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Background: Virtual reality (VR) simulators have revolutionized training in bronchoscopy, offering unrestricted availability in a low-stakes learning environment and frequent assessments represented by automatic scoring. The VR assessments can be used to monitor and support learners' progression. How trainees perceive these assessments needs to be clarified., Objective: The objective of this study was to examine what assessments learners select to document and receive feedback on and what influences their decisions., Methods: We used a sequential explanatory mixed methods strategy. All participants were pediatric critical care medicine trainees requiring competency in bronchoscopy skills. During independent simulation practice, we collected the number of learning-focused practice attempts (scores not recorded), assessment-focused practice (scores recorded and reviewed by the instructor for feedback), and the amount of time each attempt lasted. After simulation training, we conducted interviews to explore learners' perceptions of assessment., Results: There was no significant difference in the number of attempts for each practice type. The average time per learning-focused attempt was almost three times longer than the assessment-focused attempt (mean [standard deviation] 16 ± 1 min vs. 6 ± 3 min, respectively; P  < 0.05). Learners perceived documentation of their scores as high stakes and only recorded their better scores. Learners felt safer experimenting if their assessments were not recorded., Conclusion: During independent practice, learners took advantage of automatic assessments generated by the VR simulator to monitor their progression. However, the recording of scores from the simulation program to document learners' trajectory to a set goal was perceived as high stakes, discouraging learners from seeking supervisor feedback., (Copyright © 2024 by the American Thoracic Society.)

Background: Gender disparities in medical education are increasingly demonstrated, including in trainee assessment. Objective: This study aimed to evaluate whether gender differences exist in trainees' evaluation during intensive care unit (ICU) rotations, which has not been previously studied. Methods: We reviewed the in-training evaluation reports (ITERs) for trainees rotating through five academic ICUs at the University of Toronto over a 10-year period (2007-2017). We compared the mean global score for the rotation and the mean score for seven training subdomains between men and women trainees. All scores were reported on a scale of 1 (unsatisfactory) to 5 (outstanding). Results: Over the 10-year period, there were 3,203 ITERS overall, representing 1,207 women and 1,996 men trainees. The mean overall score was lower for women than for men trainees: 4.26 (standard deviation [SD], 0.58) for women and 4.30 (SD, 0.60) for men ( P  = 0.04). This difference was driven by anesthesia trainees, in whom the mean overall score was 4.21 for women and 4.37 for men ( P  < 0.001), with men trainees scoring consistently higher across all seven training subdomains. Within surgical, internal medicine, and critical care residents, there were no differences between men and women in the overall score or the scores across any of the seven subdomains. Across all ITERS, women were less likely than men to receive an overall rating of 5 (outstanding) for the ICU rotation (33% women vs. 37% men; odds ratio, 0.83; 95% confidence interval, 0.71-0.96). Conclusion: Overall, quantitative evaluation scores between women and men trainees in the ICU are relatively similar. Within anesthesia trainees, scores for men were consistently higher across all domains of evaluation, a finding that requires further investigation., (Copyright © 2021 by the American Thoracic Society.)

Point-of-care ultrasound has become an integral aspect of critical care training. The Bedside Assessment by Sonography In Critical Care Medicine Curriculum was established at the University of Toronto to train critical care trainees in basic echocardiography and general critical care ultrasound. During the coronavirus disease (COVID-19) pandemic, our program needed to adapt quickly to ensure staff safety and adherence to infection-control protocols. In this article, we share our experience and reflect on the challenges and benefits of shifting from a primarily in-person teaching model to a hybrid model of remote and in-person teaching. Curricular changes were threefold: the transition to entirely web-based interactive didactic teaching and online imaging interpretation modules, the recruitment of sonographers at multiple academic sites as instructors to facilitate in-person practices with lower instructor to trainee ratio, and the use of a mobile application for informal group case-based discussions. Challenges included lost opportunities for scanning healthy volunteers, variability in attendance at online lectures, and a lower number of study submissions for review. However, curricular changes enabled maintenance of directly observed practice, high levels of engagement with recorded content, and an expansion of our reach to a global audience. We believe that future curricula should combine high-quality online curriculum and resources with the ongoing in-person delivery of key elements of curriculum to allow for direct observation and feedback as well as the maintenance of self-directed point-of-care ultrasound portfolios., (Copyright © 2021 by the American Thoracic Society.)