Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: Cardiothoracic physiology is central to critical care but is often underemphasized during ICU rounds due to time constraints and competing clinical demands. We hypothesized that a structured, time-efficient framework could enhance the integration of physiology into ICU teaching, improve resident learning, and support bedside decision-making without disrupting workflow.
Methods: We developed the “Three-Breath Framework,” a bedside teaching tool designed to deliver high-yield cardiothoracic physiology education in under two minutes per patient. The framework includes three steps: (1) Identify the dominant physiologic issue, (2) anchor teaching in real-time bedside data, and (3) connect physiology to management decisions. Implementation strategies included prompt cards, case templates, and visual aids. During a two-month pilot in a quaternary CVICU and SICU, residents were educated using the framework. At rotation end, participants completed a survey assessing educational value, clinical relevance, and feasibility.
Results: Thirty ICU residents participated in the pilot and gave overwhelmingly positive feedback, with a 100% response rate. They reported the “Three Breath Framework” improved their understanding of core cardiothoracic concepts beyond standard teaching approaches (median Likert score 5/5), enhanced their ability to apply physiology to bedside decisions (5/5), was concise and well-integrated into ICU rounds (5/5), and should be a standard bedside teaching method (5/5). Qualitative feedback emphasized increased confidence in managing hemodynamic instability and appreciation for a physiology-based teaching approach.
Conclusions: The “Three-Breath Framework” is a concise, feasible strategy for integrating cardiothoracic physiology into ICU rounds. It improves learner engagement, knowledge application, and clinical reasoning while respecting workflow constraints. This approach is scalable and adaptable across different ICU settings and levels of training, offering a practical solution to an enduring educational gap. Future studies will evaluate the impact of the framework on short- and long-term knowledge retention through standardized assessments administered pre- and post-rotation, as well as at 3-month and 6-month follow-up intervals.
