Inova Fairfax Hospital Surgical Critical Care Service. I. Basic Science Curriculum and ACGME Competencies

Transcription

1 Trauma Acute Care Surgery Inva Fairfax Hspital Surgical Critical Care Service Surgical Critical Care Fellwship Prgram I. Basic Science Curriculum and ACGME Cmpetencies A. Patient Care 1. Cmpassinate Patient Care: Caring and respectful behavir in all interactins with patients and their families Decisin-making abut diagnstic and therapeutic interventins that incrprates patient preferences Cmpassinate end-f-life care in accrd with patients wishes including applicatin f cmfrt care measures and referral t the lcal Organ Prcurement Organizatin Use f the Animal-Assisted Care Prgram fr critical care patients 2. Apprpriate Patient Care: Gathering essential and accurate infrmatin abut patients Diagnstic and therapeutic interventins based n patient infrmatin and preferences, up-t-date scientific evidence, and clinical judgement Develpment and presentatin f patient management plans Indicatins and cntraindicatins fr varius medicatins used in the preparatin and perfrmance f prcedures Multidisciplinary runds and crdinatin f patient care in cnjunctin with residents, students, and ther health prfessinals 3. Technical Skills in Patient Care: See Sectin VIII.B f this PIF B. Medical Knwledge 1. Clinical and Basic Science Knwledge Understanding f the physilgy, pathphysilgy, diagnsis, and therapy f disrders f the fllwing systems as a whle, with special attentin t the listed subcategries listed (where applicable): Cardivascular: Shck states (hemrrhagic and hypvlemic, septic, neurgenic, cardigenic) Use f vaspressrs and intrpes

2 Page 2 Cardivascular mnitring interpretatin as it relates t cardiac physilgy, and treatment f hemdynamic instability based n physilgical parameters. Cardipulmnary resuscitatin and ACLS Respiratry Mechanical ventilatr management including varius mdes f ventilatin Nninvasive ventilatin techniques Arterial bld gas and mixed venus xygen saturatin interpretatin Physilgy, pathphysilgy, diagnsis, and management f Acute Lung Injury and Acute Respiratry Distress Syndrme Gastrintestinal Ileus and bstructin Intraabdminal infectins Stress gastritis, ulceratin, and gastrintestinal bleeding Abdminal cmpartment syndrme Enteric fistula Open abdmen management including perfrming dressing changes (vacuum assisted clsure), washuts, prper tissue handling, drain placement, and patient psitining Geniturinary Acute renal insufficiency and failure Fluid and electrlyte hmestasis and derangements Traumatic injuries: kidneys, ureters, bladder, urethra Neurlgical Traumatic brain injury Intracranial pressure and cerebral perfusin pressure interpretatin and treatment Spinal crd injuries and syndrmes Nn-traumatic cerebral hemrrhage and infarctin Seizures Ventriculperitneal and ventriculpleural shunts Endcrine Neurgenic and nephrgenic diabetes insipidus Adrenal insufficiency, testing, and treatment Thyrid disrders in the ICU Musculskeletal Extremity and pelvic trauma Cmpartment syndrme Rhabdmylysis Immune systems The inflammatry respnse t trauma and critical illness, including the Systemic Inflammatry Respnse Syndrme Nutritin inva.rg

3 Page 3 Nutritinal assessment and supprt using enteral and parenteral feeding Estimate daily energy requirements using metablic rate equatins Infectius diseases Hspital-acquired infectins including ventilatr-assciated pneumnia, catheter-assciated urinary tract infectin, catheterrelated bld stream infectin Sepsis Necrtizing sft tissue infectins Meningitis and ventriculitis Metablic, nutritinal, and endcrine effects f critical illness Hematlgic and cagulatin disrders Cagulpathies in the intensive care unit including the acute cagulpathy f trauma, disseminated intravascular cagulatin, and cagulatin disrders due t anticagulant drugs, sepsis, brain injury, vitamin K deficiency, cirrhsis, renal failure, acidsis and hypthermia, and cmmn cngenital disrders Use and interpretatin f basic labratry cagulatin tests including the thrmbelastgram Reversal f anticagulatin medicatins Heparin-induced thrmbcytpenia Transfusin-related acute lung injury Venus thrmbemblism Critical bstetric and gyneclgic disrders Trauma, thermal, electrical, and radiatin injuries Inhalatin and immersin injuries Mnitring and medical instrumentatin Critical pediatric surgical cnditins Demnstrate knwledge f rgan dnatin prcesses Understand the prcesses f dnatin after brain death and cardiac death Perfrm accurate and timely brain death examinatin and declaratin Recgnize clinical triggers fr OPO ntificatin Maintain physilgic stability f brain dead patients wh are designated as rgan dnrs Pharmackinetics and dynamics f drug metablism and excretin in critical illness Bistatistics and experimental design Age-related physilgic changes and unique characteristics f managing elderly critically ill patients 2. Leadership and Administrative Knwledge Acquire experience in the principles and techniques f administratin and management f an intensive care unit, including wrking with inva.rg

