LAUSR

BACKGROUND Faculty supervision of invasive bedside procedures (IBPs) in the intensive care unit (ICU) may enhance procedural education and ensure patient safety. However, there is limited research on teaching effectiveness in the ICU and there are no best teaching practices regarding the supervision of IBPs. RESEARCH QUESTION We conducted a multi-institutional qualitative study of pulmonary and critical care medicine (PCCM) faculty and fellows to better understand characteristics of effective IBP teachers. STUDY DESIGN and Methods: Separate focus groups (FGs) were conducted with fellows and faculty at four large academic institutions that were geographically distributed across the U.S. FGs were facilitated by a trained investigator, audio-recorded, and transcribed verbatim for analysis. Themes were identified inductively and compared against constructs from social and situated learning theories. Data was analyzed between and across professional groups. Qualitative research software (NVivo, QSR International) was used to facilitate data organization and create an audit trail of the analysis. A multidisciplinary research team was engaged to minimize interpretive bias. RESULTS Thirty-three faculty and 30 fellows participated. Inductive analysis revealed 3 categories of themes among successful IBP teachers: traits, behaviors, and context. Traits included calm demeanor, trust, procedural competence, and effective communication. Behaviors included leading pre-procedure huddles to assess learners' experiences and define expectations; debriefing to provide feedback; and allowing appropriate autonomy. Context included learning climate, levels of distraction, patient acuity, and institutional culture. INTERPRETATION We identified specific traits and behaviors of effective IBP teachers that intersect with the practice environment, which highlights the challenge of teaching IBPs. Notably, FG participants emphasized interpersonal, more than technical, aspects of successful IBP teachers. These findings should inform future curricula on teaching IBPs in the ICU, standardize IBP teaching for PCCM fellows, and reduce patient injury from procedural complications.