Medical Intensive Care Unit Rotation
This is a four-week rotation in the medical intensive care unit under the supervision of Dr. Bhagat S. Aulakh. You will be an integrated member of the MICU team providing intensive treatment on a concentrated and continuous basis.
Principal Goals and Objectives (Relevant Competencies)
- Develop the ability to initiate a rapid evaluation, diagnostic evaluation, and stabilization of critically ill adult patients. (MK, PC)
- Demonstrate skill in the initial resuscitation of patients with unstable vital signs. (PC)
- Demonstrate the ability to manage various types of shock, including hypovolemic, hemorrhagic, septic, anaphylactic, and neurogenic shock. (MK, PC)
- Demonstrate appropriate history and physical examination skills of the critically ill patient. (PC)
- Demonstrate proficiency performing diagnostic and therapeutic procedures for critically ill patients such as: central venous access, Swan-Ganz catheter placement, arterial line placement, tube thoracostomy, endotracheal intubation, etc. (PC)
- Demonstrate competence with the management of ventilator patients. (PC, SBP)
- Demonstrate effective use and interpretation of laboratory, radiographic and other diagnostic tests in the management of critically ill patients. (MK, PC, SBP)
- Demonstrate proficiency in the use of invasive hemodynamic monitoring for critically ill patients. (MK, PC, PBL & I)
- Demonstrate knowledge regarding pharmacologic agents of choice (including their indications, contraindications and complications) for the use in patients with shock, sepsis, dysrhythmias, respiratory failure, congestive heart failure, hepatic failure, and renal failure. (MK)
- Function effectively as an integrated team member of the ICU team with nurses, respiratory technicians, residents, fellows, staff, etc. (ISC, P, SBP)
- Develop skills handling social, psychological, and ethical issues affecting critically ill patients and their families. (SBP, ISC, P)
- Learn the indications for withholding and terminating resuscitation or aggressive medical treatment. (ISC, P, MK, PC)
Additional Optional/Aspirational Educational Objectives by Competency
- Demonstrate knowledge of the differential diagnosis of critically ill patients with varied clinical presentations.
- Demonstrate knowledge of an appropriate diagnostic and therapeutic plan based on the differential diagnosis.
- Demonstrate knowledge with respect to the pathophysiology of critically ill patients as a result trauma, toxicology, shock, sepsis, and cardiac failure.
- Demonstrate knowledge of invasive hemodynamic monitoring and the appropriate use thereof in the case of critically ill or injured patients.
- Demonstrate knowledge of common critical illnesses, such as respiratory failure, GI hemorrhage, renal failure and sepsis.
- Demonstrate knowledge with regard to fluid and electrolyte disturbances in critical patients.
- Demonstrate knowledge with respect to interpretation of data from hemodynamic monitoring, pulse oximetry, arterial blood gases, and end tidal CO2 monitors.
- Demonstrate knowledge regarding ventilator management including types, settings, adjustments, complications, and interpretations of readings.
- Demonstrate understanding of the ethical and legal principles applicable to the care of critically ill patients.
- Demonstrate understanding of the etiologies, diagnosis and treatment of adult respiratory distress syndrome and multisystem organ failure.
- Demonstrate knowledge regarding the indications for withholding and terminating resuscitation or aggressive medical treatment, including an understanding of “Do not resuscitate”, advance directives, living wills, and brain death criteria.
- Demonstrate competence in the interpretation of diagnostic modalities (ECG, chest x-ray, CT, ECHO).
Practice-Based Learning and Improvement
- Identify and acknowledge gaps in personal knowledge and skills with respect to the care of patients who are critically ill.
- Utilize available educational resources provided to broaden the knowledge base of critical illnesses.
- Consult with available supervisors regarding medical decision-making and utilize their input to develop knowledge and skills.
- Perform electronic searches of the medical literature to identify articles that address the issues of critically ill patients in general and of patients on the ICU service.
- Develop time management skills to perform required tasks in a reasonable amount of time with satisfactory quality.
Interpersonal Skills and Communication
- Demonstrate patient-centered interviewing techniques including:
i. a compassionate approach to history-taking
ii. the ability to modify interview techniques in response to the patient’s demeanor, cultural and/or religious background, and level of competency.
- Communicate sensitively and effectively with patients and their families.
- Explain complications of therapy or procedures in terms that patients and their families can understand.
- Receive and return sign-out of medical information in an effective and confidential manner.
- Communicate effectively and professionally with other medical staff, including nurses, respiratory therapists, pharmacists, laboratory and radiology technicians.
- Write complete and concise admission notes for all patients admitted.
- Write concise and informative progress notes on a daily basis.
- Demonstrate effective negotiation and mediation skills with patients/families who are angry, frustrated, or in disagreement with the plan of care.
- Assist patients in decision-making regarding treatment options, end-of-life care, and discharge planning.
- Utilize the electronic medical record to compose a complete and concise discharge summary.
- Discuss questions and management issues with consulting physicians.
- Adhere to the OSF Healthcare Standards of Performance.
- Demonstrate honesty and integrity at all times.
- Behave with high regard for patients, colleagues, consultants, and all members the health care team.
- Appreciate the effects of cultural and religious background on patients’ approaches and attitudes toward disease, decision-making, and treatment.
- Recognize the common ethical issues that face patients, their families, and caregivers related to chronic illness.
- Provide meaningful feedback to colleagues regarding their performance.
- Recognize the role of non-physician health care professionals in treating acutely ill patients.
- Collaborate effectively with other health care professionals to assure comprehensive patient care.
- Understand and utilize multidisciplinary resources to prepare patients and their families for hospital discharge, home management of disease, nursing home placement, or end-of-life care.
- Use evidence-based, cost-conscious strategies in the care of hospitalized patients with critical illness.
- Demonstrate an understanding of the appropriate use of consultants in critically ill patients.
During the four-week rotation, the ICU patient population offers the residents exposure to a wide variety of critical illnesses, experiences, and procedures. At all times there will be a senior IM resident, critical care fellow, or attending available to provide supervision, consultation, and assistance. Residents are expected to be actively involved with ICU admissions and to be first call for many medical issues that arise on their patients. Expectations include a comprehensive history and physical examination, differential diagnosis of chief complaint or presenting illness, assimilation and interpretation of data, development of a problem list, differential diagnosis, and plan of care. The resident is also responsible for daily notes and orders, communication with patients’ families, coordination of consultations, procedures, interventions, and discharge summaries. In addition, a brief tutorial on a specific diagnostic or intervention technique commonly needed by ICU patients and provided by the IR service will be given by the IR/DR resident to the MICU team at the end of the rotation. Topic selection will be decided by a consensus of the IR/DR resident, MICU rotation director, and IR/DR Program Director.
Residents will receive concurrent feedback from the faculty, fellows, and senior IM residents while on the MICU rotation. At the end of the rotation, the resident is evaluated by the MICU rotation director utilizing the E-value system and will include a competency-based assessment of the principal goals and objectives of the rotation and the tutorial presentation. These evaluations are available to the resident after their receipt. The IR/DR Program Director reviews all evaluations with the resident at least semiannually.