Pulmonary Medicine Training Research Articles

Best Practices for Remediation in Pulmonary and Critical Care Medicine Fellowship Training

BackgroundRemediation of struggling learners in pulmonary and critical care fellowship programs is a challenge, even for experienced medical educators.ObjectiveThis evidence-based narrative review provides a framework program leaders may use to address fellows having difficulty achieving competency during fellowship training.MethodsThe relevant evidence for approaches on the basis of each learner’s needs is reviewed and interpreted in the context of fellowship training in pulmonary medicine and critical care. Issues addressed include bias in fellow assessments and remediation, the impacts of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the specific challenges of pulmonary and critical care fellowship programs, a brief review of relevant legal issues, guidance on building and leveraging program resources, and a discussion of learner outcomes.ResultsThis results in a concise, evidence-based toolkit for program leaders based around four pillars: early identification, fellow assessment, collaborative intervention, and reassessment. Important concepts also include the need for documentation, clear and written communication, and fellow-directed approaches to the creation of achievable goals.ConclusionEvidence-based remediation helps struggling learners in pulmonary and critical care fellowship to improve their ability to meet Accreditation Council for Graduate Medical Education (ACGME) milestones.

Challenges of Training in Pulmonary Medicine in India

Challenges of Training in Pulmonary Medicine in India

Multi-Disciplinary Obstetrics and Sickle Cell Disease Clinic in Low Resource Setting Lowers Maternal and Perinatal Death Rates to the Same Levels As Those without Sickle Cell Disease

Multi-Disciplinary Obstetrics and Sickle Cell Disease Clinic in Low Resource Setting Lowers Maternal and Perinatal Death Rates to the Same Levels As Those without Sickle Cell Disease

Critical Care Medicine and Infectious Diseases: An Emerging Combined Subspecialty in the United States.

The recent rise in unfilled training positions among infectious diseases (ID) fellowship programs nationwide indicates that ID is declining as a career choice among internal medicine residency graduates. Supplementing ID training with training in critical care medicine (CCM) might be a way to regenerate interest in the specialty. Hands-on patient care and higher salaries are obvious attractions. High infection prevalence and antibiotic resistance in intensive care units, expanding immunosuppressed host populations, and public health crises such as the recent Ebola outbreak underscore the potential synergy of CCM-ID training. Most intensivists receive training in pulmonary medicine and only 1% of current board-certified intensivists are trained in ID. While still small, this cohort of CCM-ID certified physicians has continued to rise over the last 2 decades. ID and CCM program leadership nationwide must recognize these trends and the merits of the CCM-ID combination to facilitate creation of formal dual-training opportunities.

Entrustable professional activities and curricular milestones for fellowship training in pulmonary and critical care medicine: executive summary from the Multi-Society Working Group.

Assessment of graduate medical trainee progress via the accomplishment of competency milestones is an important element of the Next Accreditation System of the Accreditation Council for Graduate Medical Education. This article summarizes the findings of a multisociety working group that was tasked with creating the entrustable professional activities and curricular milestones for fellowship training in pulmonary medicine, critical care medicine, and combined programs. Using the Delphi process, experienced medical educators from the American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine, and Association of Pulmonary and Critical Care Medicine Program Directors reached consensus on the detailed curricular content and expected skill set of graduates of these programs. These are now available to trainees and program directors for the purposes of curriculum design, review, and trainee assessment.