4 Page 4 multidisciplinary health care persnnel in achieving crdinated and cperative management f the ICU. Thrugh leadership and teaching, demnstrate understanding f the significance f the natural histry f surgical critical disease, the cnsequences f surgical critical care (bth psitive and negative), and the influence f cntinuity f care upn surgical utcmes Incrprate the knwledge f ethical, legal, ecnmic, and/r scial factrs int the activities f the entire surgical team fr all cmpnents f surgical care. Demnstrate basic skills in mass casualty and internal disaster planning as it relates t ICU resurces including equipment and persnnel C. Practice-based Learning and Imprvement 1. Investigate And Evaluate Patient Care Practices Analyze practice experience using review f systematic data cllectin Analyze practice experience thrugh the prgram s Perfrmance Imprvement Prgram and implement changes based n this experience Use patient management prtcls in the management f specific patients within the larger cntext f the intensive care unit as a whle 2. Appraise and Assimilate Scientific Evidence Relevant t Patient Care Lcate, appraise, and assimilate evidence frm scientific studies related t current patients health prblems Apply knwledge f study designs and statistical methds t the appraisal f clinical studies and ther infrmatin n diagnstic and therapeutic effectiveness Perfrm practice-based imprvement activities Use infrmatin technlgy t manage infrmatin, and access n-line medical infrmatin, in supprt f the fellw s self-educatin Exhibit and recgnize the imprtance f lifelng learning in surgical practice 3. Imprve Patient Care Practices Analysis f persnal practice utcmes t imprve patient care. Perfrmance f practice-based imprvement activities Perfrm and participate in research activities related t surgical critical care D. Interpersnal and Cmmunicatin Skills 1. Demnstrate the effective exchange f infrmatin between, and cllabratin with, patients, their families, and ther health prfessinals Engage in multidisciplinary ICU runds Demnstrate ability t perfrm cncise and effective handff f patient care t and frm ther health prfessinals Include families (and patients if applicable) in daily patient runds and be able t relay pertinent medical infrmatin in understandable language, inva.rg

5 Page 5 E. Prfessinalism F. Systems-based Practice cnfirm the familys and/r patients understanding, and answer their questins Demnstrate effective teaching skills in teaching surgical critical care t ther health prfessinals, in particular residents and students Create and sustain therapeutic and ethically sund relatinships with patients and families Effectively and prmptly dcument patient care and practice activities Present all patients and cnference material in a cncise, rganized, lgical, and knwledgeable manner Utilize input frm all cllabrative interactins with all persnnel cntributing t the surgical patient care Exhibit surgical team leadership Evaluate the perfrmance and cmpetence f all members f the surgical residency team Demnstrate respect, cmpassin and integrity in all prfessinal interactins; a respnsiveness t the needs f patients and sciety that supersedes self-interest; accuntability t patients, sciety and the prfessin; and a cmmitment t excellence and nging prfessinal develpment Demnstrate a cmmitment t ethical principles pertaining t prvisin r withhlding f clinical care, cnfidentiality f patient infrmatin, infrmed cnsent, and business practice Demnstrate sensitivity and respnsiveness t patients culture, age, gender, and disabilities Cmplete required administrative respnsibilities (evaluatins, recrding hurs, chart dcumentatin, medical recrd dictatins, etc.) in a timely manner Maintain psitive prfessinal relatinships Demnstrate accuntability fr actins and decisins Present ne s physical demeanr in a prfessinal manner thrugh basic hygiene and apprpriate attire Admirably represent the surgical prfessin in all prfessinal interactins 1. Awareness and Respnsiveness t the Health Care System Understand hw patient care and ther prfessinal practices affect ther health care prfessinals, the health care rganizatin, and the larger sciety; Understand hw these elements f the system affect their wn practice Knw hw types f medical practice and delivery systems differ frm ne anther, including methds f cntrlling health care csts and allcating resurces Learn the basic methds f critical care cding and billing 2. Utilizatin f System Resurces inva.rg

