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Clinical Experience

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.

General Responsibilities

The Fellows will achieve the following general goals during their one-year residency:

  1. Successfully supervise daily activities of the junior members of the team.
  2. 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.
  3. Successfully design and implement independent clinical research projects or protocols under supervision and direction of the faculty.
  4. Become proficient at teaching residents and 4th year medical students during daily rounds in the Surgical Critical Care Unit.
  5. Maintain organization and administration of the critical care teaching conferences.
  6. 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.
  7. 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:

  1. 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.
  2. Metabolic, nutritional and endocrine effects of critical illness.
  3. Hematologic and coagulation disorders.
  4. Critical obstetric and gynecologic disorders.
  5. Trauma, thermal, electrical and radiation injuries.
  6. Inhalation and immersion injuries.
  7. Monitoring and medical instrumentation.
  8. Critical pediatric surgical conditions.
  9. Pharmacokinetics and dynamics of drug metabolism and excretion in critical illness.
  10. Ethical and legal aspects of surgical critical care.
  11. Principles and techniques of administration and management.
  12. 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:

  1. Respiratory: airway management, including endoscopy and management of respiratory systems.
  2. 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.
  3. 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.
  4. Renal: the evaluation of renal function; periotoneal dialysis and hemofiltration; knowledge of the indications and complications of hemodialysis.
  5. 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.
  6. Hematologic: application of autotransfusion; assessment of coagulation status; appropriate use of component therapy.
  7. 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.
  8. Nutritional: application of parenteral and enteral nutrition; monitoring and assessing metabolism and nutrition.
  9. Monitoring/bioengineering: use and calibration of transducers, amplifiers and recorders.
  10. Miscellaneous: use of special beds for specific injuries, employment of pneumatic antishock garments, traction, and fixation devices.
  11. Conclusively demonstrate his or her ability to manage critically ill patients on their own in a safe, effective, collaborative manner.

Research Opportunities

  • Purines and pyrimadines (under the leadership of Fievos L. Christofi, PhD).
  • Cardiovascular anesthesiology (Mark A. Gerhardt, MD, PhD).
  • Glucose control and monitoring, and its relation to wound healing; topics in infection control epidemiology (Thomas J. Papadimos, MD, MPH).
  • Neuroscience monitoring and outcomes (Sergio D. Bergese, MD).
  • All Fellows will be required to complete collaborative institutional (CITI) review board training in the first 90 days of the fellowship.