Department of Anesthesiology
Division of Critical Care
Resident Education
Goals and Objectives
Education Goals, Objectives & Evaluation policy of the ICU Rotations
The Goals and objectives of the University of Michigan Critical Care Training Program are based on the Guidelines for critical care medicine training and continuing medical education developed by the American College of Critical Care Medicine {Crit. Care Med. 2004;32:263-272}. On completion of an ACGME-approved graduate education program in a clinical specialty of medicine such as anesthesiology, each resident physician will have developed a measurable quantity of knowledge, learned a set of observable skills, demonstrated adequate decision making, and possess a caring and compassionate attitude for patients who are critically ill. Attainment of these goals is not to be necessarily misconstrued as conveying the ability to be an independent practitioner for critically ill or injured patients. Specifically, on completion of an ACGME-approved graduate education program, each resident physician will be able to perform the following:
General Goals of the Critical Care Rotations
Medical Student:
1. Familiarize yourself with the cognitive and procedural skills necessary to provide optimal care to patients admitted to an Intensive Care Unit and/or patients with severe physiologic derangements in the perioperative setting.
2. Gain experience with acquiring and presenting clinical data through the direct management of hospitalized patients.
Anesthesia Intern & CA-1 Level:
1. Develop the cognitive and procedural skills necessary to provide optimal care to patients admitted to an Intensive Care Unit and/or patients with severe physiologic derangements in the perioperative setting.
2. Achieve proficiency in the acquisition and presentation of complex clinical data for groups of patients.
3. Achieve proficiency in the recognition and management of problems commonly encountered in the ICU.
4. Gain experience with longitudinal care for patients with complex medical conditions.
CA-2 & CA-3 Level:
1. Refine proficiency in the recognition and management of problems commonly encountered in the ICU.
2. Refine ability to provide longitudinal care for cohorts of patients with complex medical conditions.
3. Gain experience with the supervision of a team of health care providers; ie medical students, residents, nurses, respiratory therapists etc.
4. Develop more sophisticated knowledge of critical care principles, monitoring and therapeutic technologies, and specifically improved understanding of peri-operative management for cardio-thoracic patients.
5. Provide opportunities to develop teaching and research skills.
Specific Goals and Educational Objectives
Clinical.
1. Identify when a patient requires treatment best delivered in an ICU under the direction of a qualified intensivist.
2. Diagnose and stabilize patients with impending organ failure (respiratory, cardiac, neurologic, hepatic, gastrointestinal, hematologic, renal, etc.).
3. Identify the need for and initiate cardiopulmonary resuscitation.
4. Diagnose and prevent hemodynamic instability and/or initiate treatment for cardiogenic, traumatic, hypovolemic, and distributive shock.
5. Identify and initiate treatment for life-threatening electrolyte and acid-base disturbances.
6. Use data from appropriate invasive and noninvasive monitoring devices to titrate therapy in an ICU.
7. Understand basic infection control techniques.
8. Understand basic nutrition support principles.
9. Understand basic sedation and analgesia principles.
10. Understand basic concepts of therapeutic decision making and medication safety.
11. Consider ethical issues and patients’ wishes in making treatment decisions including end of life and quality of life issues.
Administrative.
1. Communicate effectively with families and all members of the healthcare team about ICU capabilities and patient-specific issues.
2. Communicate with and support patients, their families, and all members of the healthcare team through the physical and psychological complexities of critical illness.
3. Seek consultation, when appropriate, with specialty physicians in managing complex ICU problems.
4. Recognize, use, and help integrate the unique skills of ICU nurses and ancillary personnel in caring for critically ill patients into the multiple-professional team model.
5. Maintain good relationships with other healthcare providers.
6. Understand the need for patient safety monitoring and error reduction strategies.
7. Familiarize with compliance with institutional and unit policies and procedures as well as regulatory policies from accreditors, regulators, and payers.
Technical Skills
In addition to practical training in the following procedural skills, the resident must have an understanding of the indications, contraindications, complications, and pitfalls of these interventions. Due to the variability of individual training programs, practical experience may be limited for some procedures.
Airway Management
a. Maintenance of an open airway in the nonintubated patient
b. Ventilation by bag-mask
c. Tracheal intubation including use of specialized airway techniques including LMAs, Bougies, Light Wands, Fiberoptic intubation as well as Airway issues unique to critical care (tracheostomy management)
d. Management of pneumothorax
Circulation
a. Arterial puncture and cannulation
b. Insertion of central venous catheters including temporary dialysis catheters
c. Pulmonary artery catheterization
d. Temporary transvenous pacer catheters
e. Dynamic electrocardiogram interpretation
f. Cardioversion and defibrillation
g. Transcutaneous pacing
h. Electrocardiographic monitoring
i. ACLS Algorithms and managing acute ‘code’ situations as the ICU code team leader
----Additional Procedures----
j. Thoracentesis
k. Paracentesis
l. Bronchoscopy
m. Pericardiocentesis in acute tamponade
n. Opening a fresh sternotomy during a post cardiac ‘code’ situation