Critical Care Rotation PGY-II

Description of Rotation or Educational Experience

The Critical Care experience is conducted in the PGYII year and is comprised of a six-week rotational block with Intensivists in the Washington Regional Medical Center ICU and CCU. Residents acquire longitudinal experience in managing critically ill patients while on the Family Medicine Service in all three years of post-graduate training. Residents are expected to be the primary provider and direct the management of at least 15 critically ill patients during their three years of training.

The Resident is expected to:

• Round with one of the eight intensivists each morning Monday through Friday.
• Attend two ½ days of continuity clinic at the FMC each week.

Goal I: To gain experience in the diagnosis and management of disease processes as well as to gain experience in managing the inpatient management of the critically ill patient.

Goal II: To develop competence in a variety of procedures vital to excellent patient care for the ICU and CCU patient.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems.  Residents are expected to:

Competencies

• Develop the skills necessary for establishing a diagnosis of critical disease processes in the ER, ICU, and CCU.
• Become familiar with the acute care needs of the critically ill patient in the ICU and to become proficient in coordinating such care in the context of a multidisciplinary team.
• Develop skills to assist and support patients and their family members as they cope with a critical illness.
• Learn procedural skills utilized in the management of the critically ill patient.

Objectives

The resident will:

• Perform a comprehensive and thorough history and physical examination of the critically ill patient.
• Learn to interpret a chest radiograph and will become familiar with other imaging modalities of the chest including V/Q lung scans and computed tomography.
• Learn to interpret EKG’s.
• Understand the use of ventilators and other respiratory aide devices (BIPAP, CPAP).
• Appropriately seek consultations for critically ill patients.
• Review and implement drug therapy regimens for critically ill patients.
• Become familiar with therapeutic modalities such as oxygen therapy.
• To develop competence and become proficient at the following procedural skills: intubation, central venous line placement, thoracentesis, and arterial blood gas sampling.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to:

Competencies

• Lumbar puncture
• Thoracentesis
• Central line placement
• Ventilator management
• Management of cardiopulmonary arrest
• Airway management
• Endotracheal intubation
• Conscious sedation
• Pneumonia
• Seizure management
• Administration and interpretation of prognostic indices
• Fluid and electrolyte management
• Cardiac arrythmias management
• COPD
• Adult Respiratory Distress Syndrome
• Pulmonary Embolus
• Respiratory Failure
• Interstitial Lung Disease/ Pulmonary Fibrosis
• Pulmonary Malignancies
• Sepsis
• Nutritional support of the critically ill patient, including TPN
• Interpretation of Arterial Blood Gas Analysis

Objectives

The resident will:

• Distinguish between the various types of pneumonia and to institute the proper treatment regimen.
• Recognize, diagnose, and treat COPD; and will advocate preventive measures with their patients.
• Learn the principles of diagnosing and treating ARDS.
• Learn the measures in preventing PE, and learn the principles of diagnosis and treatment of PE.
• Understand the criteria for respiratory failure and learn the principles of ventilator support.
• Have the opportunity to develop their intubation skills.
• Become familiar with the principles of the diagnosis and treatment of interstitial lung disease.
• Learn to recognize the warning signs of pulmonary malignancy and learn the diagnostic workup of such patients.
• Demonstrate an understanding of the appropriate management of the patient with sepsis including measures to reduce morbidity and mortality from this condition.
• Learn the principles of nutritional support including the various means of enteral and parenteral nutritional support.
• Interpret an arterial blood gas analysis and it’s clinical significance as it applies to patient management.
• Become competent to diagnose and treat “top diseases” common disease that require hospitalization by Family physician.
• Learn limitations when consultant is necessary and how to obtain a consult.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to :

Competencies

• Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
• Locate, appraise and assimilate evidence from scientific studies related to critically ill patients.
• Utilize information technology to optimize learning and quality improvement

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Work in inter-professional teams to enhance patient safety and improve patient care quality.

Objectives

• The resident will learn the different healthcare settings and how to move their patients easily to the best setting for the patient.
• Be cognizant of the financial cost, risks and benefits of various treatments in the critically ill patient.

·         Advocate for quality patient care and assist patients and families dealing with system complexities

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others.

Objectives

The resident will:

·         Gain an understanding of compassion, integrity, and respect in the care of the critically ill patient.

·         Demonstrate a commitment to carrying out his/her professional responsibilities.

·         Demonstrate respect, compassion, integrity and responsiveness to the needs of patients’ families.

·         Demonstrate adherence to ethical principles

·         Show sensitivity and respect to diverse patient populations.

·         Know when to seek consultation from other appropriate specialists to either manage or co-manage a patient for optimal care.

·         Respond to pages and other consultations in a timely manner.

·         Dictate comprehensive history and physical exams in a timely manner.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member of leader of a health care team or other professional group
• Act in a consultative role to other physicians and health professionals
• Maintain comprehensive, timely, and legible medical records

Objectives

The resident will:

• Learn appropriate consultation, timely transfers, and other options of care for acute illness. This will be monitored at daily report and on rounds.
• Demonstrate interpersonal and communication skills that result in effective information exchange with patients, families and colleagues.

Level of Supervision

Intensivists at Washington Regional Medical Center.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Educational Resources

References are available at the AHEC Library:

Critical Care, Joseph M. Civetta

Techniques and Procedures in Critical Care, Robert W. Taylor

Pfenninger JL, Fowler GC. Procedures for Primary care physicians. St. Louis, Mo.: Mosby

On Line Resources:

UpToDate and DynaMed