Critical Care Training Programs Research Articles

Combining quality improvement and critical care training: Evaluating an ICU CPR training programme quality improvement initiative at the National Hospital in Tanzania

BackgroundThe United Republic of Tanzania has had a 41.4% mortality rate in the intensive care unit. In Tanzania, the Ministry of Health and Social Welfare has implemented quality improvement (QI),...

Rapid Critical Care Training for Nurses Deployed to Intensive Care Units During the COVID-19 Surge.

During the first COVID-19 pandemic wave, non-intensive care unit (non-ICU) nurses were deployed to temporary ICUs to provide critical care for the patient surge. A rapid critical care training program was designed to prepare them to care for patients in either temporary or permanent ICUs. To evaluate the effectiveness of this training program in preparing non-ICU nurses to provide critical care for COVID-19 patients in temporary ICUs. A survey was used to evaluate the impact of rapid critical care training on nurses' critical care skills and compare the experiences of nurses deployed to temporary versus permanent ICUs. Data were analyzed with χ2 and Spearman ρ tests with α = .05. Compared with nurses in other locations, nurses deployed to temporary ICUs were less likely to report improved capability in managing mechanical ventilation; infusions of sedative, vasoactive, and paralytic agents; and continuous renal replacement therapy. Nurses in temporary ICUs also reported being less prepared to care for critically ill patients (all P < .05). The rapid training program provided basic critical care knowledge for nurses in temporary ICUs, but experiences differed significantly between those deployed to temporary versus permanent ICUs. Although participants believed they provided safe care, nurses with no critical care experience cannot be expected to learn comprehensive critical care from expedited instruction; more formal clinical support is needed for nurses in temporary ICUs. Rapid critical care training can meet emergency needs for nurses capable of providing critical care.

Cased-based education rounds-the eternal heart of an international training program.

Case-based teaching or "Morning Rounds" have been used in medical education for more than a century and remain a cornerstone for teaching in many training programs. Our Pediatric Critical Care Medicine (PCCM) program was established forty years ago and has retained this form of teaching since its inception. Case-based rounds have consistently had the highest evaluation of all curricula in our program. Here we review the history of how these rounds were introduced in medical education, provide data from the learners' evaluation of these case-based rounds, and discuss the strengths and potential drawbacks of this form of teaching from an educational theories perspective with the hope that they can be used by other Pediatric Critical Care training programs.

Evaluating the efficacy of Jahezon's educational program on critical nursing care: A quasi-experimental study

Objective: Competent and trained nurses are essential for critical care preparedness. This study assesses the impact of an educational training program (Jahezon) on the participants' critical care knowledge by comparing their pre- and post-knowledge outcomes.Methods: This study used a quasi-experimental one-group pre-test-post-test design to examine the impact of 40 days of theoretical and practical training on 43 selected nurses from 16 hospitals located in the Hai’l Health cluster, situated in the city of Hai’l, Saudi Arabia. The training program started on November 2021, the curriculum covered a comprehensive range of critical care nursing concepts and was divided into four phases. The instrument used to assess knowledge was a 50-item multiple-choice questionnaire, which was administered as a pre-test, post-test, and a 6-month follow-up test format. The data were analyzed using SPSS v29.0.Results: The mean total scores were the highest in the follow up test (M = 9.87, SD = 2.34), followed by the post-test (M = 7.57, SD = 0.98) and the pre-test (M = 5.91, SD = 1.06), showing a statistically significant difference (F(2, 117) = 64.834, p &lt; .001). From the pre-test to the post-test, 93% of the total scores improved. The only demographic factor that affected the test scores was gender, with female nurses scoring higher.Conclusions: The nurses' knowledge improved significantly after their participation in the critical care training program, but more research is needed to determine their actual performance in caring for critically ill patients during a pandemic.

