MICU (PGY-2)

Description of Rotation or Educational Experience

This dedicated one-month experience occurs in the MICU/RICU at HFH Main Campus under the direction of the pulmonary and critical care staff. The resident will manage the care of all types of critically ill patients with the assistance of fellows and staff, and will contribute to daily teaching rounds.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Receive training to perform those clinical procedures required for their future practices in the ambulatory and hospital environments.
• Receive training that focuses on the core principles of Family Medicine: including Continuity of Care, Family-Oriented Comprehensive Care Experience, Family Medicine Center Experience, Patient Care Experience, FMC Continuity and Accessibility, Medical/Surgical Experiences, and Inpatient Experiences.

Objectives

By the end of the rotation the resident is expected to be able to:

• Accurately interpret arterial blood gases and manage mechanical ventilators appropriately
• Competently place central venous access lines and arterial lines

The resident is encouraged to familiarize themselves with the following procedures:

• Central venous line insertion
• Arterial line insertion
• Thoracentesis
• Paracentesis
• Lumbar puncture
• Nasogastric tub placement
• Arterial puncture
• Urinary catheter placement
• Arthrocentesis
• Decubitus ulcer debridement

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

• This rotation fulfills family medicine-specific training and educational requirements in Intensive Care.

Objectives

By the end of the rotation the resident is expected to be able to:

• Discuss the philosophy and principles of critical care and the approach to the critically ill patient
• Describe the evaluation and management of shock and resuscitation
• Discuss the evaluation and management of respiratory failure, including chronic obstructive pulmonary disease, adult respiratory distress syndrome, acute exacerbation of asthma, and obstructive sleep apnea
• Discuss the evaluation and management of acute renal failure, including pre-renal, postrenal, and intrinsic renal failure and dialytic/nondialytic therapy
• Discuss the evaluation and management of gastrointestinal failure in the ICU setting, incluing pancreatitis, bowel obstruction, and gastrointestinal hemorrhage
• Discuss the principles of antibiotic therapy in the ICU setting
• Discuss the evaluation and management of sepsis and SIRS, nosocomial pneumonia, intravenous catheter infections, and urinary catheter associated infections
• Discuss the use of critical care monitoring devices including electrocardiogram, pulse oximetry, blood gases, swan ganz catheters and central venous pressure catheters
• Discuss the use of imaging procedures in the intensive care setting
• Discuss nutritional issues in the intensive care unit setting

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

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Set learning and improvement goals

Objectives

By the end of the rotation the resident is expected to be able to:

• Learn to autonomously manage high-risk patients in preparation for family medicine supervisory months in the third year.

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 effectively in various health care delivery settings and systems relevant to their clinical specialty
• Coordinate patient care within the health care system relevant to their clinical specialty

Objectives

By the end of the rotation the resident is expected to be able to:

• Work effectively with respiratory therapists, physical therapists, and ICU nursing staff to provide coordinated care for the patient.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Responsiveness to patient needs that supersedes self-interest
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

By the end of the rotation the resident is expected to be able to:

• Maintain calm demeanor and assist families in crisis.

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

Objectives

By the end of the rotation the resident is expected to be able to:

• Demonstrate an ability to appropriate seek additional aid in the management of patients and communicate patient concerns effectively

Teaching Methods

What teaching methods are you using on this rotation or educational experience?

• Didactic lecture
• Direct role-modeling and observation
• Firsthand experience

Assessment Method (residents)

How do you measure the resident’s performance on this rotation or educational experience?

• Faculty evaluations of the rotator’s performance
• Real-time feedback during direct observation
• Resident is to generate self-observed behavior reports in each competency at least weekly over the course of this rotation.

Assessment Method (Program Evaluation)

How do you evaluate whether this educational experience is effective?

• Resident evaluation of rotation

Level of Supervision

How is the resident supervised on this rotation?

· Directly by attending physicians

Educational Resources

List the educational resources

• Relevant orientation materials are indicated and/or given at the beginning of the rotation and used throughout.

Resources and people residents have identified as useful, and encourage new rotators to become familiar with:

• Make use of critical care website for information
• Acquire Tarscon’s Critical Care Handbook
• Watch NEJOM’s procedure video for placing a central line