CRITICAL CARE
MEDICINE
The GW critical care unit is a 48-bed mixed Med-Surg ICU which includes the care of patients following trauma, cardiothoracic surgery, neurosurgery and of all the medical and surgical subspecialties managed by two ICU teams.
The critical care fellow, regardless of the program pathway, is involved in the care of all of these patients, and through their training will develop expertise in the management of critically ill patients across these disciplines. The diversified faculty composed of faculty based in Internal Medicine, Surgery, Anesthesiology, Nephrology and Pulmonology as well as strong relationships among subspecialties at GW further creates an environment of collegiality and scholarship.
This fellowship is not for everyone and exposure to a such a large and varied patient population requires fellows strong organizational and prioritization skills along with considerable learning capacity. However, this effort is rewarded with a comprehensive training afforded by a breadth of clinical experience that is nearly unparalleled compared to other critical care programs in the United States.
APPLICATION
FORMS:
Anesthesia Critical Care Fellowship we participate in the SF Match Program www.sfmatch.org
After Match Application Form Link
Surgical
Critical Care Fellowship: Application Form
-For
Internal Medicine Critical Care Fellowship: Applications are submitted via the ERAS system- http://www.aamc.org/audienceeras.htm.
Medicine Critical Care Fellowship |
Anesthesiology Critical Care Fellowship 202-715-4710 |
Fellowship Coordinator |
CRITICAL
CARE CURRICULUM TABLE OF CONTENTS:
I. OVERALL SCOPE and EDUCATIONAL GOALS
III. DURATION OF
TRAINING
B. LIBRARY
D. MEDICAL RECORDS
V. COMPETANCY
BASED GOALS AND OBJECTIVES
VI. TEACHING
METHODS/EDUCATIONAL ACTIVITIES
VII. ASSESSMENT
METHODS
VIII. LINES OF RESPONSIBILITY AND SUPERVISION
IX. READING LIST
I.
OVERALL SCOPE and EDUCATIONAL GOALS: The goals of the George Washington University
Critical Care fellowship program are to provide fellows with the knowledge base
and clinical experience to successfully evaluate and treat medical and surgical
conditions that require admission to the critical care unit. Commonly
encountered conditions include sepsis, acute and chronic respiratory failure,
acute renal failure, hemodynamic instability, overdoses and poisonings, acute
neurologic insults, electrolyte and endocrine emergencies, coagulation
disorders, and post-operative complications. As a mixed medical/surgical unit,
the ICU fellow will also develop expertise in the management of patients with
trauma, neurosurgical emergencies, cardiac, and critical obstetric and
gynecologic disorders. Both the faculty and the
sponsoring institution are fully committed to provide the educational program,
resources, and facilities to meet these goals.
THE GWUMC ICU: Subspecialty training in critical care
medicine (CCM) occurs principally in the ICU. The ICU is capable of providing
acute and long-term life support of patients with multiple organ system
derangements. The ICU at the GWUMC is a multidisciplinary 48-bed mixed
medical/surgical unit, with cardiothoracic, neurosurgical and trauma patients.
PATIENT
POPULATION: The CCM fellows
receive a large range of exposure to clinical problems and stages of disease.
The average daily census is 20. There is one critical care fellow on service
during the day; and one critical care fellow on service at night.
|
Michael
Seneff, M.D.
|
|
Christopher
Junker, M.D.
|
Babak Sarani, MD, FACS, FCCM |
|
|
|
|
Jacqueline Honig, M.D.
|
|
Danielle
Davison, M.D.
|
|
Bruce Abell, M.D. Assistant Professor of Surgery |
|
Lynn
Abell, M.D.
Assistant Professor of Anesthesiology Critical Care Medicine and
Surgery
|
|
Seth Akst, M.D.
|
|
|
|
Jeffrey WIlliams, MD
|
|
Jalil Ahari, M.D.
Assistant
Professor of Medicine, Pulmonary and Critical Care Medicine
|
The National Library of Medicine, at the NIH, is
easily accessible from our campus by Metro.
Space for research is available in the
Anesthesiology laboratory located in the
D.
MEDICAL RECORDS:
GWUH has an electronic
medical record system that is password protected. Fellows and residents have
access to complete medical records 24 hours a day/ 365 days/year.
V.
EDUCATIONAL GOALS/OBJECTIVES: The fellows are required
to achieve the following goals and objectives based on the six core
competencies. Core competencies include Patient Care, Medical Knowledge,
Practice Based Learning and Improvement, Interpersonal and Communication
Skills, Professionalism, and Systems Based Practice. Throughout the training,
the fellow will be expected to progress through three levels of training
(Levels I-III). The levels are found in parenthesis following each objective.
