PS4-03: DESIGN OF AN ENTRUSTABLE PROFESSIONAL ACTIVITY FOR ADULT EXTRACORPOREAL MEMBRANE OXYGENATION
W. Christian Crannell, MD, Karen Brasel, MD, MPH, Bishoy Zakhary, MD, David Zonies, MD, MPH; Oregon Health and Science University

Introduction: Extracorporeal membrane oxygenation (ECMO) utilization has increased to support patients with reversible cardiac or pulmonary physiologic failure. However, robust ECMO education or training models are lacking. A recent survey of critical care program directors reported that only 1/3 feel their graduates are capable to independently manage ECMO patients. Further, only a small fraction of program directors expressed confidence that graduates can independently cannulate (5% for veno-arterial, 12% for veno-venous) patients. Within surgical education, there has been a shift towards competency-based training, recently through entrustable professional activities (EPAs). There is also literature describing EPA design, including the use of a structured interview model. The objective of this study is the creation of an EPA for ECMO using a structured interview design, permitting for competency-based critical care fellow training. The structured-interview component will also contribute to the EPA design literature. 

Methods: Seven structured-interview questions were developed and pilot tested.  In-person interviews of ECMO experts was performed at the annual Extracorporeal Life Support Organization meeting; one phone interview was conducted.  All responses were audio-recorded, transcribed, and validated by the respondents. Using grounded theory with a constant comparison method, the interviews were iteratively coded, facilitated by NVivo-12. Themes were developed and used to construct the EPA then reviewed by the content experts.

Results: Nine subjects were included with a median ECMO experience of 10yrs (3 subjects with > 20yrs). Subjects were from both adult/pediatric and medical/surgical subspecialties, and all had experience with trainees. Themes from the interviews included: patient selection, circuit familiarity and cannulation, medical management, multidisciplinary interactions and communication, problem-based learning and simulation, and entrustment decisions. The EPA was written from the themes and shared with the respondents for further validation.

Conclusions: It is feasible to use a structured interview to query highly-experienced experts to create an EPA for a complex modality such as ECMO. The themes expressed were not unexpected and demonstrate the multiple facets of ECMO provision. The EPA can be utilized by critical-care programs as a scaffolding for competency-based fellow training.