(1077) Critical Care Fellows’ Core Competencies Vary Based on Residency Training: A Cross-Sectional Survey

Monday, February 24, 2025

10:15am – 11:15am Eastern Time

Location: Connections Central - RST 16

First Author(s)

Jordan Feltes, MD (he/him/his)

Washington, District of Columbia, USA

Co-Author(s)

JR

Jeremy Richards, MD

Assistant Professor of Medicine
Massachusetts General Hospital, United States
NS

Nitin Seam, MD

Associate Chief and Fellowship Director of Critical Care
National Institutes of Health, United States
AO

Adam Odolil, N/A

Medical Student
George Washington University, United States
AD

Alisa Dewald, N/A

Medical Student
George Washington University, United States
CA

Crystal Adams, MD

Anesthesiologist and Critical Care Medicine
George Washington University, United States
LL

Lia Losonczy, MD

Associate Professor of Emergency Medicine / Anesthesiology and Critical Care
n/a, United States

Introduction: Emergency Medicine (EM) physicians have been able to become board certified in Critical Care (CC) since 2011. However, there are still no EM-specific CC fellowships, and EM graduates must do a CC fellowship through Internal Medicine (IM), General Surgery (Surg), or Anesthesiology (Anes). These training programs were not designed for EM physicians, who may have different strengths and weaknesses than their colleagues. To date, there have been no studies that identify how knowledge and procedural skills differ between CC fellows from different residency training programs.

Methods: We conducted a cross-sectional survey of Program Directors (PD) and Associate Program Directors (APD) of CC fellowships in the US. We used ACGME-defined core patient-care competencies to identify eleven key areas that may have heterogeneity between incoming fellows. We evaluated how competent the leadership felt the trainees were in each domain as measured on a 5 point Likert scale. We used repeated measures ANOVA with post hoc comparisons to assess for differences between EM and each other specialty.

Results: Surveys were sent to 429 members of CC Fellowship leadership, of which 118 (28%) were completed. 93 (78%) were PDs, 10 (8%) were APDs, and 15 (13%) had other leadership roles. 53 respondents supervised trainees from EM, 82 from IM, 59 from Surgery, and 41 from Anes.

EM physicians were found to have higher baseline performance than other trainees in domains of intubation [3.9 v 1.9 (IM), 2.0 (Surg)], point-of-care ultrasound [3.8 v 2.5 (IM), 2.3 (Surg), 2.8 (Anes)], and neurocritical care [2.7 v 2.1 (IM), 2.3 (Surg)]. EM physicians had lower performance in domains of ventilator management [2.1 v 2.5 (IM), 3.1 (Anes)], palliative care [2.1 v 3.0 (IM), 2.6 (Surg)], and perioperative critical illness [2.4 v 2.0 (IM), 3.6 (Surg), 3.1 (Anes)].

No major differences were identified in domains of sedation/analgesia, critical vasoactive medications, cardiovascular disease, and critical electrolyte abnormalities.

Conclusions: Among incoming trainees to CC Fellowship programs, EM physicians have different skills and knowledge gaps than their colleagues. PDs should consider tailoring their fellowship education to the needs of the individual fellow, with careful consideration to their baseline strengths and weaknesses.