The teaching methods/educational activity and assessment methods of the
competencies are listed in the columns on the right. The explanation of the
educational and assessment methods can be found in sections VI and VII.
Patient Care: |
TEACHING & EDUCATIONAL ACTIVITY |
EVALUATION METHOD |
|
Clinical Experience |
Direct Observation Record Chart Review |
|
Teaching Rounds Clinical Experience Case Conference |
Direct Observation Record Chart Review |
care of the patients
(Level I) |
Clinical Experience Role Modeling |
Direct Observation M and M Conference |
|
Clinical Experience Role Modeling |
Direct Observation 360 eval M and M Conference |
Monitoring Devices include: 1.
Invasive Blood Pressure Monitoring (Level
I) 2.
Pulse Contour Analyses (Level I) 3.
Central Venous Pressure and Venous Oxygen
Saturation (Level I) 4.
ICP monitoring (Level II) 5.
Pulmonary Artery Catheter (Level III) 6.
Transcutaneous and transvenous pacers (Level III) |
Teaching Rounds Clinical Experience Lecture Series Board Review Case Conference |
Direct Obs In-Training Exam |
|
Teaching Rounds Clinical Experience Role Modeling |
Direct Obs M and M
Conference |
|
Clinical Experience Anat
models/Simulators |
Direct Obs Procedural Log Review |
|
Role Modeling Clinical Experience |
Direct Obs Procedural Log
Review |
i. Ventilation
by bag and mask (Level I)
ii. Suction
techniques (Level I)
iii. Use of
oral airway (Level I)
iv. Direct laryngoscopy, endotracheal
intubation techniques including rapid sequence (Level I-II)
v. Use of
a laryngeal mask airway (Level III)
i. Needle
Thoracostomy (Level I)
ii. Chest
Tube Insertion (Level II)
iii. Drainage
Systems (Level I)
i. Central
Venous Lines (Femoral, Subclavian, Internal
Jugular, Hemodialysis catheters)- (Level I)
ii. Arterial
Lines (Femoral, Radial, Brachial, Axillary) (Level
I)
iii. Pulmonary
Artery Catheter placement (Level III)
|
Anesthesia/Airway Conf Anat
models/Simulators Clinical
Experience Role Modeling Core Lecture Series |
Procedural Log Review M and M Conference Direct Obs |
|
Anesthesia/Airway Conf Clinical Experience |
Procedural Log Review Direct Obs |
|
Anesthesia/Airway Conf ClinicalExperience Lecture Series |
Direct Obs |
|
Clinical Experience; Lecture Series Case Conferences |
Direct Obs M and M
Conferences |
CARDIOVASCULAR a.
Recognize and manage the care of a patient
in shock 1.
Adrenal Insufficiency (Level I-II) 2.
Septic Shock (Level I- II) 3.
Anaphylaxis (Level I- II) 4. Cardiogenic shock (Level II) 5. Hypovolemic/Hemorrhagic shock (Level I-II) 6. Neurologenic shock (Level II) 7.
Obstructive shock (Level I-II) b.
Manage the care of a patient during cardiopulmonary resuscitation 1. Delivery of advanced cardiopulmonary
resuscitation (Level I) 2. Cardioversion
(Level I) 3. Appropriate use of anti-arrhythmic beyond
standard ACLS(Level
II) c. Institute the
appropriate monitors and institute appropriate intervention in the patient
with cardiovascular disorders 1. Acute coronary syndrome (Level I) 2. Acute valvular disorders (Level II) 3. Congestive heart failure (Level I) 4. Aortic dissection (Level II) 5. Arrhythmias (Level I) 6. Hypertensive emergency (Level I) 7. Veno thromboembolism (Level I) 8.pericarditis and tamponade
(Level II) d. Provide appropriate fluid resuscitation based on hemodynamic
information and signs of end organ damage. (Level II-III) e. Integrate information based on hemodynamic monitoring to
determine type and amount of vasoactive and inotropic therapy (Level II-III) PULMONARY a.
Manage the acute care of a patient with
respiratory failure Secondary to Hypercapnia 1.
Obstructive lung disease (Level I-II) 2.
Drug induced (Level I-II) 3.
Neuromuscular (Level I-II)
Hypoxemia 1.
ARDS/ALI (Level I-II) 2.
Pneumonia (Level I-II) 3.
Pulmonary Edema (Level I-II) 4.
