ATS scholar最新文献

Background: The Methods in Epidemiologic, Clinical, and Operations Research (MECOR) program of the American Thoracic Society aims to strengthen research capacity in low- and middle-income countries. Objective: To compare the impact of online versus in-person MECOR level 1 and level 2 courses in Türkiye on program and research project completion rates and to understand student preferences for alternative program delivery. Methods: We enrolled all students who participated in MECOR Türkiye level 1 courses from 2020 to 2023. Through an online questionnaire, we collected information on progress of the research project developed at MECOR levels 1 and 2 and the students' progression through the end of the program. Research project progression (from design to data analysis) and three-level MECOR course completion was compared between the delivery methods, and student preference of online versus in-person courses was evaluated. Results: Sixty-five students attended MECOR course level 1 from 2020 to 2023, among whom 61 responded to the questionnaire. For the level 1 course, there was no statistical difference in completion rates of research projects in online versus in-person courses (P = 0.22). The preference for online teaching was higher (40%) among those who attended the online offering than among those who attended the in-person course (9.8%; P = 0.005). Forty students attended a MECOR level 2 course; numerically more students (87.5%) who attended an in-person course were at a data collection/analysis stage of their research project compared with the online students (56.3%; P = 0.10). At level 2, 12 students (37.5%) who attended online and 4 (50%) who attended in person also completed level 3 (P = 0.56). There was no significant difference between the groups who took level 2 in person versus online in preference of course format (78.1% and 87.5% preferred in-person level 2, respectively; P = 0.86). Conclusion: Completion rates of research projects planned during the course and the overall program completion were not significantly affected by the virtual or in-person nature of the level 1 or level 2 MECOR courses, and the students' preferences for virtual courses vary depending on their own experience.

Background: One of the key communication skills in shared decision-making is assessing a surrogate's understanding of a patient's clinical situation, which can help facilitate surrogate comprehension and encourage surrogates to share their perspectives. There is uncertainty around best practices for assessing surrogate understanding in shared decision-making to guide training in communication skills. Objective: We sought to determine what questions clinicians used to ask surrogates about the patient's current clinical situation and how surrogates responded. Methods: Twenty-seven audio recordings of clinician-surrogate conversations about adult patients who were unable to make their own life-or-death decisions and who being cared for by four clinical teams at two hospitals in the Midwest were qualitatively analyzed using conversation analysis. Ten conversations included clinician questions soliciting surrogate understanding of the patient's situation. Patterns of how surrogates responded to different clinician questions were examined. Results: There were differences in how surrogates responded to various types of clinician solicitations of their understanding. Asking what the surrogates have heard led to a retelling of statements and assessments of the patient's situation. Asking what they know or what has happened led to surrogates responding with a timeline of events. In contrast, asking what is going on or what they understand led to surrogates sharing a more "big-picture" understanding. Conclusion: We found that there were differences in how surrogates responded to different clinician solicitations of their understanding. Real-world implications of different strategies, along with surrogate perspectives of those strategies, should be investigated further to elucidate best practices that can be incorporated into communication skills training.

Continuing professional development (CPD) offerings in pulmonary and critical care medicine, such as grand rounds lectures and online trainings, are traditionally chosen on the basis of physician interest or expert opinion. The current era of rapid growth in medical innovation requires high-value education for clinicians to prevent decay of knowledge and learn new skills, with an eye to addressing performance gaps and improving clinical outcomes, rather than meeting local licensing requirements. Faculty development for CPD on how to explicitly plan and design high-value educational interventions for faculty members and measuring improvements in practice is needed. CPD courses should adhere to principles of effective adult learning, with faculty members taught to incorporate active learning strategies into multimodal, longitudinal educational interventions that are most effective in translating learning into sustained practice. CPD activities should allow time for reflection, practice, and feedback and include practical tips so that attendees can immediately apply learnings in their work setting. Providers of CPD should work with local quality improvement and implementation leaders so that CPD aligns with complex organizational needs and clinical gaps so that offerings are directed at improving clinical care at the local level. We suggest that organizations identify "just one opportunity" to develop such an intervention that addresses a local organizational priority, with buy-in from clinician educator collaborators with leadership sponsors. Organizations should further incentivize such work with local and regional scholarship opportunities that provide academic recognition for the efforts. Creative strategies may be necessary to provide resources for such high-value CPD. Regional interinstitutional learning collaboratives may be helpful in sharing infrastructure, conserving cost, sharing faculty members, and providing space and equipment to develop CPD programs that are of mutual interest to local healthcare systems. Evidence-based guidelines and implementation materials provided by national professional societies can be adapted by local CPD teams to their organizational context. Education researchers involved in these programs could pursue small grants from foundations or government agencies to help defray costs.

Background: Pediatric critical care medicine (PCCM) fellowship structures vary widely among programs and have not been examined since 2006. The development of scholarly knowledge and skills is an important part of fellowship training. However, the optimal PCCM fellowship structure to enable fellows' scholarly productivity is unknown. Objective: We examined PCCM fellowship time structure and resources to better understand their association with scholarly productivity. Methods: This is a secondary analysis of cross-sectional survey data from PCCM fellowship program directors. We defined highly productive programs as those in which greater than 75% of fellows published papers from their scholarly projects in the previous 5 years. Analyses investigated the association of scholarly productivity with dedicated scholarship time and program resources and barriers. Results: Forty-nine of 65 PCCM fellowships (75%) completed the survey. Only 20% of fellowships reported that greater than 75% of fellows published papers from their scholarly projects. Median total scholarly activity time was 16 months (interquartile range, 10-18 mo). The total amount of time devoted to scholarly activity was not associated with highly productive programs. Among resources and barriers, only T32 training grants were associated with highly productive programs. Conclusion: We found no relationship between time allocated to scholarly activity and high scholarly productivity in PCCM fellowships. Hence, programs that wish to increase fellows' scholarly productivity should not rely solely on providing more time for scholarly activity. Aside from T32 training grants, no specific resource or barrier that we evaluated is related to productivity.