Specific Goals and Objectives

The SCC resident will rotate with the Trauma/Critical Care service in the Shock Trauma Unit and the SICU, the neurosurgical service in the Neuro ICU, the cardiothoracic service in the CTICU and the pediatric critical care service in the PICU.

Sample Rotation Schedule

Month	Location
July- October	Surgical Intensive Care Unit - SICU
November - December	Shock Trauma ICU - STU
January	Cardiothoracic Service - CTICU
February	Pediatric Critical Care Service - PICU
March	Neurosurgical ICU
April - May	Shock Trauma ICU
June	Surgical Intensive Care Unit

Goals and objectives for each rotation

Shock Trauma ICU

Patient Care

The fellow will demonstrate appropriate, evidence-based care of the patient with critical illness or injury:

• Demonstrate knowledge and competency in basic principles of trauma assessment and resuscitation, including airway management with C-spine immobilization, rapid sequence intubation and establishment of adequate intravenous access;
• Demonstrate knowledge and competency in resuscitation skills, including cardiopulmonary resuscitation, emergency airway management using bag and mask ventilation, and intubation;
• Demonstrate knowledge and competency in the performance of procedures, specifically central and arterial lines, intubations, tube thoracostomy, pulmonary artery catheters and fiberoptic bronchoscopy;
• Demonstrate knowledge and competency in the evaluation and non-operative management of severe closed head injury with or without intracranial hypertension;
• Demonstrate proper assessment and management of complications occurring in patient with multi-system trauma such as respiratory failure, nosocomial pneumonia, compartment syndrome, rhabdomyolysis and renal failure;
• Demonstrate proper performance of brain death certification, and apply clinical criteria of brain death and basic principles of support for potential organ donors;
• Demonstrate knowledge and competency in ventilator management including the use of PEEP, supplemental oxygen, lung-protective ventilation strategies, pressure-cycled, volume-cycled and dual modes of ventilation;
• Apply evidence-based guidelines to the care of patients with critical illness or injury such as ventilatory management for patients with ARDS, weaning from mechanical ventilation, administration of nutritional support, prophylactic antibiotic administration, blood product transfusion and prevention of ICU related complications.

Medical Knowledge

The fellow will identify and describe the most current evidence-based medical practices pertaining to the treatment of critically ill and injured patients:

• State the etiology, describe the pathophysiology, and demonstrate the appropriate management of patients with respiratory failure including ARDS, blunt or penetrating thoracic trauma, pneumonia and pulmonary embolus;
• State the etiology, describe the pathophysiology, and demonstrate the appropriate management of patients with spinal cord injury;
• Describe the indications for intubation and mechanical ventilation;
• State the etiology, describe the pathophysiology, and demonstrate the appropriate management of patients with severe closed head injury and intercranial hypertension;
• Identify the risk, benefits, indications and contraindications of beside procedures such as central and arterial lines, intubations, tube thoracostomy and pulmonary artery catheters;
• Discuss the timing and know the risks and benefits of non-emergent open reduction and internal fixation of orthopedic injures;
• Discuss the indications for and know the limitations of non-operative management of splenic and hepatic injury;
• State the etiology, describe the pathophysiology, and demonstrate the appropriate management of patients with imminent brain death and brain-dead potential donors;
• Describe and evaluate the data from the medical literature pertaining to performance of early tracheostomy for patients with respiratory failure.

Practice-Based Learning and Improvement

The fellow will identify the best practice patterns to facilitate care of the critically ill trauma patient:

• Demonstrate motivation for improvement of medical knowledge and patient care skills through participation in all educational activities, including core lectures related to trauma, educational workshops, Journal Club, Grand Rounds and trauma conference;
• Demonstrate motivation for improvement of procedural skills by completion of mandatory procedures, verifying satisfactory performance with endotracheal intubation, central venous, pulmonary artery and arterial line insertions and chest thoracostomy insertion;
• Demonstrate self-evaluation of patient care skills and medical knowledge by identifying specific sub-optimal patient outcomes on daily rounds, describing the care received by the patient, and comparing it to the current standards of care;
• Interpret, critique and evaluate current medical literature, and discuss biostatistics and debate experimental design.