Pneumonitis
(aspiration, inhalation) (Level I-II) 5.
Pulmonary embolism (Level I-II) b.
Initiation and adjust mechanical
ventilation settings in patients with respiratory failure secondary to 1.
ARDS (Level II) 2.
Obstructive lung disease (Level II) 3.
Status Asthmaticus
(Level II) 4.
Neuromuscular Disease (Level II) c.
Interpret ventilator wave forms and adjust
ventilator appropriately (Level II-III) d.
Recognize and manage the complications of
ventilation 1.
Auto-PEEP (Level II) 2.
Barotrauma (Level II) 3.
Hypotension Level II) e.
Evaluate and determine the appropriate
timing to liberate a patient from the ventilator (Level I-II) f.Demonstrate
proficiency in the following respiratory care techniques-use of reservoir
masks, CPAP, humidifiers, nebulizers, incentive spirometry
(Level I) g.
Manage the care of a patient with massive hemoptysis (Level II) CNS a.
Employ the appropriate imaging studies and
institute the therapeutic management of choice for the following conditions 1.
Acute stroke syndromes (Level I-II) 2.
Status epilepticus
(Level I-II) 3.
CNS infections (Level I-II) 4.
Muscular paralysis (Level I-II) 5.
Delirium (Level I-II) 6.
Traumatic Brain Injury (Level I-II) 7.
Cerebral edema (Level I-II) 8.
Intoxication(Level I-II) 9.
Acute withdrawal syndrome (Level I-II) b.
Select and titrate sedatives, analgesics,
antipsychotics, anxiolytics, and paralytics (Level
I-II) GI/GU/ENDOCRINE a.
Evaluate and Manage the care of a patient
with 1.
Massive GI Bleed (Level II) 2.
Acute liver failure (Level II-III) 3.
After Abdominal surgery (Level I-II) 4.
Stress ulcer prophylaxis (Level I) 5.
DKA and HONK (Level I) 6.
Severe hypothyroidism and thyrotoxicosis INFECTIOUS DISEASES a.
Initiate the appropriate antimicrobial
therapy (Level I) b.
Manage the febrile immunocompromised
patient (Level II) c.
Implement early goal directed therapy
(Level II) HEMATOLOGY a.
Manage the care of a patient with 1.
Anemia (Level I) 2.
Platelet disorders (Level I) 3.
Coagulopathy and thrombophilia (Level I) 4.
Neutropenia (Level
II) 5.
Leukocytosis, polycthythemia, hyperviscosity
(Level II) 6.
Acute chest Syndrome (Level II) 7.
SVC Syndrome (Level II) 8.
Tumor Lysis
Syndrome (Level II) 9.
Massive transfusion (Level II)
MISCELLANEOUS a.
Manage the care of the Trauma Patients with 1.
Pulmonary contusion (Level I) 2.
Spinal cord injury (Level II) 3.
Compartment syndromes (Level II) b.
Evaluate and resuscitate the post-operative
patient (Level I-II) c.
Apply principles of palliative care and
end-of-life care (Level I-III) d.
Perform brain death certification (Level
II-III) e.
Identify if a patient is safe for
transport, and demonstrate appropriate management during transport (Level
II-III) f.
Manage the critically ill Obstetric patient
with HELLP, Preclampsia/Eclampsia, and Uterine bleeding (Level II-III) |
Teaching Rounds Clinical Experience Lecture
Series Role Modeling |
Direct Obs M and M
Conference Chart
Review
In-Training exam |
Medical Knowledge: |
TEACHING & EDUCATIONAL ACTIVITY |
EVALUATION METHOD |
1.
Seeks and locates resources useful to
secure medical knowledge (asks questions on rounds, seeks faculty advice,
looks up evidence in literature) (Level I-III) |
Teaching Rounds Fellow Lecture Series Lit Review for M and M Self study
Research Seminar |
Direct Obs M and M Conference |
2.
Identifies areas of improvement of
self-knowledge (Level I-III) |
M and M conference Board Review |
Self-Assessment (done during 360 eval) |
3.
List the risks, benefits, indications and
potential complications for the critical care procedures as listed in patient
care. (Level I-II) |
Lecture Series Teaching Rounds Board Review |
In-Training Exam Procedural Log Review |
4.
Demonstrate medical knowledge of the
following topics… CARDIOVASCULAR a.
Describe 4 types of shock and its
complications (Level I) b.
Differentiate between the different kinds
of myocardial infarctions and define the complications (Level I) c.
Recognize cardiac arrhythmias and
conduction disturbances (Level I-II) d.
