“Who wants me to do what?” varied expectations from key stakeholder groups in the surgical intensive care unit creates a challenging learning environment

Bobel, Matthew C.; Branson, Carolina Fernandez; Chipman, Jeffrey G.; Campbell, Andre R.; Brunsvold, Melissa E.

doi:10.1016/j.amjsurg.2020.12.008

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…To account for a growing patient population in need of specialist intensive care medicine and more invasive treatments regimes as well as improve work-life balance, physicians nowadays commonly work part-time in larger ICU teams [ 27 ], reducing the frequency and duration of collaboration between individual trainees and intensivists. Working in the ICU for a short period under conditions of trainee-intensivist collaboration discontinuity may lead to unclear expectations regarding trainees’ goals and level of supervision needed, unnecessary worries, and frustration among trainees and supervisors [ 28 ]. Indeed, less frequent, and shorter trainee-intensivist collaboration might consequently yield less valid and reliable formative assessments, as discussed further in theme two.…”

Section: Discussionmentioning

confidence: 99%

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Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees

Scholte,

Strehler,

Dill

et al. 2024

BMC Med Educ

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Background Assessing trainees is crucial for development of their competence, yet it remains a challenging endeavour. Identifying contributing and influencing factors affecting this process is imperative for improvement. Methods We surveyed residents, fellows, and intensivists working in an intensive care unit (ICU) at a large non-university hospital in Switzerland to investigate the challenges in assessing ICU trainees. Thematic analysis revealed three major themes. Results Among 45 physicians, 37(82%) responded. The first theme identified is trainee-intensivist collaboration discontinuity. The limited duration of trainees’ ICU rotations, large team size operating in a discordant three-shift system, and busy and unpredictable day-planning hinder sustained collaboration. Potential solutions include a concise pre-collaboration briefing, shared bedside care, and post-collaboration debriefing involving formative assessment and reflection on collaboration. The second theme is the lack of trainees’ progress visualisation, which is caused by unsatisfactory familiarisation with the trainees’ development. The lack of an overview of a trainee’s previous achievements, activities, strengths, weaknesses, and goals may result in inappropriate assessments. Participants suggested implementing digital assessment tools, a competence committee, and dashboards to facilitate progress visualisation. The third theme we identified is insufficient coaching and feedback. Factors like personality traits, hierarchy, and competing interests can impede coaching, while high-quality feedback is essential for correct assessment. Skilled coaches can define short-term goals and may optimise trainee assessment by seeking feedback from multiple supervisors and assisting in both formative and summative assessment. Based on these three themes and the suggested solutions, we developed the acronym “ICU-STAR” representing a potentially powerful framework to enhance short-term trainee-supervisor collaboration in the workplace and to co-scaffold the principles of adequate assessment. Conclusions According to ICU physicians, trainee-supervisor collaboration discontinuity, the lack of visualisation of trainee’s development, and insufficient coaching and feedback skills of supervisors are the major factors hampering trainees’ assessment in the workplace. Based on suggestions by the survey participants, we propose the acronym “ICU-STAR” as a framework including briefing, shared bedside care, and debriefing of the trainee-supervisor collaboration at the workplace as its core components. With the attending intensivists acting as coaches, progress visualisation can be enhanced by actively collecting more data points. Trial registration N/A.

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Section: Discussionmentioning

confidence: 99%

“…Frequent changes to teams with diverse backgrounds may lead to unclear expectations for trainees and intensivists [ 28 ]. Trainees may feel frustrated proving themselves to “new” assessors repeatedly.…”

Section: Discussionmentioning

confidence: 99%

Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees

Scholte,

Strehler,

Dill

et al. 2024

BMC Med Educ

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Weekly flipped classroom modules in intensive care medical training: Feasibility and acceptance

Scholte,

Strehler

2025

Journal of Critical Care

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The Need for an Adult Intensive Care Unit Boot Camp for Residents and Fellows: A Cross-Sectional Survey among Intensive Care Unit Directors

Umei

Nishimura²,

Ichiba

et al. 2022

J Nippon Med Sch

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Background:The concept of "see one, do one, teach one" raises concerns regarding patient safety in the intensive care unit (ICU) and highlights the need for prior preparation of residents/fellows for ICU rotation. This study assessed the need for an adult pre-ICU "boot camp" training course.Methods: An online questionnaire regarding the current ICU training and desirable course framework was distributed via e-mail to the ICU directors of 269 educational centers certified by the Japanese Society of Intensive Care Medicine. Results:The response rate was 39% (106/269). The number of residents/fellows undergoing ICU rotation was 5.5 (IQR 2-12)/ICU/year, and the majority (63%) were second to fourth year post-graduate residents and fellows. ICU directors opined that of the fundamental critical care skills, residents/fellows performed well or very well in only seven out of 29 skills (24%). Only 18% of the ICU directors had an established ICU training curriculum. Overall, 72% of the directors were interested in the boot camp.The desirable course framework was 3-5 hours per day with simulations and lectures. The core skills that directors considered as important to acquire during ICU rotation were central venous catheter insertion, tracheal intubation, defibrillation, initiation of mechanical ventilation, physical examination of critically ill patients, and shock assessment. Conclusions:Residents/fellows began ICU rotations with suboptimal skills as reported by ICU directors. In addition, most of the ICUs had not established a training curriculum. Therefore, having an ICU boot camp is necessary to enhance critical care skills and to decrease medical errors.

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“Who wants me to do what?” varied expectations from key stakeholder groups in the surgical intensive care unit creates a challenging learning environment

Cited by 4 publications

References 27 publications

Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees

Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees

Weekly flipped classroom modules in intensive care medical training: Feasibility and acceptance

The Need for an Adult Intensive Care Unit Boot Camp for Residents and Fellows: A Cross-Sectional Survey among Intensive Care Unit Directors

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