Interpersonal and Communication Skills

The fellow will demonstrate effective communication with staff, peers, attending and referring physicians, and consultants:

• Establish a collegial rapport with patient and family, and demonstrate through daily family presence at bedside rounds;
• Demonstrate effective discussion of patient diagnosis, prognosis and management plan (including risks, benefits and side effects) with patient and family using simple, easily understood language;
• Demonstrate proper technique for transfer of care both within and between services;
• Demonstrate effective and collegial daily communication with Trauma and other surgical services;
• Develop teaching skills through instruction of medical and procedural aspects of critical care medicine to GHSU residents, interns, medical students and other health care professionals.

Professionalism

The fellow will demonstrate proper performance of all expected professional responsibilities:

• Demonstrate the practice of ethical principals in relation to patient care, including obtaining informed consent, implementing “Do Not Resuscitate” orders, withholding or withdrawing life support, and clarifying goals of care from advanced directives;
• Demonstrate appropriate interactions with pharmaceutical representatives, and be unbiased in prescribing habits;
• Demonstrate sensitivity to culture, age, gender and disability issues.

System-Based Practice

The fellow will understand the role of the Shock Trauma ICU within the Trauma program at GHSU:

• Evaluate and demonstrate cost-effectiveness of care for the critically ill and injured patient;
• Develop proper documentation skills;
• Demonstrate enthusiasm for expansion of global medical knowledge through participation in research projects and clinical trials in the STU;
• Demonstrate awareness of the role of the Trauma Center in the regional health care delivery system through participation in the statewide trauma care regionalization plan.

Neuroscience Center NICU

Patient Care

• Demonstrate appropriate, evidence-based, direct management of critical care issues for all Neuro ICU patients.
• Demonstrate appropriate and timely evaluation and management of acute neurological decompensation and/or neurovascular pathology.
• Demonstrate proper evaluation and certification of brain death.
• Demonstrate knowledge and competency in resuscitation skills including advanced cardiopulmonary resuscitation, emergency airway management using bag and mask ventilation, and indications/techniques for intubation and mechanical ventilation, particularly when pertaining to patients with increased intracranial pressure.
• Demonstrate knowledge and competency in ventilator management skills including the use of volume and pressure modes, supplemental oxygen and lung protective ventilation.
• Demonstrate competency in the performance of bedside procedures, specifically central and arterial lines, intubations, chest tubes and pulmonary artery catheters.
• Demonstrate the proper assessment and management of patients with intracranial hypertension, including evaluation of data from ICP monitors and extra-ventricular drains.
• Identify, evaluate and prioritize current Neuro ICU patient care needs by participating in daily rounds on critically ill patients.

Medical Knowledge

• List and describe the most current evidence-based medical practices pertaining to the treatment of critically ill and injured patients.
• State the etiology, describe the pathophysiology, demonstrate the appropriate management, and evaluate the outcome of patients with central and peripheral nervous system pathology, including encephalopathy, cerebral vascular accidents, cerebral aneurysm, subarachnoid hemorrhage, subdural and epidural hematomas, neuromuscular junction pathology, intracranial hypertension, spinal cord injuries and brain death.
• Describe management rational, demonstrate care, and evaluate outcomes of pre- and post-operative patients from neurosurgical and interventional neuroradiology procedures such as cerebral aneurysm, clipping/coiling and resection of neoplasms.
• Describe the indications, limitations and general purpose of brain death evaluation and certification. List the adjunctive tests for determining brain death, and describe the indications and limitations for their use.
• List the risks, benefits, indications and contraindications for ICP monitor or extra-ventricular drain placement, and describe the possible limitations and complications of these devices.
• List the risk, benefits, indications and contraindications of bedside procedures such as central and arterial lines, intubations, chest tubes and pulmonary artery catheters.

