B38-21 Defining Educational Priorities For Oncologic Critical Care Education For Pulmonary And Critical Care Medicine Fellows: A Modified Delphi Study

Rationale

Advances in cancer diagnosis and treatment have led to an increasing number of ICU admissions for patients with malignancy, requiring intensivists to have the knowledge and skills to care for these patients. Despite this evolving clinical landscape, oncologic critical care education within Pulmonary and Critical Care Medicine (PCCM) fellowship training remains unstructured, with no consensus on educational priorities or expectations for trainee practice. Thus, we sought to define consensus-based educational priorities in oncologic critical care for PCCM fellowship training and clarify expectations regarding trainee management responsibility.

Methods

We conducted a modified Delphi study between October and December 2025. Expert panelists were purposively recruited based on clinical or educational expertise in PCCM, hematology, oncology, and fellowship education. Using a REDCap-based survey, panelists rated 47 proposed topics across 11 oncologic critical care domains for importance to graduating PCCM fellows without additional sub-specialty training. Topics were rated using a four-point scale, with consensus defined a priori as ≥ 70% Must Know ratings. Open-ended feedback informed addition of a secondary rating scale in Round 2 assessing expected management responsibility (independent management vs. co-management with hematology/oncology). Responses were analyzed descriptively and in aggregate.

Results

Of 58 invited experts, 41 (70%) completed Round 1. All Round 1 respondents were invited to participate in Round 2, of whom 32 (78%) completed the survey. Panelists represented diverse disciplines, geographic regions, and levels of experience. Of the 47 topics presented in Round 1, 33 met consensus criteria. Three non-consensus topics were carried forward based on panelist feedback. Five new topics were introduced in Round 2, three of which achieved consensus. In total, 39 topics were retained across both Delphi rounds. Consensus priorities emphasized core principles of oncologic critical care including, ICU triage, procedural safety, management of infectious, metabolic, neurologic and oncologic emergencies, respiratory failure and therapy-related complications. Management-responsibility ratings further distinguished topics appropriate for independent PCCM management from those requiring co-management with hematology/oncology. Panelists rated core critical care topics, such as, procedural performance, respiratory support selection, early intubation decision-making, and common oncologic emergencies as appropriate for independent management. In contrast, complications related to cancer-directed or immune-based therapies were consistently identified as requiring shared management with hematology and oncology specialists.

Conclusion

This study defines consensus-based educational priorities in oncologic critical care and clarifies expectations for trainee management and interdisciplinary collaboration, providing a practical framework to align PCCM fellowship training with contemporary ICU practice.

This abstract is funded by: None