A Volunteer Passion: A Qualitative Look at How We Measure and Reward the Work of Medical Educators.

Background  Medical educators face many challenges, including the absence of defined roles, lack of standard career paths, and limited support in systems that generally prioritize research and clinical productivity over educational activities. Providers also teach to widely varying degrees. This study was designed to specifically examine the professional rewards and obstacles experienced by physicians who have dedicated significant energy and career focus to medical education.

CLINICAL REASONING AND ARTIFICIAL INTELLIGENCE: CAN AI REALLY THINK?

Artificial intelligence (AI) in the form of ChatGPT has rapidly attracted attention from physicians and medical educators. While it holds great promise for more routine medical tasks, may broaden one's differential diagnosis, and may be able to assist in the evaluation of images, such as radiographs and electrocardiograms, the technology is largely based on advanced algorithms akin to pattern recognition. One of the key questions raised in concert with these advances is: What does the growth of artificial intelligence mean for medical education, particularly the development of critical thinking and clinical reasoning? In this commentary, we will explore the elements of cognitive theory that underlie the ways in which physicians are taught to reason through a diagnostic case and compare hypothetico-deductive reasoning, often employing illness scripts, with inductive reasoning, which is based on a deeper understanding of mechanisms of health and disease.

Process of Withdrawal of Mechanical Ventilation at End of Life in the ICU: Clinician Perceptions.

Background: Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However, there are few data on which to base best practices for interdisciplinary ICU teams to conduct WMV.

Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement.

This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society (ERS) and the European Society of Intensive Care Medicine (ESICM).

Do we teach critical thinking? A mixed methods study of faculty and student perceptions of teaching and learning critical thinking at three professional schools.

Introduction: Critical thinking (CT) is an essential set of skills and dispositions for professionals. While viewed as an important part of professional education, approaches to teaching and assessing critical thinking have been siloed within disciplines and there are limited data on whether student perceptions of learning align with faculty perceptions of teaching.

Materials And Methods: The authors used a convergent mixed methods approach in required core courses in schools of education, government, and medicine at one university in the Northeast United States.

DYSPNEA AND MECHANICAL VENTILATION: APPLYING PHYSIOLOGY TO GUIDE THERAPY.

While advances in our understanding of mechanical ventilation have improved mortality from acute respiratory distress syndrome, recent studies indicate a rising incidence of post-ventilation mental health sequelae, including post-traumatic stress disorder (PTSD). Concurrent research on the physiology of dyspnea provides insights about the role of multiple sources of sensory information underlying respiratory discomfort along with the contribution of efferent-afferent dissociation to dyspnea, and the subsequent relationship of dyspnea to a range of affective responses, including fear and anxiety. An understanding of the mechanisms of dyspnea may provide holistic approaches to managing acute respiratory failure that can achieve the best physical and emotional outcomes for patients requiring mechanical ventilation.

Evidence Guiding Withdrawal of Mechanical Ventilation at the End of Life: A Review.

Objective: Distress at the end of life in the intensive care unit (ICU) is common. We reviewed the evidence guiding symptom assessment, withdrawal of mechanical ventilation (WMV) process, support for the ICU team, and symptom management among adults, and specifically older adults, at end of life in the ICU.

Setting And Design: Systematic search of published literature (January 1990-December 2021) pertaining to WMV at end of life among adults in the ICU setting using PubMed, Embase, and Web of Science.

Progression of Self-Directed Learning in Health Professions Education: Clarifying Terms and Processes.

As the complexity ofmedical knowledge and clinical practice continues to grow, physicians and physicians-intrainingmust learn to identify gaps in their knowledge and understand and engage in self-directed learning (SDL) in pursuit of academic goals and improved clinical performance. There is a lack of consensus, however, on the precise definition of SDL and how it relates to self-regulated learning (SRL) and co-regulated learning (CRL). We propose a conceptual framework for understanding the progression of a self-directed learner in the health professions and describe the interplay of SRL and CRL.

End-Of-Life Care in the Potential Donor after Circulatory Death: A Systematic Review.