Practice-Based Learning and Improvement

• Identify the best practice patterns to facilitate care of the critically ill patient with severe neurological injury or dysfunction.
• Interpret, critique and evaluate medical literature.
• Discuss biostatistics and debate experimental design.
• Demonstrate motivation for improvement of medical knowledge and patient care skills through participation in all educational activities provided.
• Demonstrate self-evaluation of patient care skills and medical knowledge by identifying specific sub-optimal patient outcomes on daily rounds, describing the care received by the patient, and comparing the care received to the current standard of care.

Interpersonal and Communication Skills

• Demonstrate effective communication with neuroscience center of excellence staff, peers, attendings and consultants.
• Establish a collegial rapport with patient and family, and demonstrate an attentive listening to their concerns.
• Demonstrate effective discussion of patient diagnosis, prognosis and management plan (including risks, benefits and side effects) with patient and family using simple, easily understood language.
• Demonstrate proper written and verbal techniques for transfer of care both within and between services.
• Develop teaching skills through instruction of medical and procedure aspects of critical care medicine to neurosurgery residents, medical students and other heath care professionals.

Professionalism

The fellow will demonstrate proper performance of all expected professional responsibilities:

• Demonstrate the practice of ethical principles in relation to patient care;
• Demonstrate appropriate interactions with pharmaceutical representatives, and be unbiased in prescribing habits;
• Demonstrate sensitivity to cultural, age, gender and disability issues.

System-Based Practice

Describe the role of the hospital within the Georgia Trauma Care System:

• Evaluate and demonstrate cost-effectiveness of care for critically ill and injured patients;
• Develop proper documentation and billing skills;
• Demonstrate enthusiasm for expansion of global medical knowledge through participation in research projects and clinical trials occurring in the Neuroscience ICU;
• Demonstrate awareness of the role of the Neuroscience ICU within the hospital and the national organ donation system through compliance with standard operating procedures, and participation in quality improvement initiatives.

Cardiothoracic ICU

Patient Care

• Demonstrate appropriate, evidence-based, direct management of critical care issues for all SICU/CTU patients.
• Demonstrate proper emergency consultation to the emergency room, post anesthesia recovery, medical/surgical wards and ICUs.
• Demonstrate knowledge and competency in resuscitation skills including advanced cardiopulmonary resuscitation, emergent airway management using bag and mask ventilation, recognition and identification of abnormal cardiac rhythms, and indications for intubation and mechanical ventilation.
• Demonstrate knowledge and competency in ventilator management skills including the use of volume and pressure modes, supplemental oxygen and lung protective ventilation.
• Demonstrate competency in the performance of procedures, specifically central and arterial lines, intubations, chest tubes and pulmonary artery catheters.
• Identify, evaluate and prioritize current CTU patient care needs by conduction daily rounds on critically ill patients.

Medical Knowledge

• Describe the most current evidence-based medical practices pertaining to the treatment of critically ill patients with cardiovascular instability including arrhythmias, myocardial infarction, congestive heart failure, vascular abnormalities and shock.
• State the etiology, describe the pathophysiology, demonstrate the appropriate management and evaluate the outcomes of patients following CABG and thoracic surgery.
• Describe management rationale, demonstrate care and evaluate outcomes of post-operative patients from cardiothoracic and vascular procedures.

