Competency Based Curriculum

Program: Internal Medicine

Program Director: Mohamed Siddique, MD

Specialty/Course: Medical Intensive Care Rotation for PGY-2 & 3

Curriculum Coordinators: 1. Hassan Makki, MD

Administrative Support: Robin Pastorius

Date Revised: 02/04/2009

Competency	Objectives Specific	Educational Experiences Knowledge/ Skills Integration/Application	Assessment Tools
Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health	1. Learner based learning. Residents should be able to examine patients efficiently and accurately 3. Provide residents with an understanding of the social impact of critical illness and the contribution of patient behavior to these problems. 4. The resident should understand the appropriate ordering and performance of diagnostic studies 5. Residents should be able to supervise interns for patient care and procedures.	1. Assesment of patients with critical illness. 2. Integration of the history, physical examination and laboratory data along with imaging. 3. Case Presentation to ICU attending. 4. Daily management of critically ill patients with emphasis on recognition of change in the condition of patients in the critical care unit and implementation of management’s decision under the direct supervision of an ICU Attending. 5. On call Cross coverage of all ICU pts.	Rotation evaluation by ICU attending 2. RN evaluation
Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care	Demonstrate working knowledge of initial therapy for common and serious medical problems Commitment to continuous learning Develop comprehensive understanding of complex medical problems 4. Demonstrate analytical thinking	1. Critical Care Attending will hold teaching rounds on a daily basis. 2. Residents will be asked to review the literature and share their readings with the Critical Care Team. 3. Directed Reading	1.Rotation evaluation by ICU attending 2.RN evaluation
Interpersonal and Communication Skills That result in effective information exchange and teaming with patients, their families, and other health professionals	Communicate effectively with attending faculty Demonstrate effective patient/family interviewing skills Establish excellent relationships with patients/families Able to educate and counsel patient/families Improve listening skills Able to maintain comprehensive, timely, legible medical records	1. Interaction with families of patients who are critically ill Post call and management rounds by the Critical care attending. Interaction with Sub-specialty attendings and other services.	1. Rotation evaluation by ICU attending 2. RN evaluation .
Professionalism As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population	Treat patient and families with respect and consideration Treat nursing and other health care professional with respect Understand issues of race, religion, sexual orientation, disability, age, culture, gender etc. in patients and other health care providers Always respect patients’ autonomy Serve the interest of the patients Maintain trust by managing conflicts of interest Always be honest with patients Always maintain patients’ confidentiality Strive to improve patients’ quality of care 10. Maintain appropriate relations with patients	Daily interaction with health care professionals Peer-group discussion Faculty Role modeling 4. Interaction with families of patients who are critically ill	Monthly rotation evaluation by attending RN evaluation
Practice-Based Learning and Improvement That involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care based on constant self-evaluation and life-long learning.	Learn to accept feedback from others Regularly self-assess Use information technology to manage information, access on-line medical information and support their own education on a regular basis 5.Facilitate learning of others	Post call and management rounds by the Critical care attending. Use of standard order sets/clinical pathways to promote optimal cost effective care Self-directed inquiry Interactive computer programs	1.Rotation evaluation by ICU attending
Systems-Based Practice As manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide optimal health care.	Participate efficiently in multidisciplinary discharge planning Practice cost-effective care Learn to minimize patient care errors 4. Advocate for patients within the health care system	Daily interaction with nurse care coordinator Multidisciplinary health care team rounds Net learning M & M conference	Monthly rotation evaluation by attending

Resource Materials

Recommended Textbooks:

o The ICU book by Marino (publishers: Lea and Febiger)

o The ICU manual :Dept Of Medicine.

o Textbook of Critical Care by Schoemaker, Ayers, Grenvik Holbrook (publishers: Sanders)

o Critical Care Medicine-The Essentials by Marini and Wheeler (publishers: Williams and Wilkens)

o Essentials of Critical Care Pharmacology by Chernow (publishers: Williams and Wilkens)

o Intensive Care Radiology: Imaging of the Critically Ill by Goodman and Putman (publishers: Saunders)

o Procedures and Techniques of Intensive Care Medicine by Rippe, Irwin, Fink, Cerra, Curley, Heard (publishers: Little, Brown)

SCHEDULE

The daily schedule provided here is followed as strictly as possible. Unit coverage is maintained seven days a week. In the event that resident clinics fall on the same day, arrangements will be made to alter the schedule so at least one resident is always in the unit.

