Abstract Rationale Critical care physicians work in settings with varying resources. Consequently, they may be the most qualified clinicians to perform rare but life-saving interventions that would be performed by other specialists in higher-resource settings. We surmised that it is important to train PCCM/CCM fellows to perform these high acuity, low occurrence (HALO) procedures. Our objective was to perform an exploratory needs assessment and to evaluate a foundational training session for PCCM/CCM fellows in HALO procedures. Methods We developed a 4-hour workshop incorporating didactic content with low-fidelity task trainer simulation. We identified 5 institutional HALO procedures: bronchial blocker, cricothyrotomy, needle thoracostomy, pericardiocentesis, and Sengstaken-Blakemore tube placement. The session was delivered to 12 first year PCCM/CCM fellows. Prior to the session, participants completed a survey assessing perceived importance of training, prior experience performing HALO procedures, and baseline comfort in three procedural domains (identifying patients who may need the procedures, performing the procedures, and teaching the procedures). A follow-up survey was conducted immediately after the training session to assess change in comfort. Pre- and post-course comfort was compared using the exact McNemar test with some level of comfort, defined as ≥ 4/5 Likert. Results Twelve fellows completed the pre-course survey; ten provided matched pre-post responses. Fellows (n = 12) rated the importance of learning to both perform and teach these procedures as high (median of 5.0). Pre- and post-course matched responses (n = 10) demonstrated improved comfort across all 5 procedures in the 3 domains assessed. The mean proportions of participants reporting some level of comfort across each procedure increased from 26% to 78% for identifying patients, 4% to 70% for procedural performance, and 2% to 70% for procedural teaching. Improvements were consistent across procedures with 9/15 paired tests reaching statistical significance by exact McNemar (p 0.05). Among non-statistically significant items, favorable shifts were still noted. Fellows were unanimously concerned about skill decay following the course. Conclusions This exploratory survey of PCCM/CCM fellows demonstrates a need for simulation training in HALO procedures. Comfort in both performing and teaching HALO procedures can be significantly improved after a single training course. However, there is significant concern among participants of the course about maintaining the skills to perform these procedures in the future due to their inherent infrequency suggesting the need for a longitudinal curriculum. While the number of participants is small, our sample reflects a common PCCM/CCM fellowship program size and includes fellows from a variety of training backgrounds. This abstract is funded by: None
Kulas et al. (Fri,) studied this question.