The Post Coronavirus Disease-19 Pandora-Box: Future Directions for Critical Care in Low and Medium-Income Countries

The novel Coronavirus disease-19, caused by the Severe Acute Respiratory Syndrome-Coronavirus-2 virus posed a worldwide public health emergency and remains a large health burden till date in some continents, causing a significant morbidity and mortality among the critically-ill, not sparing the low and medium-income countries. The critical care surge in most countries exposed the unpreparedness and “struggling” health systems of these countries, including Low and medium-income countries in containing the epidemic. The suddenness of Coronavirus disease in China is suggestive that another “Pathogen X” epidemic may occur. In addition, the increasing global terrorism index may precipitate another epidemic secondary to a bioterrorism contagion. In mitigating this, however, lessons learnt from the management of the critically-ill patients with the Coronavirus disease may assist the low and medium-income countries in charting the future directions of critical care in the event of any Post Coronavirus disease public health challenge. The import of systems approach and collaboration with development partners cannot be over-emphasized, alongside increasing critical care beds and improving oxygen availability and accessibility. Finally, changing the narrative of “struggling” health systems of developing countries by addressing the major debilitating factors, including the issue of critical care workforce and training is needed. The new Essential and Emergency Critical Care training program is proffered. Furthermore, offering skilled healthcare workers adequate remuneration and other incentives to guard against their migration to “greener pastures” may help the low and middle-income countries retain critical care specialists in preparing for any sudden Post-Coronavirus disease public health emergency.

Assessing the Effectiveness Between Nurse Educator and Clinical Coach Critical Care Training Programs for New Graduate Nurses in the ICU

The aim of this study was to assess the differences in effectiveness between nurse educator-led and clinical coach-led intensive care unit (ICU) training programs for new graduate nurses. New graduate ICU nurses require substantial clinical training, which is often provided by peers serving as clinical coaches who have not been formally trained for an educator role. Our medical center successfully transitioned from a nurse educator-led to clinical coach-led model for initial ICU education after formally training the clinical coaches. Nurses enrolled in nurse educator-led (n = 114) or clinical coach-led (n = 166) ICU clinical training programs were compared on program pass rate, satisfaction, preparedness, turnover, and competence. There were no statistically significant differences between the groups on any of the identified measures of program effectiveness. Both educator-led and clinical coach-led models, with appropriate training, effectively prepared ICU nurses in this setting. Implementing a clinical coaching model for ICU training of new graduate nurses could assuage common resource issues, such as a shortage of nurse educators, as well as address the increasing demand for well-trained ICU nurses.

Fifty Years of Critical Care Medicine: The Editors' Perspective.

Fifty Years of Critical Care Medicine: The Editors' Perspective.

Graduates of a Multidisciplinary Critical Care Training Program from 2000 to 2020: Looking at Their First Job.

Little is known regarding the career paths of adult multidisciplinary critical care medicine (CCM) fellowship graduates. The purpose of this study is to describe the demographic profiles and characteristics of the first jobs held by internal medicine-CCM fellowship graduates trained at a freestanding cancer center. An electronic survey was developed via Research Electronic Data Capture that addressed first employment parameters and was sent between May 1, 2019, and December 31, 2021, to 133 CCM fellows who completed CCM fellowship training from 2000 to 2020 at our institution. A total of 93 fellows (70%) responded to the postfellowship job survey; 80(60%) with complete responses were analyzed. Seventy-four percent of respondents were men, 41% were White, 81% were international medical graduates, and 31% were holders of J-1 exchange visitor (n = 8) or H-1B (n = 17) visas. The mean age at completion of CCM fellowship was 36 years. Twenty-seven respondents (34%) completed two years of fellowship training and 53 (66%) completed one year. Internal medicine was the primary residency training before CCM fellowship for 75 respondents (94%) and emergency medicine for 5 (6%). Of those who did one year of fellowship (n = 53), 45 (85%) had already completed two-year fellowships in pulmonary medicine. Thirty-two respondents (40%) completed training from 2000 to 2009 and 48 (60%) from 2010 to 2020. The first employment for the majority (>80%) of graduates was in community teaching hospitals. Of the graduates who spent ⩾50% of time clinically in CCM, 85% rounded in multiple intensive care units (ICU). Compensation sources were from hospitals for 81%, private billing for 15%, and through faculty practice plans for 4% of respondents. At the time of survey completion, 51 respondents (64%) were still at their first jobs; of these, slightly more than half (56%) had graduated from the fellowship program in the past 10 years. The majority of CCM fellowship graduates from our program practiced CCM at community teaching hospitals, rounded in multiple ICUs, and were compensated primarily by the hospital.

Cardiovascular Critical Care Training: A Collaboration between Intensivists and Cardiologists.