Practice-Based Learning

• The fellow will identify the best practice patterns to facilitate care of the cardiothoracic patient.
• The fellow will interpret, critique and evaluate the current medical literature.
• The fellow will discuss biostatistics and debate experimental design.
• The fellow will demonstrate motivation for improvement of medical knowledge and patient care skills through participation in all educational activities provided.
• The fellow will demonstrate motivation for improvement in procedural skills.
• The fellow will demonstrate self-evaluation of patient care skills and medical knowledge by identifying specific sub-optimal cardiothoracic patient outcomes on daily rounds, describing the care received by the patient, and comparing the care received to the current standard of care

Interpersonal and Communication Skills

The fellow will demonstrate effective communication with cardiothoracic staff, peers, attendings, consultants and outside representatives:

• Establish a collegial rapport with patients and families, and demonstrate patient and attentive listening to their concerns;
• Demonstrate effective discussion of patient diagnosis, prognosis, and management plan with patient and family using simple, easily understood language;
• Demonstrate proper written and verbal techniques for the transfer of care both within and between services;
• Develop teaching skills through instruction of medical and procedural aspects of cardiothoracic critical care to junior residents, interns, medical students and other health care professionals.

Professionalism

• Demonstrate proper performance of all expected professional responsibilities.
• Demonstrate the practice of ethical principles in relation to patient care and confidentiality.
• Demonstrate sensitivity to cultural, age, gender and disability issues.

• Describe the role of cardiothoracic medicine within the health system.
• Evaluate and demonstrate cost-effectiveness of care for critically ill patients.
• Develop proper documentation and billing skills.
• Demonstrate enthusiasm for expansion of global medical knowledge through participation in research projects and clinical trials.

Surgical ICU

Patient Care

• Demonstrate appropriate, evidence-based, direct management of critical care issues for all SICU patients.
• Demonstrate proper emergency consultation to the emergency room, post anesthesia recovery, medical/surgical wards and ICUs.
• Demonstrate knowledge and competency in resuscitation skills including advanced cardiopulmonary resuscitation, emergent airway management using bag and mask ventilation, and indications for intubation and mechanical ventilation.
• Demonstrate knowledge and competency in ventilator management skills including the use of volume and pressure modes, supplemental oxygen, and lung protective ventilation.
• Demonstrate competency in the performance of procedures, specifically central and arterial lines, intubations, chest tubes and pulmonary artery catheters.
• Identify, evaluate and prioritize current SICU patient care needs by conduction daily rounds on critically ill patients.

Medical Knowledge

• Describe the most current evidence-based medical practices pertaining to the treatment of critically ill patients in the SICU.
• State the etiology, describe the pathophysiology, demonstrate the appropriate management and evaluate the outcomes of patients with:
• Respiratory failure including acute respiratory distress syndrome, chronic obstructive lung disease, respiratory muscle weakness, pneumonia and pulmonary embolus;
• Acute and chronic renal insufficiency;
• Central nervous system pathology including encephalopathy, cerebral vascular accidents and brain death;
• Metabolic, endocrine and electrolyte abnormalities;
• Infectious diseases including sepsis and septic shock;
• Hematologic disorders including anemia, neutropenia, thrombocytopenia and thrombocytosis;
• Gastrointestinal diseases including acute and chronic liver failure, pancreatitis cholecystitis, gastritis, peptic ulcer disease, and upper and lower gastrointestinal hemorrhage;
• Genitourinary pathology;
• Nutritional disorders;
• Oncologic complications;
• Life-threatening geriatric problems, and
• Psychiatric disorders causing special ICU problems
• Describe management rationale, demonstrate care and evaluate outcomes of post-operative patients from plastics, ENT, vascular, gastrointestinal, genitourinary, endocrine and orthopedic procedures.

Practice-Based Learning

• The fellow will identify the best practice patterns to facilitate care of the surgical ICU patient.
• The fellow will interpret, critique, and evaluate the current medical literature.
• The fellow will discuss biostatistics and debate experimental design.
• The fellow will demonstrate motivation for improvement of medical knowledge and patient care skills through participation in all educational activities provided.
• The fellow will demonstrate motivation for improvement in procedural skills.
• The fellow will demonstrate self-evaluation of patient care skills and medical knowledge by identifying specific sub-optimal SICU patient outcomes on daily rounds, describing the care received by the patient, and comparing the care received to the current standard of care.

