Critical Care Medicine Curriculum

Faculty Director: Gary Weinstein, M.D.

Hospital: Texas Health Presbyterian Hospital Dallas

Offered: All

Length of Rotation: 4 weeks

First Day Contact: Gary Weinstein, M.D.

First Day Time: Monday thru Friday 6:00 am to 6:00 pm

First Day Place: Hamon ICU

Weekends: No weekends

Vacation: No vacation

1. Course Description:

The residents will work in the intensive care units of Texas Health Presbyterian Hospital Dallas. The residents will be responsible for all patients in the units. They will see multiple diseases specific to the ICU setting and are expected to work closely with the multi-disciplinary team to facilitate the safe, evidence-based treatment of the patient. They are expected to perform multiple procedures under the direction of the pulmonologists from Southwest Pulmonary (see below for details).

2. Course Goals and Objectives: (based on ACGME competencies for resident education)

Patient Care:

Residents are expected to provide patient care that is compassionate, appropriate, and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.

• Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures. Examples:
  • History: The resident will gather complete history through patient interviews, current hospital records, old records, and communication with other physicians and family members.
  • Physical Exam: The resident will perform a comprehensive physical exam on the initiation of care and then a thorough problem-based exam at least twice daily.

• Make informed recommendations about preventative, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference. Examples: The resident will learn to make informed recommendations about prevention of conditions including: DVT, pulmonary embolus, delirium, decubiti, sepsis.
  
  
• The resident will be familiar with the following diagnostic and therapeutic options and interventions: use of invasive monitoring; use of laboratory tests or radiological tests to help in the diagnosis and management of the patient; initiation of antibiotics; pressure supporting medications; sedatives and pain medications; initiation of nutritional therapy.

• Develop, negotiate and implement effective, patient management plans and integration of patient care. Examples:
  • In the ICU patient, the resident will write daily a detailed note which reflects the development and implementation of a comprehensive managment plan for each clinical problem.
  • The resident will use the resources available to him/her to facilitate the managment of the patient including nursing, dietary, respiratory therapy, physical therapy, social workers, etc.

• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine. Examples: Residents will be able to perform competency procedures including:
  • Central Line Placement
  • Arterial Puncture
  • Interpretation of Swan Ganz measurements
  • Thoracentesis
  • Chest tube placement
  • Airway management

Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the applicaiton of their knowledge to patient care and the education of others.

• Apply an open-minded, analytical approach to acquiring new knowledge. Examples:
  • The resident will demonstrate a willingness to learn from all members of the ICU team.
  • The resident will document his/or knowledge deficits, read in those areas and apply what he/she learns to the care of the patient.

• Access and critically evaluate current medical information and scientific evidence. Examples:
  • Resident will use the electronic information system available to him/her, referring to peer-reviewed journals/web sites for their information. Many of the residents use Up-to-Date as a source of reliable, accurate information.
  • Resident will participate in Journal Club during which the critical appraisal of the literature is taught.

• Develop clinically, applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine Examples: Understanding of the physiology of the cardiovascular and respiratory systems will be needed to evaluate and treat ICU patients. Additionally, knowledge of the pathophysiology of the sepsis syndrome will be needed to care for the patients.

• Apply this knowledge to clinical problem-solving, clinial decision-making, and critical thinking. Examples: See above.

Practice-Based Learning and Improvement:

Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices:

Objectives:

• Identify areas for improvement and implement strategies to enchance knowledge, skills, attitudes and processes of care. Examples:
  • Resident will identify areas of knowledge deficit as it pertains to the care of the critically ill and work to improve that knowledge to better care for the patient. The resident will continuously search for ways to improve the system of care for the patient in the intesive care unit.

• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. Examples: See above.

• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples:
  • Errors in medication dosing, invasive procedures, or other therapeutic interventions used commonly in the ICU will be used to improve the knowledge of the resident and improve the safety of the system in which he/she works.

• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. Examples:
  • Computer stations are available in every ICU for the resident to quickly access patient information. Resident will use the electronic data base to access literature to help in guiding patient care.

Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of health care teams.

• Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethcially sound professional relationships with patients, their families, and colleagues.Examples: Residents will work with the ICU team, including nursing, respiratory therapy and pharmacists to improve the care of the patient. They will communicate with the other consultants, the primary care physician, and residents involved in the care of the patient on a regular basis. They will also communicate with the patient and family members regarding the patient's current medical condition.

• Use effective listening, nonverbal, questioning, and narrative skills to communicate to the patients. Examples: See above.

• Interact with consultants in a respectful, appropriate manner. Examples: See above.

• Maintain comprehensive, timely, and legible medical records. Examples:
  • The ICU progress note should document current history, physical findings, the laboratory data. There should be an assessment of each problem in a systematic way. There should be notes documenting any new data, change in therapy or change in patient status during the day.

Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity, and a responsible attitude toward their patients, their profession, and society.

• Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues. Examples:
  • Resident will learn communication skills and professional skills needed to care for the critically ill patient. He/she will understand the enormity of responsibility to the patient and his/her family in the ICU setting.

• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues.

• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent. Examples:
  • Resident will understand the ethics of obtaining consent for a patient who is unable to give consent. He/she will learn and apply HIPAA rules regarding patient information.

• Recognize and indentify deficiencies in peer performance.

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

• Understand, access and utilize the resources, providers and systems necessary to provide optimal care. Examples: Residents will work close with the multi-disciplinary ICU team on a daily basis to ensure optimal care of the patient.

• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient.

• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management. Examples: Residents will develop management plns that take into consideration evidence-based recommendations as well as cost constraints.

• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care. Examples: Residents will participate actively in daily multi-disciplinary ICU rounds.

III. Methods of instruction:

1. Didactic (schedule, topic, faculty)

Daily residents conference 12:00-1:00 p.m. - IM Training Room
Wednesday mornings 7:30-8:00 a.m. - Clinical Ground Rounds - IM Training Room
Wednesday afternoons 12:15-1:00 p.m. - Internal Medicine Update - Haggar Hall

B. Clinical

Residents will round on ICU patients and document these interactions at least twice daily. They will be active participants in daily multi-disciplinary ICU rounds.