Discuss vasoactive
and inotropic therapy (Level I-II) e.
Derive the equations of oxygen transport
and utilization (Level II-III) f.
Distinguish between thrombus, air, fat, and
amniotic pulmonary emboli (Level II) g.
Define pulmonary hypertension and cor pulmonale (Level I) h.
Define hypertensive urgency and emergency
and describe the management (Level I) i.
Distinguish between cardiogenic
and non-cardiogenic pulmonary edema (Level I)
PULMONARY a.
List the five causes of hypoxia (Level I) b.
Define ALI and ARDS (Level I) c.
Summarize the path physiology of ARDS
(Level I) d.
Explain the purpose and mechanism behind
lung protected ventilator strategies (Level I-II) e.
Summarize the patho-physiology
and therapy for status asthmaticus (Level I) f.
Recognize smoke inhalation and airway
burns. Recite the management (Level II-III) g.
Define flail chest and pulmonary contusion
(Level I-II) h.
Summarize tests used to measure pulmonary
mechanics and gas exchange i.
Describe the following terms used with
mechanical ventilation 1.
Pressure vs. volume controlled ventilation
(Level I) 2.
CPAP, SIMV, AC, PC, PRVC, APRV (Level II) 3.
NIPPV (Level I) 4.
Barotrauma (Level I) 5.
Volutrauma (Level
I) 6.
Inverse ration ventilation (Level II-III) 7.
Permissive hypercapnea
(Level I) 8.
Auto-peep (Level II) j.
Summarize methods to improve oxygenation on
the ventilator (Level II) k.
Describe the flow-volume loop of a patient
with auto-peep (Level II) l.
Discuss the criteria for weaning mechanical
ventilation (Level I) m.
List the different weaning techniques and
recite the evidence (Level II-III) n.
Recite the causes of ventilator muscle
failure (Level III) CNS a.
Describe brain death evaluation and
certification (Level II-III) b.
Describe the definition and management of
status epilepticus (Level II) c.
Describe and give examples of the following
CNS pathologies- metabolic, anoxic, and infectious encephalopathy. (Level
I-II) d.
Summarize the pathophysiology and
management of traumatic brain injury. (Level II) e.
List a differential diagnosis for altered
mental status (Level I) f.
Define Intracranial hypertension (Level I) g.
List the different modes of management for
elevated intracranial pressure and discuss their mechanism of action (Level
II-III) h.
Explain the principles of management of
vasospasm in SAH (Level II) GI/ GU/
ENDOCRINE a.
Provide a differential diagnosis for GI
bleeding. (Level I) b.
Describe the pathophysiology and
presentation of acute and chronic
liver failure, pancreatitis, cholecystistis,
gastritis, and peptic ulcer disease (Level II) c.
Summarize the major causes of acute renal
failure and define the ways to distinguish them (Level I-II) d.
Recognize derangements in osmolarity and electrolytes (Level I-II) e.
Explain the principles of renal replacement
therapy including hemodialysis, ultrafiltration,
CVVH, CVVHD (Level II-III) f.
Describe the presentation and treatment of rhabdomyolysis (Level I) g.
Contrast HONK vs. DKA and explain the
management of each (Level I) INFECTIOUS
DISEASE: a. Define
and describe the pathophysiology of systemic inflammatory response syndrome
and sepsis (Level I) b. List the most common nosocomial
infections and describe the algorithm for antimicrobial agents. (Level I-II) c. Delineate the time line for infectious complications after
transplant. (Level III) d. Formulate an algorithm for the evaluation of fever in the ICU
(Level I-II) e. List the diagnostic criteria for Ventilator Pneumonia (Level
I) f. Describe the algorithm
for the management of catheter related blood stream infections (Level I) HEMATOLOGY: a.
Describe the following acute defects in hemostasis (Level I-II) 1.
Thrombocytopenia 2.
Disseminated intravascular coagulation 3.
Anticoagulaton 4.
Fibrinolytic
therapy b.
Explain the difference between the
following blood therapy components: (Level I) 1.
Platelets 2.
Red Blood Cells 3.
Fresh Frozen plasma 4.
Coagulation factor concentrates 5.
Cryoprecipitate 6.
Albumin c.
Summarize acute syndromes associated with neoplastic disease and antineoplastic
therapy (Level II-III) d.
Acute allergic reactions and/or anaphylaxis
(Level I) MISCELLANEOUS a.
Define the following obstetric terms and
list the tx for: (Level II) 1.
HELLP 2.
Pre-Eclampsia/Eclampsia b.
