ICU Rotation Specific Objectives
Neurosurgery residents at the University of Toronto are required to spend 3 months on an ICU service as part of their PGY2 training. They will rotate to one of the teaching hospitals within the University, most often Sunnybrook Health Sciences Centre, Toronto Western Hospital/Toronto General Hospital, and St Michael's Hospital. The following is a description of the rotation-specific objectives for neurosurgery residents undertaking their ICU rotation:
To develop the clinical skills, professional attitudes, and knowledge base for the practice of surgery through exposure to critically ill medical/surgical disorders. Appreciate the medical management and basic foundations underlying the care of critically ill surgical patients.
The trainee will function as a junior consulting member of the ICU service. Senior residents and attending staff will supervise the trainee and evaluate their progress.
MEDICAL EXPERT/CLINICAL DECISION MAKER
- Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
- Access and apply relevant information to clinical practice.
- Follow protocols implemented in the unit and adhere to established unit standards.
At the end of 12 weeks of ICU rotations the resident will be able to do the following:
- Elicit, present, and document a history that is relevant, concise, accurate and appropriate to the patient's problem(s).
- Perform, interpret the findings of, present, and document a physical examination that is relevant and appropriate.
- Select medically appropriate investigative tools, interpret the results of common diagnostic tests and demonstrate an understanding of their cost effectiveness, limitations and complications.
- Formulate a comprehensive patient problem list, synthesize an effective diagnostic and therapeutic plan and establish appropriate follow up.
- Capable of basic airway management (bag/mask ventilation and uncomplicated intubation)
- Able to place central line with appropriate technique
- Able to place arterial line with appropriate technique
- Understands principles of ACLS and can apply them in a patient resuscitation.
- Able to recognize common rhythm disturbances
- Able to interpret blood gases and assess acid-base status
- Can provide basic ventilator orders for most patients
- Can classify shock and outline hemodynamic patterns
- Awareness of the ethical principles pertinent to critically ill patients especially end of life care, and issues around withdrawing and withholding life support.
- Familiar with airway management and indications for intubation.
- Can use inotropes and vasopressors appropriately
- Can interpret an electrocardiogram and recognize important life-threatening findings.
·Establish a professional relationship with patients and families.
- Obtain and collate relevant history from patients, and families.
- Listen effectively.
- Discuss appropriate information with patients and families and other members of the health careteam.
- Demonstrate consideration and compassion in communicating with patients and families.
- Demonstrate skills in:
- providing clear, concise and timely verbal and written communication as applied to progress notes, sign over of patient care and discharge planning;
- communication with patients and families regarding informed consent, the medical condition, plan of treatment, prognosis, primary and secondary prevention, adverse events, medical uncertainty, medical errors, end of life wishes, autopsy and organ donation
- communication with other health care professionals regarding all aspects of patient care.
- Personally examine and review each of their assigned patients before morning rounds.
- Able to present the history and physical findings of critically ill patients to the attending physician in an organized concise manner.
- Identify the problems in a critically ill patient and generate a problem list.
- Write daily progress notes on assigned patients. The notes are expected to be legible and should identify the relevant daily events and issues for each patient.
- Outline their plan to address the problems identified for each patient with which they are involved.
- Consult effectively with other physicians and health care professionals.
- Contribute effectively to other interdisciplinary team activities.
- Develop an ability to work effectively and harmoniously with other health care workers.
- Identify and describe the role, expertise and limitations of all members of an interdisciplinary team required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility.
- Effectively participate in interdisciplinary rounds, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing personal specialty-specific expertise.
- Utilize personal resources effectively in order to balance patient care, continuing education, and personal activities.
- Allocate finite health care resources wisely.
- Work effectively and efficiently in a health care organization.
- Utilize information technology to optimize patient care, and life long learning.
- Utilize appropriate time management for effective patient care, administrative duties and scholarly activities.
- Implement patient care practices considering available health care resources.
- Able to complete the tasks discussed on rounds in a timely manner.
- Able to seek help appropriately and appreciate their personal limitations.
- Identify the important determinants of health affecting patients.
- Contribute effectively to improved health of patients and communities.
- Recognize and respond to those issues where advocacy is appropriate.
- Educate patients and families about and promote the importance of long-term healthy behaviours and preventive health care (e.g. smoking cessation, screening tests, vaccinations, exercise, and nutrition).
- Respect and empower patient autonomy.
- Promote equitable health care.
- Apply the principles of quality improvement and quality assurance.
- Appreciate the existence of global health advocacy and initiatives for elimination of poverty and disease, (e.g. tuberculosis, malaria, Acquired Immune Deficiency Syndrome), the role of advocacy groups and funding agencies.
- Develop, implement, and monitor a personal continuing education strategy.
- Critically appraise sources of medical information.
- Facilitate learning of patients, students, and other health professionals.
- Should read around their cases and recognize gaps in their knowledge base
- Should be aware of the medical literature in their clinical decision making and understand how to search and critically appraise the medical literature.
- Demonstrate the ability to teach medical students, residents, patients, colleagues and other health care professionals.
- Deliver highest quality care with integrity, honesty and compassion.
- Exhibit appropriate personal and interpersonal professional behaviours.
- Practice medicine ethically consistent with the obligations of a physician.
- Should have exhibited appropriate personal and interpersonal professional behaviours. This includes keeping attending physicians appraised of relevant events, interacting appropriately with the nursing staff, and being available to the unit when needed while on call.
- Recognize, analyze and attempt to resolve in clinical practice ethical issues such as truth telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation, research ethics, interactions with the pharmaceutical industry.
- Recognize and know how to deal with unprofessional behaviours in clinical practice, taking into account local and provincial regulations.
- Evaluate one's abilities, knowledge and skills, recognize one's limitations and use appropriate strategies to maintain and advance professional competence.
- Know and understand the professional, legal and ethical codes to which physicians are bound.