With growing patient complexity, the cardiovascular intensive care unit (CICU) of today has evolved substantially from the coronary care unit (CCU) of decades ago. The growing burden of noncardiac critical illness and highly specialized acute cardiovascular disease requires a degree of expertise beyond that afforded through a general cardiology training program. Therefore, the American Heart Association (AHA) has proposed a CICU staffing model to include dedicated cardiac intensivists; in the present day, "dual-trained" physicians are extremely sparse. Guidance on designing critical care fellowships for cardiologists is limited but will require collaboration between cardiologists and medical intensivists. Here, we review the evolution of the CICU, describe training pathways, and offer guidance on creating a cardiology critical care training program.

Evolving Needs of Critical Care Trainees during the COVID-19 Pandemic: A Qualitative Study.

Critical care trainees were integral in the coronavirus disease (COVID-19) pandemic response. Several perspective pieces have provided insight into the pandemic's impact on critical care training. Surveys of program directors and critical care trainees have focused on curricular impact. There is a lack of data from the trainee perspective on curricular enhancements, career development, and emotional and well-being needs to succeed in a critical care career in the ongoing COVID-19 pandemic. Our objective was to elicit perspectives from critical care trainees on their personal and professional needs as they continue to serve in the COVID-19 pandemic. This was a hypothesis-generating qualitative study. Individuals in a U.S. critical care training program during the COVID-19 pandemic participated in either focus groups or semistructured interviews. Interviews were conducted between July 2020 and March 2021 until data saturation was achieved. Audio recordings were professionally transcribed and analyzed using qualitative content analysis. A codebook was generated by two independent coders, with a third investigator reconciling codes when there were discrepancies. Themes and subthemes were identified from these codes. Thirteen participants were interviewed. The major themes identified were as follows: 1) Curricular adaptation is necessary to address evolving changes in trainee needs; 2) COVID-19 impacted career development and highlighted that trainees need individualized help to meet their goals; 3) receiving social support at work from peers and leaders is vital for the sustained well-being of trainees; 4) fostering and maintaining a sense of meaning and humanity in one's work is important; and 5) trainees desire assistance and support to process their emotions and experiences. The needs expressed by critical care trainees are only partially captured in conceptual models of physician well-being. The need for multilevel workplace social networks and identifying meaning in one's work have been magnified in this pandemic. The themes discussing curricular gaps, career development needs, and skills to process work-related trauma are less well captured in preexisting conceptual models and point to areas where further research and intervention development are needed.

Why women say no to leadership positions.

Despite a growing trend of more women entering pediatric critical care training programs, women continue to be underrepresented in leadership positions. A 2019 report on the pediatric critical care workforce revealed that only 32% of division directors are women and 25% of Department of Pediatrics Chairs are women. Women in critical care face systemic barriers to advancement into leadership positions which often lead women to reject leadership positions despite being appropriately matched or even overqualified for the position. The obstacles can appear insurmountable, especially for women of color and mothers of young children. In this article, I share my perspective on strategies to reduce these hurdles by providing guidance on preparing for these roles, embracing and promoting women when opportunities arises and matching recruitment packages to women’s values. If the goal is to recruit and retain more women into the ranks of academic leadership, especially women of color, academia must transform current practices. An approach that aims to fully understand the leader’s motivation is a key first step. Additionally, we need to invest in women earlier in their career, reward often uncompensated work, value women at their home institution, offer salary transparency and recognize the unique challenges of leading while mothering.

Critical Care Pharmacy Program Accreditation Standards Framework and Core Competencies in Saudi Arabia

Clinical pharmacy services in Saudi Arabia are expanding steadily, particularly with notable developments in critical care pharmacy services and training programs, including four critical care residency programs localized in Riyadh and one program in Jeddah. The Scientific Council of Pharmacy leads extensive efforts to advance clinical pharmacy practice and training under the Saudi Commission for Health Specialties (SCFHS), the accrediting body for critical care training programs and all other specialties. Despite launching critical care pharmacy programs in 2013, currently available accreditation standards and competency assessments for specialized residency programs in critical care were established in 2020. These accreditation standards and competency assessment modalities have been found to have significant areas of improvement based on the feedback of practicing critical care pharmacy residency program directors and trainees over the past few years. This is an opinion paper based on a consensus of critical care and emergency medicine pharmacy experts which recommends updating the current accreditation standards framework and competency assessment blueprint for specialized critical care pharmacy programs. Additionally, it highlights the need to modify the accreditation standards framework for critical care pharmacy programs. Further evaluation of these modalities can be revised as deemed reasonable by governmental authorities by recruiting practicing critical care clinical pharmacy experts.

