Department of medicine

Critical Care Medicine Rotation

Educational Purpose:

Critical Care Medicine encompasses the diagnosis and treatment of a wide range of clinical problems representing the extreme of human disease.  These critically ill patients require coordinated care by a team that usually includes a general internist, sub-specialist, and allied health personnel.  The general internist, at times, provides care and coordination with those trained in critical care medicine.  However in some settings, the internist may be the primary provider of care and serve as a consultant for critically ill patients on surgical services.  Care of these patients requires competency in end-of-life decisions, advance directives, estimating prognosis, and counseling of patients and their families.

Goals and Objectives:

PGY-1-

1.  To gain expertise in the diagnosis and management of critically ill patients in the Medicine Intensive Care Unit setting.

2.  To develop the procedural skills necessary to care for the critically ill patient.

3.  To understand the concepts of mechanical ventilator management.

4.  To learn the interpretation of telemetry, pulse oximetry, and hemodynamic monitoring.

5.  To understand the principles of test ordering and interpretation.

6.  To gain competency in end-of-life decision making and understand advanced directives.

PGY-2&3-

1.  To gain expertise in the diagnosis and management of critically ill patients in the Medicine Intensive Care Unit setting.

2.  To develop the procedural skills necessary to care for the critically ill patient.

3.  To understand the concepts of mechanical ventilator management.

4.  To learn the interpretation of telemetry, pulse oximetry, and hemodynamic monitoring.

5.  To understand the principles of test ordering and interpretation.

6.  To gain competency in end-of-life decision making and understand advanced directives.

7.  Supervise PGY-1 residents and senior medical students in all clinical aspects and procedural activities.

8.  Serve as first call on critically ill patients.

Teaching Methods:

The major teaching method in the MICU is teaching rounds with patient specific education by the MICU attending physician.  Additionally, all MICU admissions are discussed with the Pulmonary/Critical Care fellow at the time of the admission.  The patient’s diagnosis and treatment are discussed at length.  Procedures are directly supervised.  The attending physicians also conduct regular didactic sessions with the MICU team each month.

Mix of Diseases and Pathological Material:

The resident is expected to gain expertise in diagnosing and managing patients with acute respiratory failure, COPD, asthma, ARDS, septic and cardiogenic shock,  abdominal pain, acute chest pain, acute intoxications, acute hepatic failure, acute renal failure, altered mental status of coma; hypotension, life-threatening arrhythmias, massive GI bleeding, massive hemoptysis, respiratory failure, severe hypertension, stroke, meningitis, encephalitis, and status epilepticus.

Patient Characteristics:

Patients are adult as defined by age 17 and older.  The distribution of races reflects that of South Carolina with approximately 68% Caucasian persons, 28% African American persons, and 3.8% Hispanic persons with the remainder being Asian or other.  There is a near equal distribution of male and female persons.  There is on average of one pregnant person every 2 months.

Types of Clinical Encounters:

Patients are evaluated in the Emergency Room, on the general inpatient service, and in the intensive care unit.  Patients are seen in a consultative role to determine their candidacy for intensive care as well as in the role of primary care giver.  They are also direct ACLS resuscitation for the code team as PGY 2 and 3 residents.

Procedures and Services:

Procedural skills that need to be acquired include advanced cardiac life support, arterial puncture, mechanical ventilation, placement of arterial and central venous lines, paracentesis, thoracentesis, use of point of care ultrasound and placement of pulmonary artery catheters.

The resident will be able to interpret hemodynamic monitoring, pulse oximetry, and telemetry.  The trainee needs to know when to order certain tests and have a working knowledge of the meaning of these tests.  These include bronchoscopy, CT of the chest and abdomen, CT and MRI of the brain, coronary angiography, echocardiography, and electoencephalography.

Supervision:

Residents are directly supervised in their patient care duties by the Pulmonary fellow and the Pulmonary attending physician.  The PGY 2 or 3 residents on the service supervise the PGY 1 residents and the senior medical student on service.

Educational Resources to be Used and Reading Lists:

The major resource is an online handbook that includes important articles related to critical care medicine.  These articles have been selected by pulmonary critical care with some input from neurocritical care, and anesthesia critical care.  They are also encouraged to complete a series of modules developed regarding pharmacotherapy in the ICU.  In addition, they are given a link to educational modules developed by the Society of Critical Care Medicine.  Finally, at the beginning of each month they are taken for additional ACLS training in the state of the art simulation center.  Additionally, the resident is expected to search the literature for journal articles regarding specific diagnoses or treatments when indicated.  Other texts include The ICU Book, by Merino, Critical Care Pearls, by Drs. Sahn and Heffner, and Care of the Ventilated Patient.

Method of Evaluation of Resident Competence:

Residents are evaluated by the attending with the assistance of the fellow each month using the standard Departmental Evaluation form for each competency.  Patient Care is assessed based on direct observation and chart review.  Medical Knowledge is assessed through direct questioning on rounds.  Professionalism is assessed based on observation of the resident’s demeanor and behavior in this stressful situation.  Interpersonal and Communication Skills is assessed by observing the resident’s interactions with patients, families, and staff.  Systems-Based Practice is evaluated based on the resident’s ability to function and excel in a critical care team setting.  Practice-Based Learning is evaluated based on the resident’s ability to learn and improve his or her skills based on feedback, study, and literature review.

 
 
 

© Medical University of South Carolina | 171 Ashley Avenue, Charleston, SC 29425