Starting time is 7:00 a.m. All rotators will check the progress of their respective patients, take on new patients admitted during the night, and gather data to present on rounds. New patients will be assigned to the on call resident starting at 7:00 a.m. Calls are every fourth day. All post call teams are to sign off their unfinished work to the on-call team once their 30 hour work limit is reached. Day offs are arranged as per the resident’s and Attendings preferences so that each resident and Intern do get 4-5 day offs over this 1 month rotation

PATIENT CARE ROUNDS

Rounds begin between 7.30 a.m. and 8:00 a.m. and are primarily work related. This time serves for the entire team to determine each patient's progress and outline a daily plan. Orders are entered during rounds and brought to the attention of the nurse so they may be instituted in a timely fashion.

MORNING REPORT

This is a mandatory conference which begins at 9:30 a.m. The ICU staff makes every effort to complete work rounds by 9:30 a.m. so the team may attend morning report. However, patient acuity may preclude members of the team from attending the conference.

X-RAY ROUNDS

X-ray rounds will begin after morning report, All new and as needed old x-rays are reviewed with the ICU attending and management plans made accordingly.

ICU TEACHING CONFERENCES

Conferences are multi-disciplinary involving physcians, students and nursing personel. They are in the form of didatic lectures two or three times per week around 11 a.m.-12 p.m.. A list of topics to be covered in these lectures is provided in the ICU manual at the beginning of the month. Patient care issues and bedside discussions occur daily based on individual patient needs and questions that arise during rounds.

ADDITIONAL CONFERENCES

Sub-speciality conferences, medical grand rounds, and x-ray conference are all mandatory. These conferences are announced at the beginning of the month so that attendance can be optimal.

AFTERNOON CHECK - OUT ROUNDS

Check out rounds are made with the entire team reporting to the on-call resident usually between 3.00p.m. and 4.00 p.m. The ICU attending on-call, may or may not be present for these rounds. If the attending is not available for the sign out rounds, he will contact the appropriate on-call resident and discuss the plan for the night. It must be remembered that since unit coverage is maintained 24 hours a day, plans which were initiated during the day that have not been completed by sign out rounds will be continued and followed up throughout the remainder of the day and night. It is the responsibility of the on-call team to insure that these plans are carried out.

IMPORTANAT TOPICS COVERED DURING ROTATION AT BEDSIDE AND DIDACTIS.

Cardiopulmonary arrest

Hypertensive Emergency

Shock

Respiratory Failure

Gastrointestinal Bleeding

Coma and its management

Seizures

Drug overdose and poisoning

ARDS

Pulmonary thromboembolism

Hepatic failure and other life threatening diseases

Aortic dissection

Gastrointestinal bleeding (upper and lower)

Status epilepticus

Disorders of temperature regulation

o Hypothermia

o Hyperthermia

Cerebrovascular accident/subarachnoid hemorrhage

Meningitis

Diabetic ketoacidosis, hyperosmolar nonketotic coma

Endocrine emergencies including: thyroid storm, myxedema, Addisonian crisis

Disseminated Intravascular Coagulopathy

Hypoxemia and hypoventilation

Severe acid-based abnormalities

Pressors, Paralytics, Analgesia

Special skills and techniques

Establishment and maintenance of open airway in nonintubated, unconscious, paralyzed patients

Pressure-cycled, volume-cycled, time-cycle and flow-cycled mechanical ventilation

Use of reservoir masks and continuous positive airway pressure masks for delivery of supplemental oxygen, humidifiers, nebulizers, and incentive spirometry

Weaning and respiratory care techniques

Management of pneumothorax (needle insertion and drainage systems)

Maintenance of circulation

Arterial puncture and blood sampling

Insertion of central venous and arterial catheters

Basic and advanced cardiopulmonary resuscitation

Cardioversion

Calibration and operation of hemodynamic recording systems

Ventilatory support, weaning, and respiratory care techniques