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