Effect of COVID-19 Specific Critical Care Nursing Program on Knowledge and Skills of Nursing Officers in an Apex Level Hospital of Uttarakhand - A Pre-Post Design

Introduction: COVID-19 was global pandemic during its outbreak and it brought challenges for healthcare workers at every level. The patients were admitted in ICU for critical care and COVID-19 specific nursing care was urge in need. Hence, to keep this background in mind there was specific need of training regarding COVID-19 critical care and the study was conducted on same. Methods: A quantitative research analysis was done on 100 nursing personal who worked in COVID-19 areas. The knowledge was assessed and then training was given followed by reassessment of knowledge and skills. The training included different 12 critical care procedures which were specific to COVID-19 care. Results: The study result showed the significant increase in knowledge from pre-test to post-test 1 and 2. The skill assessment was done for 12 procedures with the OSCE checklist. Nursing officers who performed better in posttest also performed better in OSCE skills assessment. COVID-19 specific critical care training program had a significant impact on knowledge and skills of nursing officers. Conclusion: Evidence based nursing practice on COVID-19 specific critical care training was significantly effective on knowledge and skills of nursing officers. The simulator based training on different critical care procedure helped our nurses for enhancing their knowledge, practice, and skills during patient care

FEASABILTY, UTILITY, AND SAFETY OF CRITICAL CARE TRANSESOPHAGEAL ECHOCARDIOGRAM PERFORMED IN A COMMUNITY HOSPITAL ICU

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: The Intensivist faces the challenging hemodynamics and complex heart-lung interaction in ventilated patients on daily basis. Critical care transesophageal echocardiogram (TEE) serves as another valuable diagnostic tool for the critical care provider when the transthoracic echocardiogram (TTE) fails to solve the hemodynamic dilemma, most likely because of inadequate window. We want to share our experience at a community hospital intensive care unit (ICU). Most importantly we examined the safety and feasibility of the procedure as well. METHODS: We retrospectively reviewed the charts, TEE reports and images of 16 patients in our ICU. We looked at the rationale behind doing a TEE, weather or not there was any clinically relevant finding from the TEE image acquisition and if that changed clinical management. RESULTS: TEE was feasible and safe in all 16 exams. There were no complications. The most common reason for the TEE was complex hemodynamics in the setting of poor TTE views. 4 exams were done to assess resuscitation during cardiac arrest and to identify any reversible or irreversible causes of the arrest. 1 exam was done to guide ECMO cannula insertion under direct visualization. 1 exam was done to examine the effect of a recruitment maneuver on the right ventricle (RV). We observed a clinically relevant finding in 14 exams. Subsequently these results were conveyed to the medical team taking care of the patient. As a result of the TEE report, a medical decision that changed current management by the primary team was done in 13 exams out of all 16. The most common treatment implemented based of the TEE report was the adjustment of the ventilator settings to improve RV function. Other important decisions included shock differentiation in a complex hemodynamic state, starting an inotrope and even changing LUCAS device position during CPR since initially it was observed via the TEE that the compressions were obstructing the left ventricle outlet (LVOT). CONCLUSIONS: In line with previous data, we found that critical care TEE is feasible, clinically useful and most importantly safely done by intensivists who received adequate training in advanced echocardiography. Our study shows that TEE is another valuable tool that intensivists in north America should be familiar with as it is the case in Europe. CLINICAL IMPLICATIONS: Critical Care TEE is a valuble tool that the intensivist can use to solve hemodynamic dilemmas. It is safe and feasible and has an attractive learning curve.We encourage critical care training programs to consider training their fellows in advanced echocardiography. In the Era of visual medicine, advanced critical care echocardiography is knocking on the doors. DISCLOSURES: No relevant relationships by Mohammad Arabiat, source=Web Response No relevant relationships by Karan Singh, source=Web Response

Standardized Training for Physicians Practicing Pediatric Cardiac Critical Care.

In the vast majority of Children's Hospitals, the critically ill patient can be found in one of three locations: the PICU, the neonatal ICU, and the cardiac ICU. Training, certification, and maintenance of certification for neonatology and critical care medicine are over seen by the Accreditation Council for Graduate Medical Education and American Board of Pediatrics. There is no standardization of training or oversight of certification and maintenance of certification for pediatric cardiac critical care. The curricula from the twenty 4th year pediatric cardiac critical care training programs were collated, along with the learning objectives from the Pediatric Cardiac Intensive Care Society published "Curriculum for Pediatric Cardiac Critical Care Medicine." This initiative is endorsed by the Pediatric Cardiac Intensive Care Society as a first step toward Accreditation Council for Graduate Medical Education oversight of training and American Board of Pediatrics oversight of maintenance of certification. A taskforce was established of cardiac intensivists, including the directors of all 4th year pediatric cardiac critical care training programs. Using modified Delphi methodology, learning objectives, rotational requirements, and institutional requirements for providing training were developed. In the current era of increasing specialized care in pediatric cardiac critical care, standardized training for pediatric cardiac critical care is paramount to optimizing outcomes.

