrate AI into patient-centered care. In Canada, medical education is guided by the CanMEDS framework, which has recently transitioned to a competency-based medical education (CBME) model. CBME emphasizes outcomes-based learning, focusing on patient-centered care through direct observation and assessment of Entrustable Professional Activities (EPAs). These EPAs are specific, observable, and measurable units of professional practice, underpinned by milestones that track progression and facilitate continuous feedback to learners. The CBME framework is divided into four stages—transition to discipline, foundation, core, and transition to practice—and is structured around seven CanMEDS roles: Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar, and Professional. Despite the growing influence of AI in healthcare, there is a notable absence of AI-specific competencies for critically evaluating AI tools, interpreting AI-generated outputs, and safely and ethically integrating AI into clinical decision-making. To address these gaps, we propose the integration of AI-specific competencies into the CanMEDS framework. This integration should adopt a constructivist approach, leveraging active learning, case-based scenarios, simulations, and real-world experiences to prepare learners for the complexities of AI in clinical practice. These AI-specific competencies can be adapted for undergraduate medical education and tailored to align with the Royal College’s subspecialty groups, including imaging-based, internal medicine, surgery, pediatrics, critical care, obstetrics and gynecology, psychiatry, and other specialized areas. Central to this approach is the incorporation of feedback loops from both learners and instructors to ensure a sustained focus on patient-centered care. While concerns about cognitive load exist with the introduction of AI-specific competencies, AI’s generative capabilities can be harnessed for self-assessment and reflective practice, potentially mitigating this challenge. Through an exploration of global efforts to integrate AI into medical education, we identified gaps within the current CanMEDS framework and evaluated existing EPAs for Royal College subspecialties using Generative AI. Our findings highlight opportunities to embed AI competencies across training stages and milestones. Preliminary results suggest that the optimal strategy for integrating AI into the CanMEDS framework focuses on the core stage of resident training and the role of the Medical Expert. Rather than creating a new role centered on digital literacy and AI, we recommend augmenting the existing CanMEDS framework to incorporate these competencies. By leveraging the flexibility of the CanMEDS framework, we aim to establish AI-specific competencies that are measurable, progressive, and conducive to longitudinal learning and continuous feedback. This integration will prepare the next generation of healthcare providers to use AI safely and effectively in their practice while maintaining a patient-centered focus.

A SERENDIPITOUS DETOUR: DIRECT PERCUTANEOUS EMBOLIZATION OF ECTOPIC VARIX

CONSIDERATIONS FOR SODIUM-GLUCOSE TRANSPORTER 2 INHIBITOR THERAPY RESULTING IN EUGLYCEMIC DIABETIC KETOACIDOSIS

RISPERIDONE-INDUCED MODERATE CENTRAL HYPOTHERMIA