Summarize the initial approach to the
management of multisystem trauma (Level II) c.
Diagram the organization and staffing of
critical care units. (Level II-III) d.
List the antidote for toxins commonly seen
in the ICU (Level I- II) e.
Define abdominal compartment syndrome and
its management (Level I-II) f.
List the advantages of enteral
vs. parental feeding. (Level I) |
Lecture Series Board Review Teaching Rounds |
In-Training Exam |
5.
Define the mechanism of action,
indications, contraindications, and side effects of paralytics, analgesics,
and sedatives used on ICU patients. (Level II) |
Lecture Series |
In-Training Exam |
6.
Describe the psychosocial and emotional
effects of critical illness on patients and their families. (Level I-III) |
Role Modeling Computer Modules Clinical Experience |
360 Eval
Palliative Care Assessment Direct Obs |
7.
Describe the strategies to manage ethical
and legal dilemmas between families, patients, and staff in the ICU. (Level
I-III) |
GME Conference Computer Modules Clinical Experience |
360 Eval
In-Training Exam |
8.
Discuss ways to detect and prevent
iatrogenic and nosocomial problems in the ICU.
(Level II) |
M and M Conf Quality Performance Project |
M and M Conf. In-Training Exam |
|
Lecture Series Teaching Rounds Board Review |
In-Training Exam |
11. List the
indications, risks, and contraindications for insertion of an esophagogastric
balloon tamponade device. (Level III) |
Lecture Series Teaching Rounds Board Review |
In-Training Exam |
12. List the indications, risks, and contraindications of
performing a pericardiocentesis (Level III) |
Lecture Series Teaching Rounds |
In-Training Exam |
13.
List the indications, risks, and
contraindications for insertion of a. Extra-corporeal membrane oxygenation (Level III) b. Ventricular assist device (Level III) |
Lecture Series Teaching Rounds Board Review |
In-Training Exam |
14. Describe the indications, risks, and
contraindications for insertion of an intra-aortic balloon device. (Level
III) |
Lecture Series Teaching Rounds Board Review |
In-Training Exam |
15. Describe the indications, risks, and
contraindications and limitations for ICP monitor or extra-ventricular drain
placement (Level II) |
Lecture Series Teaching Rounds Board Review |
In-Training Exam |
Interpersonal/Communication
skills |
TEACHING & EDUCATIONAL ACTIVITY |
EVALUATION METHOD |
1.
Appropriately identify themselves to the patient and/or
family members (Level I) |
Clinical Experience Role Modeling |
360 Eval Direct Obs |
2.
Communicate effectively to maximize the
patient/family’s understanding a. Demonstrate skill
in conducting family conferences concerning prognosis, end of life care, code
status, and withdrawal of support with the assistance of an attending. (Level
I-II) b. Independently
conduct family conferences concerning prognosis, end of life care, code
status, and withdrawal of support. (Level III) |
Clinical Experience Role Modeling |
Palliative Care Assessment 360 Eval Direct Obs |
3.
Demonstrate sensitivity to different educational levels
and socio- cultural backgrounds (Level I-II) |
GME Conferences Computer Modules Role Modeling |
360 Eval Direct Obs |
4.
Provide education and counseling to patients and
families, using nontechnical and clear language. (Level I-II) |
Clinical Experience Role Modeling |
360 Eval Direct Obs |
5.
Exhibit a leadership role of the critical care team a. Organize and
communicate effectively with housestaff including running sign-out rounds and
coordinating follow up on plans developed on rounds. (Level I-II) b. Supervise and teach
residents on rounds, during procedures, and during the management of patients
(Level II-III) c. Provide
constructive verbal feedback to residents (Level II-III) d. Demonstrate
leadership skills in running a code, appropriately delegate tasks (Level II) |
Clinical Experience GME Lecture Series Anat
Models/Simulators |
Direct Obs |
6.
Establish collaborative and effective working
relationships with other members of the healthcare team a. Coordinate
discussions with the consulting physicians and together decide on appropriate
diagnostic and therapeutic strategies (Level II-III) b. Foster effective
and respectful discussion with nurses, respiratory therapists, and case
managers concerning specifics of patient care plans and problems they may
encounter
i. Communicate with
the charge nurse regarding allocation of resources, transfers and admissions
(Level I-II)
ii. Collaborate with
case management and the patient/family to accomplish appropriate discharge
planning (Level I-II) c. Contact and
Communicate effectively with a patient’s primary care physician upon a
patient’s admission and discharge (Level I) |
Clinical Experience I |
360 Evals Direct
Observation M and M
Conference |
7.