A qualitative study of physician perceptions and experiences of caring for critically ill patients in the context of resource strain during the first wave of the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has led to global shortages in the resources required to care for critically ill patients and to protect frontline healthcare providers. This study investigated physicians’ perceptions and experiences of caring for critically ill patients in the context of actual or anticipated resource strain during the COVID-19 pandemic, and explored implications for the healthcare workforce and the delivery of patient care.MethodsWe recruited a diverse sample of critical care physicians from 13 Canadian Universities with adult critical care training programs. We conducted semi-structured telephone interviews between March 25–June 25, 2020 and used qualitative thematic analysis to derive primary themes and subthemes.ResultsFifteen participants (eight female, seven male; median age = 40) from 14 different intensive care units described three overarching themes related to physicians’ perceptions and experiences of caring for critically ill patients during the pandemic: 1) Conditions contributing to resource strain (e.g., continuously evolving pandemic conditions); 2) Implications of resource strain on critical care physicians personally (e.g., safety concerns) and professionally (e.g. practice change); and 3) Enablers of resource sufficiency (e.g., adequate human resources).ConclusionsThe COVID-19 pandemic has required health systems and healthcare providers to continuously adapt to rapidly evolving circumstances. Participants’ uncertainty about whether their unit’s planning and resources would be sufficient to ensure the delivery of high quality patient care throughout the pandemic, coupled with fear and anxiety over personal and familial transmission, indicate the need for a unified systemic pandemic response plan for future infectious disease outbreaks.

Sleep medicine exposure offered by United States residency training programs.

To understand the sleep medicine educational exposure among parent specialties of sleep medicine fellowships, we conducted an online survey among Accreditation Council of Graduate Medical Education-approved training programs. Target respondents were program directors of family medicine, otolaryngology, psychiatry, neurology, pediatrics, and pulmonary and critical care training programs in the United States. The survey was based on the Sleep Education Survey, a peer-reviewed, published survey created by the American Academy of Neurology Sleep Section. The modified 18-question survey was emailed via Survey Monkey per published methods totaling 3 requests approximately 1 week apart in January 2017. A total of 1228 programs were contacted, and 479 responses were received for an overall response rate of 39%. Some programs in every specialty group offered a sleep medicine elective or a required rotation to trainees. Pulmonary and critical care and neurology reported the highest percentages of sleep medicine rotation as an option for housestaff (85.7% and 90.8%, respectively), and pulmonary and critical care had the highest portion of programs indicating a rotation requirement (75.4%). Teaching format was a mixture of didactic lectures, sleep center/laboratory exposure, and case reports, with lectures being the most common format. Didactics averaged 4.75 h/y. Few programs reported trainees subsequently pursuing sleep medicine fellowship (<10% produced a fellow over 5 years), and even fewer reported having a trainee who pursued grant funding for sleep-related research over 5 years. There is wide variability and overall low exposure to sleep medicine education among United States "parent" Accreditation Council of Graduate Medical Education training programs whose medical boards offer sleep medicine certification.

Airway Pressure Release Ventilation setting disagreements. A survey of clinicians

Background: Airway pressure release ventilation has been available to clinicians for the last four decades. Unfortunately, its clinical value continues to be debatable. One of the many reasons responsible is the lack of consistency between its settings in clinical practice and research. We hypothesized that clinicians disagree on specific methods when establishing these parameters. Materials and Methods: A questionnaire-based survey was developed and sent to clinicians (critical care attending physician, critical care fellows in training and respiratory therapists) in about one hundred different academic hospitals with critical care training program. The survey consisted of ten questions including each of the four major APRV settings: T-High, T-Low, P-High, and P-Low. The survey was anonymous. Main results: Amongst the 187 respondents, there were significant disagreements between different categories of clinicians regarding methodology for establishing initial settings of APRV. However, when the responses were analyzed after sub-grouping based on categories of clinicians (Critical care attending physician vs critical care fellows vs respiratory therapists), no significant differences could be found. Conclusions: There is no agreement between different categories of clinicians when it comes to the methodology for establishing initial APRV settings. Our study highlights the need for larger clinical trials comparing different approaches to the same which could then be used for establishing scientific guidelines based on best evidence. Keywords: APRV, survey, T-High, T-Low, P-High, P-Low