6 Page 6 Practice cst-effective health care and resurce allcatin that des nt cmprmise quality f care. Use critical care prtcls t manage patients within the larger cntext f critical care at the hspital level and health system level Advcate fr quality patient care and assist patients in dealing with system cmplexities Partner with health care managers and health care prvides t assess, crdinate, and imprve health care and understand hw these activities can affect system perfrmance II. Clinical Cmpnent A. Tpic Outline and Teaching Methds (PR IV.A.2.b).(1)) All Surgical Critical fellws must be prvided with a structured curriculum in the fllwing areas. Dente hw each area is taught using the fllwing chart: Cardirespiratry resuscitatin Physilgy & pathphysilgy f majr rgan systems Metablic & cagulatin disrders Hematlgic & cagulatin disrders Critical bstetric and gyneclgical disrders Trauma, thermal, electrical & radiatin injuries Inhalatin and immersin injuries Mnitring and medical instrumentatin Critical pediatric surgical cnditins Drug metablism and excretin in critical illness Ethical and legal aspects f SCC Patient Management Cnference/ Lectures Self-directed study Cmputer/ AV Other Jurnal club ICU Nursing instructin Runds with pharmacist present inva.rg

7 Page 7 Principles f administratin and management Bistatistics an experimental design Interactin with ICU med directr Research meetings B. Clinical Skills Required (PRIV.A.2.a).(1)) All SCC residents must be prvided with supervised clinical educatinal experiences in the fllwing skills. Cnfirm which are prvided. 1. Airway management Endscpy (brnchscpy, direct laryngscpy. ( ) YES ( ) NO 2. Circulatry Invasive mnitring... ( ) YES ( ) NO Nn-invasive mnitring... ( ) YES ( ) NO Transesphageal and pericardial ultrasund... ( ) YES ( ) NO Transvenus pacemaker... ( ) YES ( ) NO Cardiac utput... ( ) YES ( ) NO Systemic and pulmnary vascular resistance... ( ) YES ( ) NO Electrcardigram... ( ) YES ( ) NO Cardiac assist devices... ( ) YES ( ) NO 3. Neurlgical Cmplete neurlgical examinatin... ( ) YES ( ) NO Intracranial pressure mnitring... ( ) YES ( ) NO Electrencephalgram... ( ) YES ( ) NO Hypthermia in cerebral trauma... ( ) YES ( ) NO 4. Renal Evaluatin f renal functin... ( ) YES ( ) NO Peritneal dialysis and hemfiltratin... ( ) YES ( ) NO Hemdialysis... ( ) YES ( ) NO 5. Gastrintestinal GI intubatin... ( ) YES ( ) NO Endscpic techniques... ( ) YES ( ) NO Enteral feeding... ( ) YES ( ) NO Stma, fistula and percutaneus catheter drainage... ( ) YES ( ) NO Measurement f bladder pressures... ( ) YES ( ) NO 6. Hematlgic Auttransfusin... ( ) YES ( ) NO Cagulatin status... ( ) YES ( ) NO Cmpnent therapy... ( ) YES ( ) NO 7. Infectius disease Islatin technique... ( ) YES ( ) NO Drug therapy with rgan failure... ( ) YES ( ) NO Nscmial infectins... ( ) YES ( ) NO inva.rg

8 Page 8 Hyperbaric xygen therapy... ( ) YES ( ) NO 8. Nutritinal Parenteral & enteral... ( ) YES ( ) NO Assessing metablism and nutritin... ( ) YES ( ) NO 9. Mnitring Use & calibratin f transducers, amplifiers and recrders... ( ) YES ( ) NO inva.rg