ATS scholar
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Background: International family-centered critical care guidelines recommend formal, structured communication to ensure that clinical decision making is informed by a shared understanding of diagnosis and prognosis and patient goals and preferences. Tools to facilitate these recommendations are limited. Objective: To examine the feasibility, acceptability, and utility of a standardized serious illness conversation (SIC) to guide communication between nonpalliative care trained providers and surrogates of critically ill, mechanically ventilated patients. ⋯ Conclusion: We found that implementation of a structured communication tool in the intensive care unit was feasible and acceptable to surrogates and providers; yet, fidelity to the timing and completion was modest. The tool appeared to yield valuable information for understanding the goals, fears, and care preferences of mechanically ventilated patients. Steps to increase fidelity, in accordance with family-centered care guidelines, are warranted.
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Background: The diversity in pulmonary and critical care medicine (PCCM) training programs in the United States has not been systematically evaluated, despite emphasis on workforce diversity and its role in improving gender and racial healthcare disparities. Objectives: We analyzed the diversity of the PCCM pipeline by gender, race, and ethnicity over the last 10 years. Methods: The PCCM pipeline was defined as internal medicine residents, fellowship applicants, and fellows in pulmonary-only, critical care medicine-only, and combined PCCM programs. ⋯ The percentage of UIM fellows decreased in PCCM programs over the last decade to 10.3%. In 2018, there was a drop-off from the percentage of UIM residents (13.7%) to the percentage of UIM fellows in all three programs (<12.9% in all three programs). Conclusions: Striking disparities remain in gender, race, and ethnicity in the pipeline of trainees in PCCM programs; these have not improved (for gender) or have even worsened (for race and ethnicity) over the last decade.