Present cases to the ICU attending in a clear, concise
and thorough manner a. Communicate
effectively regarding new admissions to the ICU (Level I) b. Communicate
effectively the status of patients and the progress of care plans. (Level I) |
Clinical Experience |
360 Evals Direct Obs |
8.
Provide and complete timely and comprehensive notes on
patients who have had significant changes in status and after family
discussions. (Level I) |
Clinical Experience GME Lecture Series |
Chart Review |
Professionalism: |
TEACHING & EDUCATIONAL ACTIVITY |
EVALUATION METHOD |
1.
Demonstrate punctuality and appropriate attendance of
all lectures (Level I) |
Role Modeling |
Direct Obs |
2.
Maintain timely and accurate medical records (Level I) |
Clinical Experience GME Lecture Series |
Chart Review |
3.
Demonstrate the following professional attributes (Level I) a. Act with honesty
and integrity b. Maintain patient
confidentiality c. Demonstrate
accountability and admit to error d. Provide compassion
and empathy by listening attentively and responding to concerns of patients
and families e. Interact with
patients and staff in a respectful manner including appropriate dress, verbal
and non-verbal behavior f. Indicate knowledge
of one’s own limitations by seeking guidance/ supervision from attending and
completing self-evaluation form g. Respond positively
to constructive criticism by improving behavior and/or skill |
Computer Modules Role Modeling GME Lecture Series |
Direct Obs M and M
Conference 360 Evals |
4.
Demonstrate commitment to on-going professional
development through (Level II) a. Regular attendance
and participation at conferences (list of conferences, see below) b. Attendance to a national
meeting c. Demonstrate reading
of the medical literature as demonstrated by discussion on rounds and
inclusion of material in fellow’s lectures. d. Seeking feedback
from attending after week on clinical service e. Adhere to deadlines
regarding research projects f. Maintain a complete
procedural log g. Actively
participate in teaching rounds and ICU conferences |
Teaching Rounds Lecture Series Research Seminar Journal Club Research Project |
Direct Obs Chart Review
Procedure Log Review |
5.
Obtain proper informed consent from patient or family
member/legal guardian. (Level I) |
GME Lecture Series Computer Modules |
Direct Obs Chart Review |
6.
Recognize the situational need to determine competence.
(Level I-II) |
GME Lecture Series Computer Modules |
Direct Obs Chart Review |
System-Based Practice: |
TEACHING & EDUCATIONAL ACTIVITY |
EVALUATION METHOD |
1.
Exhibit resource allocation and demonstrate commitment
to the practice of cost-effective medical care. a.
Work closely with the charge nurse to decide the
priority of admissions from the emergency room, out-of-hospital transfers,
PACU, and floor. (Level I-II) b.
Consider cost/benefit analysis of diagnostic or
therapeutic interventions prior to initiation. (Level III) |
Clinical Experience GME Conference Series |
360 Eval M and M
Conference |
2.
Effectively collaborate with health care manager
providers to assess, coordinate, and improve health care discharge planning
and transition from critical care to outpatient or to the floor. (Level
II-III) |
Clinical Experience |
360 Eval |
3.
Demonstrate awareness of how to manage patients in
different treatment settings (Level
II) a.
Recognize the available resources available and
communicate with the support staff in the ED, PACU, medical floor or surgical
floor. |
Clinical Experience |
360 Eval Direct
Observation M and M
Conference |
4.
Demonstrate knowledge regarding the business aspects of
medical practice including coding, billing, reimbursement, and insurance
(Level III) |
GME Lecture Series Computer Modules |
Direct Observation |
5.
Appreciate the necessity and rationale for program
policies, protocols and procedures. (Level III) |
Quality Performance Project |
Direct Observation |
Practice-Based Learning: |
TEACHING & EDUCATIONAL ACTIVITY |
EVALUATION METHOD |
1.
Demonstrate a willingness to learn from errors.
Identify strengths, deficiencies and limits to knowledge and expertise. (Level I-II) |
Role Modeling M and M Conference |
M and M Conference Direct Obs |
2.
Implement strategies to enhance knowledge, skills,
attitude, and processes of change. (Level II-III) |
Conference Series Board Review Quality Improvement
Project |
M and M Conference Direct Obs |
|
ICU retreat Quality performance project |
Direct Obs |
4.
Demonstrate an understanding of the principles of
evidence-based medicine and statistics by performing a critical appraisal of
the literature (Level III) |
Journal Club Research project Research seminar |
Direct Obs |
5.
Effectively utilize technology to promote life-long
learning a.
