Enhanced Skills Program: NYGH ICU Rotation – Goals and Objectives (CanMEDS-FM)

During the rotation in the NYGH Intensive Care Unit (ICU), the FPA resident will improve technical skills and knowledge in the management of the critically ill patient. This rotation will also be an opportunity for the FPA resident to participate in team care of patients with both physicians and non-physicians and to improve skills in communication with patients, staff and families.

1. Medical Expert:

At the end of the rotation the FPA resident will be able to:

a. Technical Skills

Demonstrate basic competency in:

• Invasive and noninvasive physiological monitoring
• Thoracentesis

b. Knowledge Base

Demonstrate understanding of the etiology, pathophysiology, diagnosis, treatment and complications of:

• Respiratory Failure, different types/modes of ventilation and weaning
• Cardiac emergencies including cardiac arrest, arrhythmias, ischemia, infarct, failure, tamponade and severe hypotension/hypertension
• The different types of shock
• Neurological disorders including coma, cerebrovascular accidents,status epilepticus, raised intra-cranial pressure
• Sepsis
• Acid-Base, fluid and electrolyte disorders
• Renal Failure – acute and chronic and management of renal failure
• The “acute abdomen”, GI hemorrhage, bowel obstruction and hepatobiliary disease
• Coagulation disorders
• Anemia and Blood products replacement therapy
• Nutrition for the critically ill patient: enteral and parenteral
• Hypothermia – implications, complications and management
• Intoxications – diagnosis and management
• Transportation of the critically ill patient
• Ethical and legal aspects of Critical Care Management

c. Complete a patient assessment (e.g. history, physical examination) that is relevant to the patient condition, recognizing all major significant findings

d. Use all of the pertinent information to arrive at complete and accurate clinical decisions; orders the appropriate investigations and develop an appropriate therapeutic plan.

e. Recognize and manage any complications that arise. Provides thorough handover of all patients being transferred out of the Intensive Care Unit or to the next shift.

2. Communicator:

At the end of the rotation, the FPA resident will be able to:

• Establish effective relationships with patients and families of the patients
• Listen effectively
• Obtain and synthesize relevant history from patients/families/communities
• Discuss appropriate information with patients/families and the health care team
• Produce appropriate and concise written documentation in the patient healthcare record

3. Collaborator:

At the end of the rotation, the FPA resident will be able to:

• Consult effectively with other physicians and health care professionals
• Contribute effectively to interdisciplinary team activities

4. Manager:

At the end of the rotation, the FPA resident will be able to:

• Allocate finite health care resources wisely
• Work effectively and efficiently in a health care organization
• Utilize information technology to optimize patient care and to life-long learning
• Utilize personal resources effectively to balance patient care, learning needs and outside activities

5. Health Advocate:

At the end of the rotation, the FPA resident will be able to:

• Demonstrate a general understanding of the diverse determinants of health, disease and illness, and how occupational/environmental exposures, socio-economic factors and life style factors relate to critical illness
• Demonstrate a general understanding of the structure, function and financing of intensive care units
• Demonstrate an understanding of the importance of medico-legal considerations for the critically ill
• Recognize and respond appropriately in advocacy situations, particularly with regard to patient safety
• Intervene on behalf of patients with respect to their care. Attend to preventative measures

6. Scholar:

At the end of the rotation, the FPA resident will be able to:

• Facilitate the learning of patients/families and other health care professionals
• Develop, implement and monitor a personal learning education strategy

7. Professional:

At the end of the rotation, the FPA resident will be able to:

• Demonstrate an understanding of the moral and ethical issues surrounding the management of critically ill patients and the impact that these issues have on families and critical care providers
• Demonstrate an understanding of the role and the responsibilities of the critical care physician