Background: Donation after circulatory death (DCD) is becoming increasingly common, yet little is known about the way potential donors receive end-of-life care.

Purpose: The aims of this systematic review are to describe the current practice in end-of-life care for potential donors and identify metrics that are being used to assess discomfort among these patients.

Research Design And Study Sample: This review encompasses published literature between June 1, 2000 and June 31, 2020 of end-of-life care received by potential DCD patients.

Rating Dyspnea and Pain: "No" is Not Always "Zero".

Nurses routinely assess pain in hospitalized patients; similar assessment of dyspnea is increasing. Most nurses start with a yes-no question when assessing pain or dyspnea; many record "no" as a zero rating, skipping the rating scale. We tested the hypothesis that recording "no" answers as "zero" fails to detect the symptoms that would have been detected with a rating scale.

A multisite randomized trial of implicit versus explicit modeling in clinical teaching.

Purpose: Faculty modeling of desired behaviors has historically been a part of the apprenticeship model of clinical teaching, yet little is known about best practices for modeling. This study compared the educational impact of implicitly versus explicitly modeled communication skills among U.S.

Enhancing Clinical Teaching in Critical Thinking, High-Value Care, and Health Care Equity.

Introduction: Faculty development in the clinical setting is challenging to implement and assess. This study evaluated an intervention (IG) to enhance bedside teaching in three content areas: critical thinking (CT), high-value care (HVC), and health care equity (HCE).

Methods: The Communities of Practice model and Theoretical Domains Framework informed IG development.

The Harvard Medical School Pathways curriculum: A comprehensive curricular evaluation.

Purpose: The Harvard Medical School Pathways curriculum represents a major reform effort. Our goals were to enhance reasoning and clinical skills and improve the learning environment and students' approach to learning via use of collaborative, case-based pedagogy; early clinical exposure; and enhanced approaches to teaching and evaluating clinical skills. We evaluated the impact of Pathways on key outcomes related to these goals.

Optimizing allocation of curricular content across the Undergraduate & Graduate Medical Education Continuum.

Background: Medical educators struggle to incorporate socio-cultural topics into crowded curricula. The "continuum of learning" includes undergraduate and graduate medical education. Utilizing an exemplar socio-cultural topic, we studied the feasibility of achieving expert consensus among two groups of faculty (experts in medical education and experts in social determinants of health) on which aspects of the topic could be taught during undergraduate versus graduate medical education.

Medical Students and the Drive for a Single Right Answer: Teaching Complexity and Uncertainty.

The arrival of Generation Z, the next generation of medical learners, has been accompanied by efforts to adapt teaching practices for this new group of students. Many have identified challenges associated with addressing the needs of modern medical learners. One particular trend we have observed is that medical students are increasingly requesting an "answer key" for all aspects of their medical education.

Six-Month Impairment in Cognition, Mental Health, and Physical Function Following COVID-19-Associated Respiratory Failure.

Unlabelled: To determine the prevalence and extent of impairments impacting health-related quality of life among survivors of COVID-19 who required mechanical ventilation, 6 months after hospital discharge.

Design: Multicenter, prospective cohort study, enrolling adults 18 years old or older with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received mechanical ventilation for 48 hours or more and survived to hospital discharge. Eligible patients were contacted 6 months after discharge for telephone-based interviews from March 2020 to December 2020.

Advanced Integrated Science Courses: Building a Skill Set to Engage With the Interface of Research and Medicine.

Scientific research has been changing medical practice at an increasing pace. To keep up with this change, physicians of the future will need to be lifelong learners with the skills to engage with emerging science and translate it into clinical care. How medical schools can best prepare students for ongoing scientific change remains unclear.

Promoting Critical Thinking in Your Intensive Care Unit Team.

Effective and efficient critical thinking skills are necessary to engage in accurate clinical reasoning and to make appropriate clinical decisions. Teaching and promoting critical thinking skills in the intensive care unit is challenging because of the volume of data and the constant distractions of competing obligations. Understanding and acknowledging cognitive biases and their impact on clinical reasoning are necessary to promote and support critical thinking in the ICU.