Use on-line technology to manage information, generate
fellow lectures, and teach medical students/residents on rounds (Level
II-III) |
Lecture Series GME Lecture Series |
Direct Obs |
VI. TEACHING
METHODS/EDUCATIONAL ACTIVITIES:
i. Obtaining thorough and complete history and physical examination
of all new admissions and help to formulate and prioritize a differential
diagnosis and treatment plan. The fellow will ensure appropriate documentation.
ii. Triaging- Decide the priority of admissions from the
emergency room, out-of-hospital transfers, PACU, and floor. Communicate with
the charge nurse regarding allocation of resources, transfers and admissions.
iii. Performing
or supervising bedside procedures.
iv. Respond to changes in patient status-incorporating results from
labs, radiographic studies, and monitoring devices in order to provide
appropriate treatment. Skills include endotracheal tube/airway management,
ventilator management, changing sedative/analgesic or initiating paralysis, resuscitation
and titration pharmacologic infusions, renal replacement therapy, nutrition,
antibiotic administration, control of electrolytes… etc.
v. Conducting
family and patient discussions
vi. Initiating
and discussing plans with consultants. Keep other services (i.e. surgical
services) informed of changes in status or changes in interventions
vii. Leading
the code team- delegate responsibilities and order appropriate ACLS
interventions.
viii. Conducting
sign-out with residents, mid-level practitioners, and with the other fellow at
the end of each shift.
ix. Collaborating
with case management and the patient/family to accomplish appropriate discharge
planning.
x. Evaluating
and performing tests to confirm brain death.
xi. The
critical care fellow spends one week in the operating room with an anesthesia
attending to practice intubating in a controlled
environment.
As a multi-disciplinary unit, the fellow also
develops clinical experience in the management of patients with trauma, neurosurgical
emergencies, and critical obstetric and gynecologic disorders. The fellows also
complete a 4-week elective in the cardio-thoracic ICU each year. ( See CT ICU Goals and Objectives). The fellows also have
the opportunity to pursue elective rotations in burns and in the neonatal ICU.
The topics of burns and neonatal critical care are reviewed in our lecture
series.
2. Departmental Conferences and
Lectures
a. Core Lecture Series:
Weekly one hour lecture given by a critical care attending on a topic from the
curriculum. Fellows, residents, and medical students attend.
b. Fellow Core Lecture Series:
Twice weekly, a fellow gives a lecture to housestaff
and attendings covering a basic topic from the
critical care curriculum. A list of the lecture topics can be found at http://gwicu.com/Pages/shedulepage.htm.
The fellows play an active role in planning of these conferences.
c. Case Conference:
Occurs weekly. Attending reviews a case. Fund of knowledge and patient care
skills are tested as the fellows are asked questions about how he/she would
diagnose and manage the particular case. A review of the literature is
provided.
d. Morbidity and Mortality
Conference: Each fellow will present a case at the
monthly conference. The fellow will complete a self-analysis form for each
case, in attempts to improve patient safety, patient care, and education. The
fellow will perform a targeted literature review and present the data with
respect to each case. The Morbidity and Mortality Conference will serve as
stimulus for a quality improvement project.
e. Journal Club:
Occurs monthly. Two articles from topics in current journals are presented by
the fellow and discussed. Specifically, whether practice patterns should change
based on the data review. A review of all abstracts from Critical Care Medicine is also reviewed.
f.
Research
Seminar: Conducted monthly by Dr. Chawla, Director
of ICU research. The aim of the seminar is to discuss scientific methods and
analysis of results.
g.
Department
Grand Rounds: Anesthesia, Surgery, and Medicine
departments each have weekly grand rounds.
Fellows and faculty attend to one of the GRs when critical care topics
are discussed.
h.
GME
Conference: Monthly lectures for fellows and residents
on the following topics (subject to change yearly):
i. Financial
Planning for Physicians
ii. Communications
and Interviewing Success
iii. Primer
on Business and contract Issues for New Physicians
iv. Alternative
Medicine: What Every Resident Should Know
v. The
Epidemiologic Cycle and Clinical Practice
vi. Rapid
Response
vii. Resident
Impairment
viii. Health
Policy
ix. Business
of Medicine
x. Spirituality
in Medicine
xi. Navigating
the IRB
xii. Emergency
Preparedness
xiii. Case
Topics TBA
xiv. The
Peer Review Process
xv. Town
Hall Meeting
xvi. Infection
Control and Patient Safety
i.
Board
Review: Multiple choice questions from board review courses and
book (i.e. seek questions) are reviewed.
j.
