Box 3 Barriers to education and patient care and proposed improvement strategies

Barriers	Proposed improvement strategy
Role ambiguity	Up-front, frequent, and transparent communication
Cognitive disengagement	Clear delineation and demarcation of roles, clear curriculum for all parties
Lack of ICU expertise	Creation of faculty development educational opportunities to cross-pollinate and develop each other
Shared barriers—medical complexity, time pressure challenges, etc.	Faculty acknowledgment of share common patient care and educational barriers
Communication challenges	Avoid placing learners or interprofessional team members “in the middle”—disagreements should be openly discussed in-person, ideally face-to-face, at the attending level
Communication challenges	Formalize more communication between the teams at a senior resident/attending level and efforts should be made to establish joint in-person rounding, or at least a dedicated time period to discuss comanaged patients