Description of Clinical Experience
The critical care Fellow will rotate 6-7 months in the surgical intensive care unit, gaining experience in general surgery, orthopedic, trauma, transplant, burn, neurosurgery, urology, gynecology and surgical oncology. The Fellow will also spend 2-3 months in the cardiovascular intensive care service. There will be three elective months.
The Fellows will achieve the following general goals during their one-year residency:
- Successfully supervise daily activities of the junior members of the team.
- Develop and implement daily therapeutic plans for the critical care management of patients under their care in close collaboration with faculty and primary surgical services.
- Successfully design and implement independent clinical research projects or protocols under supervision and direction of the faculty.
- Become proficient at teaching residents and 4th year medical students during daily rounds in the Surgical Critical Care Unit.
- Maintain organization and administration of the critical care teaching conferences.
- Successfully coordinate small group discussions during the 3rd year medical student surgical clerkship dealing with perioperative management, cardiovascular physiology, shock and other areas related to critical care.
- Provide a high level of professionalism, interpersonal communication skills, ethical behavior and sensitivity to a diverse critically ill patient population and their families.
Fundamental Critical Care Knowledge
The Fellows will acquire advanced critical care knowledge and skills during their training, including:
- Cardiorespiratory resuscitation: Physiology, pathophysiology, diagnosis and therapy of disorders of the cardiovascular, respiratory, gastrointestinal, genitourinary, neurologic, endocrine, musculoskeletal, and immune systems as well as infectious diseases.
- Metabolic, nutritional and endocrine effects of critical illness.
- Hematologic and coagulation disorders.
- Critical obstetric and gynecologic disorders.
- Trauma, thermal, electrical and radiation injuries.
- Inhalation and immersion injuries.
- Monitoring and medical instrumentation.
- Critical pediatric surgical conditions.
- Pharmacokinetics and dynamics of drug metabolism and excretion in critical illness.
- Ethical and legal aspects of surgical critical care.
- Principles and techniques of administration and management.
- Biostatistics and experimental design.
Specific Critical Care Skills
The ACC Fellows will acquire and demonstrate competence in the following specific critical care skills during the training, including:
- Respiratory: airway management, including endoscopy and management of respiratory systems.
- Circulatory: invasive and noninvasive monitoring techniques, including transesophageal and precordial cardiac ultrasound and application of transvenous pacemakers; computations of cardiac output, and of systemic and pulmonary vascular resistance; monitoring electrocardiograms and management of cardiac assist devices.
- Neurological: the performance of complete neurological examinations; use of intracranial pressure monitoring techniques and of the electroencephalogram to evaluate cerebral function; application of hypothermia in the management of cerebral trauma.
- Renal: the evaluation of renal function; periotoneal dialysis and hemofiltration; knowledge of the indications and complications of hemodialysis.
- Gastrointestinal: utilization of gastrointestinal intubation and endoscopic techniques in the management of the critically ill patient; application of enteral feedings; management of stomas, fistulas and percutaneous catheter devices.
- Hematologic: application of autotransfusion; assessment of coagulation status; appropriate use of component therapy.
- Infectious disease: classification of infections and application of isolation techniques; pharmacokinetics, drug interactions, and management of antiobiotic therapy during organ failure; nosocomial infections; indications for application of hyperbaric oxygen therapy.
- Nutritional: application of parenteral and enteral nutrition; monitoring and assessing metabolism and nutrition.
- Monitoring/bioengineering: use and calibration of transducers, amplifiers and recorders.
- Miscellaneous: use of special beds for specific injuries, employment of pneumatic antishock garments, traction, and fixation devices.
- Conclusively demonstrate his or her ability to manage critically ill patients on their own in a safe, effective, collaborative manner.