Interpersonal and Communication Skills

The fellow will demonstrate effective communication with surgical staff, peers, attendings, consultants and outside representatives:

• Establish a collegial rapport with patients and families, and demonstrate patient and attentive listening to their concerns;
• Demonstrate effective discussion of patient diagnosis, prognosis, and management plan with patient and family using simple, easily understood language;
• Demonstrate proper written and verbal techniques for the transfer of care both within and between services;
• Develop teaching skills through instruction of medical and procedural aspects of cardiothoracic critical care to junior residents, interns, medical students and other health care professionals.

Professionalism

• Demonstrate proper performance of all expected professional responsibilities.
• Demonstrate the practice of ethical principles in relation to patient care and confidentiality.
• Demonstrate sensitivity to cultural, age, gender and disability issues.

System-Based Practice

• Describe the role of the surgical ICU within the health system.
• Evaluate and demonstrate cost-effectiveness of care for critically ill patients.
• Develop proper documentation and billing skills.
• Demonstrate enthusiasm for expansion of global medical knowledge through participation in research projects and clinical trials.

Pediatric ICU

Medical Knowledge

• Demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of knowledge to patient care and education of others.

Patient Care

• Provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness and treatment of disease.
• Provide direct bedside care for patients in the PICU.
• State the physical signs of organ system dysfunction in the infant, child and adolescent.
• Interpret laboratory and physiological data, synthesize it to recognize patient deterioration or improvement, and make fundamentally sound decisions regarding patient support.
• Manage a child following major surgery.
• Manage pediatric trauma patients including those with multi-system trauma, cervical spine fractures (airway management), head trauma (increased intracranial pressure), and spinal cord injuries.
• Describe an approach and treatment plan for sedation and analgesia in the PICU.
• Demonstrate proficiency performing PICU procedures.
• Demonstrate effective and compassionate communication skills with parents and patients.
• Discuss ethical issues of particular relevance in the PICU including informed consent, surrogate decision- making, limiting support and withdrawal of support.
• Provide consultation to the emergency room and pediatric floors.
• Teach and supervise medical students and residents assigned to PICU.
• Initiate appropriate invasive monitoring, evaluate data and implement appropriate treatment plans.
• Manage all aspects of patient care including ventilatory support, nutritional assessment and support, and infectious disease issues.
• List indications for extra-corporeal membrane oxygenation (ECMO) and be competent in the management of patients on ECMO.
• Describe the treatment of acute, life-threatening illnesses in children ranging from newborn to adolescents. Specifically, this includes understanding the etiology and pathophysiology as well as the management of pediatric patients with:
  • Cardiovascular instability including arrhythmias, congestive heart failure, cardiomyopathy and vascular abnormalities;
  • Respiratory failure including acute respiratory distress syndrome, status asthmaticus, upper airway obstruction, pneumonia and bronchiolitis;
  • Airway management issues including difficult airway;
  • Renal insufficiency, acute and chronic;
  • CNS pathology including meningitis, encephalopathy, head injury, post-operative tumor removal and status epilepticus;
  • Metabolic, endocrine and electrolyte abnormalities including hypo or hypernatremic dehydration, diabetic ketoacidosis and urea cycle defects;
  • Infectious diseases including differentiation of immunocompetent versus immunodeficient patients;
  • Shock including neurogenic, cardiogenic, septic and hypovolemic;
  • Hematologic disorders including anemia, neutropenia, thrombocytopenia and coagulation disorders;
  • Gastrointestinal diseases including acute and chronic liver failure, pancreatitis, upper and lower GI hemorrhage, and chronic malabsorptive syndromes;
  • Oncology complications including the treatment of shock, fever and neutropenia, as well as the intensive care unit complications from chemotherapy;
  • Toxic ingestions, including their presenting symptoms, complications and treatment strategies.

