Abstract Rationale Critical care training offers broad procedure exposure, yet opportunities to perform specific, emergent procedures may be limited. These are classified as High Acuity Low Occurrence (HALO) procedures. Despite limited exposure, it is crucial to ensure comfort and competence during training. HALO procedures have been studied across many medical disciplines. Literature review suggests that simulation training is one of the most effective means of teaching. Our goal was to assess the needs of pulmonary-critical care fellows and create a simulation-based curriculum to improve procedural comfort and competency. Methods We identified several procedures relevant to a medical intensive care unit via a literature review of HALO procedures. We then asked faculty, current fellows, and recently graduated fellows to rank these procedures in order of importance. The final procedures chosen were: placement of endobronchial blockers (EBB), Blakemore tubes and surgical chest tubes, along with needle decompression and cricothyroidotomy. Standardized checklists were created and reviewed by a procedural expert. Each step was given a weighted percentage, and certain steps were deemed “critical”. Competency was determined by meeting a minimum of 80% along with performing all critical steps. Prior to each simulation, participants were provided checklists, a didactic session, hands-on procedural instructions with guided practice time, and video demonstration resources. The pilot for the HALO curriculum took place from July 2024 to June 2025 and included 13 pulmonary-critical care fellows. Fellows were assessed on comfort performing the procedure and medical knowledge assessment of pre and post intervention. Results There were 13 pre-procedural responses and 5 post. Overall average comfort improved for all procedures based on the percent of fellows reporting feeling comfortable performing the procedure pre vs post curriculum: cricothyroidotomy increased from 16.6% to 40%, Blakemore Tube placement 33.3% to 60%, EBB 46.2% to 80%, surgical chest tube 16.6% to 40%, and needle decompression 41.7% to 60%.Through mastery learning all participating fellows demonstrated competency in their attended simulations. Conclusion A curriculum via simulation-based, mastery learning with structured checklists, learning aids and pre/post procedural surveys demonstrated an overall improvement in comfort with performing five HALO procedures. We plan to implement the curriculum with minor improvements based on participant feedback for another cohort. With some fellows taking part in the curriculum for both years, this will allow us to assess the impact on comfort over repeated exposures. Further, we will assess if degradation of skills and comfort occurs between each year of curriculum. This abstract is funded by: None
Moseley et al. (Fri,) studied this question.