C56-05 Halo Effect: A National Survey of Critical Care Fellow Experiences With High Acuity, Low Occurrence Procedures

Abstract Introduction Developing proficiency with bedside procedures in the intensive care unit (ICU) is a core competency for Critical Care Medicine (CCM) fellows. Learning experiences of fellows with high acuity, low occurrence (HALO) procedures, such as emergent cricothyroidotomy, are variable and not fully understood. The aim of this study is to characterize clinical experiences of CCM fellows learning and performing HALO procedures at the bedside. Methods A survey instrument was developed using a systematic seven-step process inclusive of literature review, pre-testing, and cognitive interviews. The survey asks participants about preparedness, clinical learning experience, and readiness for independence for eight HALO scenarios. The IRB-approved electronic survey was distributed to pulmonary and critical care medicine (PCCM) and CCM fellows at United States training programs using the online survey platform Qualtrics. Invited programs were selected to represent diverse training environments with consideration of program size, geographic region, and training setting (academic versus community). Survey invitations are ongoing and we anticipate 100-150 responses at final study enrollment. Results Preliminary data have been collected from 15 fellows out of the 38 who have received the survey invitation, representing three fellowship programs. The majority (67%) of responses were received from 2nd year fellows and participants reported completion of 8-14 months of fellowship ICU rotations at the time of survey completion. Less than half of fellows have performed gastroesophageal balloon tamponade tube (GEBT; 4 respondents out of 15, 26.7%), emergent cricothyroidotomy (1, 6.7%), pericardiocentesis (1, 6.7%), or transvenous pacer placement (TVP; 1, 6.7%). More than half of fellows had managed life-threatening hemoptysis (11, 73.3%) or performed emergent chest tube placement (12, 80%), synchronized cardioversion (12, 80%), or massive transfusion protocol (MTP; 14, 93.3%) at least once. Few endorsed readiness to independently perform GEBT (2 out of 15, 13.3%), cricothyroidotomy (3, 20%), pericardiocentesis (0), or TVP (0) while more respondents felt confident in their readiness to manage life-threatening hemoptysis (7, 46.7%), place an emergent chest tube (11, 73.3%), perform synchronized cardioversion (12, 80%), or lead MTP (13, 86.7%). Conclusion Despite completion of many ICU rotations, a minority of fellows have clinically encountered many HALO scenarios and feel ready for independent practice. This novel study characterizing the clinical experiences of learners with HALO procedures demonstrates the need for improved educational practice to meet the needs of graduating critical care fellows. This abstract is funded by: None