Department of Anesthesiology
Division of Critical Care

Fellow Education

Please evaluate the critical care fellows at the end of your week working with them, in centricity or using the accompanying form.

Please evaluate their performance based on the 6 core competencies, where applicable. These include (and are listed in centricity forms);
        
The following overall objectives, arranged by general competencies, apply to all anesthesia critical care fellows during all rotations.  Methods used to assess those competencies are listed in parentheses after item.

A.     Medical knowledge. Medical knowledge is obtained by participating in direct patient care in the ICU and during clinical electives, attending didactics including core critical care lectures and supervision, doing reading, asking questions and participating in the Society of Critical Care Medicine’s Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP). (Medical knowledge is assessed by clinical supervision, discussion during didactics, Tri-annual checklist evaluation of core competencies, MCCKAP exam, and ultimately by passing the critical care boards.)

Specific objectives:

1. To be familiar with the epidemiology and risk factors for commonly encountered critical care conditions including the systemic inflammatory response syndrome (SIRS), Sepsis and multiorgan dysfunction, common causes of shock and hemodynamic instability, Acute Lung Injury, ARDS, Acute Renal failure, Nosocomial infections, acute bleeding. Knowledge of epidemiology also includes:
2. Relative prevalence rates and risks for individuals based on previous clinical conditions, type of surgical or procedural interventions, demographics such as age, gender.
3. General statistics ICU related morbidity, mortality, and costs to society, the healthcare system.
4. Precise knowledge of Advanced Cardiac Life Support and ability to direct emergent/Code scenarios in a variety of clinical settings.
5. To know the signs, symptoms, clinical course, complications and treatment of  common post-operative conditions for general, thoracic, vascular, cardiac, urologic, orthopedic, neurosurgical and other surgical specialty operations.
6. Advanced management of specialized patient populations including post-cardiotomy, mechanical support devices including extra-corporeal life support (ECMO), Solid organ transplantation.
7. To have a comprehensive understanding of the pharmacology of all commonly used medications in an ICU and other monitored clinical settings including;
1. Sedative, analgesic and muscular relaxant drugs.
2. Hemodynamic support with vasoconstrictors, inotropic agents and antihypertensive agents.
3. Other specialized medications that are commonly only used in monitored settings including insulin drips, thrombolytics, some anti-rejection induction agents, antiarrthmic agents.
8. To understand the role, principles and limitations of Physiologic monitoring, Diagnostic laboratory & radiological tests commonly used in the critical care setting including;
1. Indications, techniques for placement, complication recognition & management of invasive intravenous catheters including arterial lines, central lines, introducers, cavity drains and thoracostomy tubes
2. Knowledge of common chest radiographical interpretation especially for location of intravenous/arterial catheters and airway tubes
3. Knowledge of common laboratory tests including blood chemistries, microbiology interpretation.
9. To be familiar with current guidelines and standards of care developed by relevant medical organizations such as the Society of Critical Care Medicine, the American Boards of Anesthesiology & Surgery.

B.        Patient Care (Patient care is assessed by clinical supervision, 360 degree evaluation, Tri-annual checklist evaluation & procedure logs.)

1. Fellows will gather essential and accurate information by performing complete and clinically-relevant history and physical exams.
2. Fellows will understand how to order and interpret appropriate diagnostic tests.
3. Fellows will make informed diagnostic and treatment decisions by analyzing and synthesizing information.
4. Fellows will understand the limits of their knowledge and expertise and will use consultants and referrals appropriately.
5. Fellows will develop and carry out care plans as well as develop superb communication abilities.
6. Fellows will perform a variety of invasive procedures competently including the ability to correct complications resulting from these procedures.
7. Fellows will routinely participate in conversations with family members to gather other clinical information, understand patient’s and families wishes.
8. Fellows will become competent in palliative care and end of life discussions
9. Appropriate and timely coordination for the safe transport of critically ill patients from other health care centers to the appropriate ICU setting to or from the University of Michigan.

C.  Practice-Based Learning and Improvement (Assessed by review of procedure  logs, follow-through on questions posed during supervision, attendance at didactics, performance as discussion leader at Journal Club and other presentations, review of clinical practice during M&M and review of Tri-annual evaluations.)
1.  To keep logs of all major procedures including difficult airway, bronchoscopy, ECHO exams, and specialized patient situations; ECMO, ventricular assist devices.
2.  To use current evidence-based practice guidelines, and to obtain supervision when existing guidelines require supplementation with experience-based practices for individual cases.
3.  To access and use on-line medical information as pertains to patients’ diagnosis and treatment in the form of reference texts, searches, electronic journals such as UpToDate, Web MD’s e-Medicine and other networked resources as made available through the University of Michigan Health System Medical Library (http://www.lib.umich.edu/medsearch/).
4.   To critically read and discuss the relevant scientific literature presented in Journal Club, for example) while seeking application to actual practice.
5.    To facilitate the learning by other health care professionals and trainees with regard to substance-related disorders.  The type of health care professional and trainee will vary with the specific rotation.

4. Interpersonal and Communication Skills (Assessed by evaluations of supervising faculty during patient care rounds or elective consultation services, 360-degree review from clinical work sampling; chart review; presentation skills, and contributions during team meetings.)

1. Fellows will exhibit communication that is characterized by socio-cultural effectiveness.
2. Fellows will demonstrate the ability to develop highly effective therapeutic relationships with patients and families.
3. To establish collaborative and effective working relationships with other staff members involved in patient care including supervisors, nurses, physician extenders (NPs, Pas), respiratory therapists, pharmacists, dieticians other physicians and trainees.
4. To function effectively as a team member and leader such as in the multidisciplinary team meeting.
5. Fellows will communicate respectfully and effectively with other health professionals.
6. Fellows will be able to act in a consultative role to other physicians and health professionals.
7. Fellows will maintain comprehensive, timely, effective, and legible medical records.

           
E.  Professionalism (Assessed by evaluations of supervising faculty during patient care rounds or elective consultation services, 360-degree review from clinical work sampling; chart review; presentation skills, attendance & contributions during team meetings.

1. Fellows will document all relevant diagnostic and treatment encounters with patients through effective medical record keeping.
2. Fellows will demonstrate accountability, reliability, and punctuality during performance of all responsibilities and duties.
3. Fellows will demonstrate a balance between independence and recognition of limits of competence/experience
1. Heightened awareness when engaged in procedures with higher than average complexity including difficult airway management, invasive lines in patients whose underlying conditions/physiognomy increase risk ie coagulopathy, morbid obesity, previous interventions .
4. Fellows will conduct oneself in an ethically and legally sound manner with respect to issues such as maintenance of treatment boundaries, patient confidentiality, informed consent, provision or withholding of clinical care, and good business practices.

F.  Systems-Based Practice (Assessed by clinical supervision, compliance with program and institutional policies and procedures, and completion of University of Michigan Health System mandatories.)

1. To understand the managed care of critically ill and post surgical patients, and how one tailors a patient's treatment to the resources available without compromising quality care.
2. To understand the quality improvement process and how to partner with health care managers and providers to assess, coordinate and improve care.
3. To develop awareness of cost-effectiveness issues with post-operative and/or clinically unstable patients, and how these are managed in different treatment settings such as a surgical ICU, PACU, other ICU or step-down unit.
4. To act as a patient advocate for helping patients and families navigate through sometimes complex and bureaucratic systems related to their health-care needs, patient wishes and resources available.
5. To appreciate the necessity and rationale for various program policies and procedures.