Transferencia del aprendizaje de emergencias y cuidado crítico desde la simulación de alta fidelidad a la práctica clínica

IntroductionThe training of medical students has followed a traditional model. However, clinical simulation is increasingly being used in the curriculum. In the Alexander von Humboldt University in Armenia, Colombia, an emergency and critical care training program was designed using an intensive medicine approach based on high fidelity simulation for medical students from the 7th to 10th semester. The objective of this study was to determine the students’ perception of learning and its transfer to current clinical practice. Materials and methodsA descriptive, cross-sectional study was conducted using a structured online Likert-type survey of 42 questions and 5 options, sent to 73 students who participated in the program and were in supervised clinical practice. The participation was voluntary. ResultsA total of 65 students responded (89%). The median age was 22 years (IQR: 21-24), and the majority were women (65.2%). The overall learning agreement was high (98.7%). When grouping by dimensions, an agreement of 90.7% was found with theory-practice integration, 93.7% with similarity in context, and 98.5% with clinical performance. The agreement on transfer of human factors was 82.8%, being higher in students with more experience in simulation (P = .007). ConclusionMedical students who have been trained in emergencies and critical care with simulation perceive more learning and transfer of this to clinical practice. The clinical simulation possibly helps to integrate theory and practice, and accelerates the learning curve and development of technical skills and human factors from the first semesters of exposure.

CRITICAL CARE ULTRASONOGRAPHY USE AT ACADEMIC TRAINING PROGRAMS: A SURVEY OF CRITICAL CARE FELLOWS

SESSION TITLE: PCCM - The Next Generation or Building the Skills of Tomorrow SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Although in widespread use, data regarding the training and practice of critical care fellows in critical care ultrasonography (CCUS) are limited. We hypothesized that significant variation exists in critical care training programs in relation to accessibility to expert faculty, number of dedicated ultrasonography machines for teaching and patient care, methods of instruction, and modes of application. METHODS: An anonymous online survey was sent to program directors (PD) of all ACGME accredited critical care training programs (n = 453). PD were asked to forward the survey to their critical care fellows. The 22-question survey consisted of questions related to training by expert faculty, modalities of ultrasonography used, and methods of instruction. Data was collected over a three-month period. RESULTS: There were 73 respondents, from the critical care fields of pulmonary (n = 31), pediatrics (n = 21), surgery (n = 9), internal medicine (n = 8) and anesthesia (n = 4). The response rate was not calculated as the total number of critical care fellows is not known. The majority of respondents reported having faculty with expertise in CCUS (73%). Methods of learning included mandatory rotation (14%), national course attendance (25%), elective rotation (29%), local course attendance (40%), simulation (53%), lectures (53%), hands-on lectures (67%), and informal bedside teaching (85%). More expert faculty was associated with participation in institutional-based CCUS training and through local, national, or international courses (78%). Although >80% of respondents utilize CCUS for vascular access, lung ultrasonography, and volume responsiveness, While the majority of critical care fellows reported having an ultrasound machine for learning (95%), agree that CCUS is clinically useful (99%) and can result in a change in patient management (80%), < 50% use CCUS daily. Only 13% of respondents were actively engaged in CCUS research, and fewer than 30% are required to submit CCUS studies and interpretations to expert faculty for review. Low response rates in this study make generalization of this data problematic. CONCLUSIONS: Critical care fellows report widespread use of CCUS; however, there exists a disconnect between its use and the allotment of necessary resources and attention to ensure the modality is correctly taught and used. Further research is needed to confirm the generalizability of this study. CLINICAL IMPLICATIONS: The widespread use of CCUS amongst critical care fellows without formal standardization of training has resulted in widespread variation in fellow training and overall practice patterns with varied emphasis on allotment of resources to ensure safe and successful CCUS programs. DISCLOSURES: No relevant relationships by Andrew Berman, source=Web Response No relevant relationships by Sunil Chulani, source=Web Response No relevant relationships by Yonatan Greenstein, source=Web Response No relevant relationships by Keith Guevarra, source=Web Response No relevant relationships by Amee Patrawalla, source=Web Response