Anesthesia/Airway
Management Conference: Occurs yearly. Fellows are exposed to
various intubating devices and techniques for the
difficult airway. Anatomic models are provided for practice.
k.
GW
ICU Retreat/Program
Review: Each year, the ICU attendings,
mid-level practitioner, director of nursing, and chief ICU fellow review all aspects
of the ICU program including current and previous board scores, on-going and
future research projects, faculty development, allocation of resources, and
quality improvement projects etc.
3. Individual or Group Project:
a.
Individual
Research Project: Each fellow will complete one research
project during their fellowship
b.
Group
Project: The critical care fellows individually or as
a group complete a quality performance project or help to develop a critical
care protocol.
4. Computer Modules:
computer-based instructional unit on risk management, conducting appropriate
informed consent, patient confidentiality, demonstrating social-cultural
sensitivity, medical ethics, billing and coding procedures.
5. Anatomical Models/Simulators:
Prior to starting fellowship, each fellow completes a central line course and
a-line course using ultra-sound guidance on anatomical models. (beginning Sept
2011) The fellows also have 24 hour access to our sim-center
which has the fellow can practice or rehearse skills including- difficult
airway management, running an ACLS code, treating various arrythmias,
and placing central and arterial lines.
6. Role Model: At
GWU ICU, the attending physicians are in house for at least 18 hours per day
and provide constant supervision. The attending physician is present for family
discussions, bedside management…etc.
Throughout their training, the fellow will try to emulate the
professional behaviors, communication skills, and clinical skills of the
attending physicians.
7. Self Study/Reading:
Fellows are expected to read and familiarize themselves with each of the
general principles of critical care medicine. A list of topics from the curriculum
is reviewed during the core lectures (for topics – www.gwicu.com/schedules-
lecture topics. Library resources- see resources.
VII. EVALUATION & ASSESSMENT METHODS:
VIII. LINES OF RESPONSIBILITY and
SUPERVISION: The ICU fellow will progress through three
levels of training. The fellow will be expected to meet each detailed level of
competency as described above. In general, during level I of training, the ICU
attending will conduct morning teaching rounds. The ICU fellow will be present
and actively participate in rounds. During the afternoon and evening, the level
I ICU fellow will present all cases to the ICU attending in a concise and
thorough manner that includes all important factors contributing to the
patient’s critical illness. The ICU attending will be present during family
meetings in situations where poor outcome is expected.
The level II ICU fellow will continue to
meet prior objectives while taking a greater leadership role on rounds,
teaching, and in the care of patients. The level II ICU fellow will
independently communicate with patients and families in situations where a poor
outcome is expected with occasional help from the attending. The Level II
fellow will expand his/her ability to formulate and initiate diagnostic and
care plans without first consulting the attending, while keeping attending
informed of all decisions made.
The level III critical care fellow will
continue to meet prior objectives. The level III critical care fellow will occasionally
conduct rounds without the attending present and communicate a summary of the
care plans developed to the attending. The level III fellow will independently
conduct family conferences concerning prognosis, end of life care, DNR,
withdrawal of support. At this level, the fellow will assist the resident in performing
the initial evaluation on most admissions and formulate a treatment plan,
including appropriate consultations without assistance. The Level III fellow
will also coordinate lectures, fellow schedules, and complete a research
project.
Moonlighting
Policies and Procedures: Moonlighting
is permitted during the critical care fellowship. All policies and procedures
are in accordance with those of the GME rules. Prior to moonlighting, the
fellow must obtain written consent from the program director. Moonlighting hours will count towards total
resident-work hours and must be reported. Moonlighting privileges will be
revoked if difficulties with learning, performance, patient care, fatigue or
other issues arise. Please visit the GME
website for further information regarding moonlighting: http://smhs.gwumc.edu/graduatemedicaleducation/currentresidentresources/moonlightingaddendum.
VI. READING
LIST:
1. The
ICU Book/ Paul L. Marino
2. ACLS/
ATLS
3. Irwin
and Rippe’s Intensive Care medicine/ editors, Richard Irwin, Frank B. Cerra,
James M. Rippe.
4. Principles
and practice of intensive care monitoring/ editor, Martin J. Tobin
5. Critical
Care Medicine: Principles of Diagnosis and Management in the Adult / Joseph E.
Parillo and R. Phillip Dellinger
6. Critical
Care Medicine: The Essentials/ John J. Marini and Arthur P. Wheeler
7. Commonly
Cited Articles in Critical Care – See www.gwicu.com
under section “articles”