Standards for Education and Credentialing in Critical Care Medicine

HE PROVISION OF INTENSIVE CARE TO PATIENTS IN THE throes of life-threatening acute illness is one of the most important and most expensive parts of US health care. Today, adults in the United States are increasingly likely to receive intensive care unit (ICU) care compared with previous generations, with the greatest ICU resource use occurring among older patients and those at the end of life. 1 Several million individuals are admitted to ICUs in the United States each year at a cost approaching 1% of the nation’s gross domestic product. 2,3 A large body of evidence suggests that the likelihood a patient will survive an episode of critical illness is exquisitely dependent on how the ICU is staffed. 4 In particular, care led by physicianstrainedandcertifiedincriticalcaremedicine(CCM) isstronglyassociatedwithimprovedoddsofsurvival.Inthe rest of the developed world, ICUs are staffed exclusively by physicians trained in CCM. However, in the United States, only a third of patients in the ICU are managed by critical care physicians. 5 There is no coordinated effort to train an expanded workforce of CCM physicians. In the United States, CCM is recognized neither as an independent discipline such as surgery, internal medicine, or anesthesiology, nor as a conjoined subspecialty with uniform education, training, and credentialing. Rather, there are now 6 separate adult intensive care training pathways following residency training in anesthesiology, emergency medicine, internal medicine (either as critical care alone or jointly with training in pulmonary medicine), neurology, and surgery, leading to an array of training programs with separate credentialing criteria. No other medical subspecialty has such an inconsistent approach. Criticalcaremedicineseemstobemovingawayfromuniformstandardsevenasitmaturesasaspecialty.Criticalcare medicine arose in the United States during the 1960s just as ICUs emerged. In the United States, CCM has been regarded as a “niche” specialty in that training is undertaken by a minority of physicians within a primary specialty. 6 In

Workforce needs and training in pulmonary and/or critical care medicine

A consistent feature of discussions of health care reform has been the assertion that there is an oversupply of specialists.' Although there is some data that address the issue of physician workforce,2 there is not universal agreement as to how the information should be interpreted and acted upon.3'4 Given these uncertainties and the need to chart a clear course for training in critical care medicine and in pulmonology that is consistent with the anticipated needs for specialists in these areas, accurate data on which to base projections are essential. Therefore, on January 16 to 17, 1995, the American Thoracic Society, American College of Chest Physicians, Society of Critical Care Medicine, and the Association of Pulmonary/Critical Care Training Program Directors met to discuss future needs for training in pulmonary and critical care medicine. In addition to representatives of each society, the meeting was also attended by representatives of the American Board of Internal Medicine (ABIM), individuals who have performed studies of workforce needs for other subspecialties, and physicians who have conducted prior studies of workforce needs in pulmonary and critical care medicine. The workshop addressed two concerns: (1) workforce needs (numbers of trainees) and (2) quality of training. These two areas have not been addressed for a significant period of time by societies with a specific interest in either pulmonary or critical care medicine. The rapid changes in healthcare delivery and the implications of these changes for training were additional stimuli to hold this meeting. Although each society could develop its own recommendations for training, it was believed that *From the American Thoracic Society (Dr. Hunninghake, president); the American College of Chest Physicians (Dr. Mark, president); the Society of Critical Care Medicine (Dr. Rainey, president); and the Association of Pulmonary/Critical Care Training Program Directors (Dr. Fish, president). This article has also appeared by prior agreement in the official journals of the American Thoracic Society and the Society of Critical Care Medicine and is a joint report on the meeting of the ACCP, ATS, SCCM, and APCCTPD, January 16-17 at ACCP National Headquarters in Northbrook, Illinois, at which issues relating to this article's topic were discussed. these recommendations would not be as effective as recommendations that were endorsed by all societies with an interest in pulmonary and critical care training. The importance of joint recommendations was reinforced in a discussion by Dr. Harry Kimball, president of the ABIM, who also noted that it was the responsibilities of the societies interested in pulmonary and critical care to address these issues. He further noted that recommendations coming from these groups would be very influential in developing policy. It was acknowledged that critical care, as a discipline, is unique compared with other internal medicine areas in that it is practiced by noninternal medicine physicians, eg, surgeons, anesthesiologists, and pediatricians. In addition, although most of the internal medicine physicians who practice critical care are also trained in pulmonary medicine, other internal medicine subspecialists as well as general internists are trained and certified in critical care medicine. Finally, the practice of critical care crosses traditional boundaries, eg, internal medicine-based critical care physicians often work in surgical or mixed medical-surgical ICUs.

Development of a Knowledge Test in the Science of Prevention of Lung Diseases

We developed a 50-item multiple choice test to assess knowledge of preventive pulmonary medicine. We derived the content of test items from a comprehensive preventive pulmonary curriculum, which we developed. The test was administered to 167 medical students, residents, and practicing physicians to establish its psychometric properties and to determine if the test scores discriminated between different levels of training. Using this sample, the reliability of the test was 0.86, and the test significantly differentiated between levels of training in pulmonary medicine. We are using this multiple choice test to assess changes in knowledge of second-year medical students and of fourth-year medical students completing a pulmonary medicine elective rotation.