Residency Program
Curricula Area - Critical Care
1. Location:
Inpatient critical care units within UTMC Knoxville which include:
MICU, SICU, CVICU, CCU, NRU, TICU and the Emergency Department
2. Faculty:
Paul Branca, MD, Critical Care Section Chief
Tina Dudney, MD,
Critical Care Curriculum Coordinator
Kevin Martinolich, MD
Mike McCormack,
MD
Lisa Schriver, MD
James Shamiyeh,
MD
Bruce
Ludwig, MD
4. Schedule:
Days:
Residents should complete work rounds prior to 9 AM . Management rounds will begin with the Attending physician at that time. The resident will be excused from Morning Report and their Ambulatory Care Clinic. A critical care teaching session will be held at 11:15 daily in the MICU Conference Room. Residents will attend Noon Conference when the schedule permits. The workday generally ends at 5 PM when not on call.
Nights:
The resident is typically on call every fourth night from 6 PM until 6AM. When post-call, the resident will leave by 1 PM.
5. Related Conferences/Venues:
6. Primary Goals:
The rotation will provide the resident experience in the management of patients with critical illness. The resident will understand complex multisystem pathophysiology, pharmacology and technology as they relate to critical illness and will have hands-on experience with varied procedures. The resident will participate in management rounds with a multidisciplinary team, and will interact on a daily basis with ancillary staff, patients and their families. The resident will be introduced to complex ethical issues including end of life decisions and advance directives and learn how to counsel patients regarding these matters.
7. Primary Objectives:
PGY-1 residents will be expected to recognize common clinical presentations of critical illness and to initiate treatment. They will be expected to perform common procedures necessary for diagnosis and treatment of critically ill patients. They will have readily available assistance in these endeavors from the upper level resident and the attending staff.
In addition to the above, PGY-2 and 3 residents will be expected to understand more complex presentations of critical illness, be competent in all commonly encountered aspects of critical illness and possess the necessary procedural skills needed for both diagnostic and therapeutic indications.
Please see core competency table for further detail‡.
8. Supplemental References, Suggested Readings :
Rose, BD (Ed); Critical Care Adult Medicine, UpToDate, Wellesley, MA , 2004. Specific topics to be provided at a later date. Available in Preston Medical Library
Grenvik, A, Ayers, S, Holbrook, P, Shoemaker, W. (Editors)
Textbook of Critical Care, 2000. Philadelphia : WB Saunders. (Preston )
Additional reference material is provided for loan during the rotation. These materials must be returned prior to rotation end.
Marino, Paul L. The ICU Book, 2 nd Edition. Lippincott, Williams and Wilkins. ISBN 0-683-05565-8.
Irwin, R, Rippe, J. (Editors)
Irwin & Rippe’s Intensive Care Medicine, 5th Edition. Philadelphia; Lippincott, Williams, and Wilkins. c2003. Also available in Preston Medical Library. RC86.7.15552003
9. Procedures†:
Required:
ACLS certification
Airway management (oral airways, bag/mask use)
Endotracheal intubation
Arterial puncture, line placement
Central venous line placement
Ventilator management
Nasogastric tube placement
Suggested:
Pulmonary artery flotation catheter placement and data interpretation
Thoracentesis
Lumbar puncture
Arthrocentesis
Introductory:
Thoracostomy tube insertion and management
Fiberoptic bronchoscopy and intubation
Pericardiocentesis
Transvenous pacemaker insertion
10. Other Resources
The rotation is multidisciplinary and the resident will have the opportunity to interact with both medical and surgical subspecialists as well as residents from other services. They will also interact with members of the Metabolic Support Team, Pharmacists, Chaplains and Respiratory Therapists in addition to the typical nursing and ancillary staff. Additionally, video materials and anatomic models are available for use during the rotation.
11. Research Opportunities:
Residents frequently encounter patients during the rotation who are suitable for a case report, oral or poster presentation. The faculty is available for mentoring to assist with these efforts. Clinical outcomes research and/or bench research may be available depending on the motivation and interest of the individual resident.
12. Method of Resident Evaluation:
Residents will be evaluated in an ongoing and informal manner throughout the rotation by each attending who supervises them. The Critical Care Teaching Sessions will allow an opportunity for interactive discussion in a small group setting. A portion of the rotation grade will be determined by preparation for these sessions as well as resident participation. Residents will be evaluated using New Innovations electronic forms at the completion of the rotation and the evaluation will be discussed with the resident. Residents will be asked to complete a pre and post written test to assess medical knowledge. The final composite grade will be determined as follows: attending evaluation – 65%, teaching sessions – 10% and Post test score – 25%.
13. Method of Specialty Evaluation:
Residents are asked to provide feedback regarding major concerns at any time to the Section Chief, Curriculum Coordinator or supervising attending. They will complete an evaluation form using New Innovations at the end of the rotation. Cumulative feedback to the attending faculty member will be given by the Departmental Chair.
* See Appendix A - Noon conference schedule
§ See Appendix B - Teaching session schedule
‡ See Appendix C - Competency Table
† Please refer to Procedural Skills Venue Worksheet for further details
|