Practice-Based Learning

• Use scientific evidence and methods to investigate, evaluate and improve pediatric patient care practices.
• Develop and maintain a willingness to learn from successes/errors and use successes/errors to improve the system or processes of care, incorporate feedback into improvement activities.
• Used information technology and other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education.
• The fellow will interpret, critique and evaluate the current medical literature.
• The fellow will discuss biostatistics and debate experimental design.

Interpersonal and Communication Skills

The fellow will demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of the health care team:

• Maintain comprehensive, timely and legible medical records;
• Provide effective and professional consultation to other physicians and health care professionals;
• Sustain therapeutic and ethically sound professional relationships with patients and their families, as well as with colleagues and students;
• Use effective listening, nonverbal, questioning and narrative skills to communicate with patient and their families.

Professionalism

The fellow will demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward patients, their profession and society:

• Demonstrate respect, compassion, integrity and altruism in relationships with patients, families and colleagues in the PICU;
• Demonstrate sensitivity to cultural, age, gender, behavioral and disability issues;
• Adhere to the principles of confidentiality, scientific/academic integrity and informed consent.

System-Based Practice

The fellow will 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 by:

• Utilizing the resources, providers and systems necessary to provide optimal care such as social services, PharmDs nutrition service, case managers physical therapists, etc.;
• Apply evidence-based strategies to prevention, diagnosis and disease management;
• Collaborate with other members of the health care team and triage patients to appropriate level of care.

Optional Elective in Critical Burn Care at Joseph M. Still Burn Center

Patient Care

• Demonstrate the appropriate and evidence based evaluation, resuscitation, clinical management and rehabilitation of burn patients in the ICU.
• Demonstrate knowledge and competency with bedside procedures, including venous, arterial or pulmonary artery catheterizations, orotracheal intubations, bronchoscopies and chest tube insertions.

Medical Knowledge

• Describe the most current evidence-based medical practices pertaining to the treatment of critically ill burn patients.
• Understand the concepts of burn injury and its pathophysiology.
• Describe and differentiate the pathology and management of thermal, chemical, electrical and inhalation burn injury to mortality, morbidity and course of patient recovery.
• Develop an initial treatment plan for stabilization and resuscitation of a burn patient.
• Identify and describe the clinical factors necessitating immediate intervention to preserve life, limb and function.
• Evaluate the appearance of the burn wound in relation to its depth, bacteriological condition, healing potential and requirement for intervention.
• Outline the principles of burn shock, including immunologic alterations and bacteriologic susceptibility of burned skin.
• Describe the indications, harvest techniques, application, immobilization and post-operative care of split and full thickness skin grafts.
• Explain the principles of wound contracture.
• Describe the desirable and harmful effects of wound contracture on the closure of the burn wound, and the initial management and subsequent rehabilitation of the burn patient.
• Review the epidemiology, prevention, socioeconomic effects and psychological consequences of burns.

Practice-Based Learning

• The fellow will identify the best practice patterns to facilitate care of the burn ICU patient.
• The fellow will interpret, critique and evaluate the current medical literature.
• The fellow will discuss biostatistics and debate experimental design.
• The fellow will demonstrate motivation for improvement of medical knowledge and patient care skills through participation in all educational activities provided.
• The fellow will demonstrate motivation for improvement in procedural skills.
• The fellow will demonstrate self-evaluation of patient care skills and medical knowledge by identifying specific sub-optimal burn patient outcomes on daily rounds, describing the care received by the patient, and comparing the care received to the current standard of care.

Professionalism

• Demonstrate proper performance of all expected professional responsibilities.
• Demonstrate the practice of ethical principles in relation to patient care and confidentiality.
• Demonstrate sensitivity to cultural, age, gender and disability issues.

System-Based Practice

• Describe the role of the Joseph M. Still Burn Center within the health care system and the statewide trauma regionalization plan.
• Evaluate and demonstrate cost-effectiveness of care for the critically ill burn patient.
• Develop proper documentation and billing skills.