THE UNIVERSITY OF BRITISH COLUMBIA Department of Urologic Sciences Faculty of Medicine Gordon & Leslie Diamond Health Care Centre Level 6, 2775 Laurel Street Vancouver, BC, Canada V5Z 1M9 Tel: (604) 875-4301 Fax: (604) 875-4637 ICU Rotation Goals & Objectives for Urology Residents During the two block rotation in ICU, the urology resident will participate in the care of critically ill patients and work with physicians, surgeons, nurses and allied health personnel with special knowledge of critical care medicine. The following is an outline of general objectives for the urology resident during this rotation. General Objectives 1. To gain an understanding of the integrative nature of disease in the critically ill patient and the interdisciplinary approach to the management of such patients. 2. To understand the pathophysiology of common conditions in critically ill patients. 3. To become familiar with the principles of airway management and ventilator care. 4. To become comfortable in the management of a cardiac arrest and the acute resuscitation of a traumatized or acutely ill patient. The urology resident should try to participate in the care of patients so that they are able to gain experience and knowledge in the following areas: Initial Assessment of the Critically Ill 1. Obtain an appropriate history from a patient, family or other medical personnel. 2. Perform a problem oriented physical examination. 3. Identify problems in order of priority. 4. Outline a plan of management, in conjunction with ICU Fellow or Consultant. 5. Institute appropriate investigations and treatment under the supervision of an ICU Fellow or Consultant.
During the ICU rotation, it is expected that the urology resident will demonstrate knowledge in the following areas. It is also expected that the urology resident will recognize the severity of illness in patients with these conditions, provide emergency support when required and follow up with an appropriate diagnostic and management plan. Coma and other neurological problems 1. The pathophysiology of coma and raised intracranial pressure (ICP). 2. The investigation of coma, raised ICP and the monitoring techniques involved. 3. The available treatment for cerebral resuscitation and management of raised ICP. 4. Metabolic, structural and infectious causes of altered level of consciousness. 5. Brain death. Respiratory failure 1. The pathophysiology of disease states leading to respiratory failure, including hypoxemic and hypercarbic respiratory failure. 2. An approach to the management of the airway. Renal preservation and support 1. Ability to distinguish between prerenal, renal and postrenal failure. 2. Pathophysiology, diagnosis, and treatment of serious acid-base disorders. 3. Pathophysiology, diagnosis and treatment of serious fluid and electrolyte disorders. 4. Knowledge of the interaction between drugs, nephrotoxins and the kidneys in both normal and diseased states. 5. Indication and understanding of intermittent hemodialysis and CVVHDF. Trauma 1. The need for continuing care of the traumatized patient with regard to all vital systems, whether or not these systems have received the primary trauma. 2. The secondary insults that enhance the primary pathogenicity of traumatized organs. 3. The short and long term predictable sequelae and complications of traumatized patients.
Hematological abnormalities and blood replacement 1. The immunocompromised host and the diseases and treatment unique to the immunodeficient state. 2. Blood component therapy and indications for transfusion in the ICU. Sepsis 1. Available diagnostic techniques for infectious organisms. 2. Epidemiology of infectious disease. 3. Techniques to control and limit infections, specifically and approach to the septic patient in terms of foci of infection and source control. 4. Approach to ICU nosocomial infections, specifically ventilator associated pneumonia (VAP) and central line infections. 5. The understanding of the systemic inflammatory response syndrome and multiple organ dysfunction. 6. The pharmacology, indications, complications, interactions, monitoring and efficacy of antimicrobial agents including antibiotics, antifungals, antivirals and antiparasitics. Nutrition: Enteral and parenteral 1. Methods of assessing energy requirements and monitoring the effectiveness of nutritional support. 2. The indications, limitations, methods and complications of enteral and parenteral nutrition. 3. The indications, methods, limitations and complications of various access routes for both enteral and parenteral nutrition. Ethical, legal and philosophical considerations (including end of life care) 1. Including consent, power of attorney and alternate decision-makers. 2. Understand how decisions are made regarding end of life care.
Competencies to be assessed Medical Expert: At the completion of the ICU rotation, the urology resident will be: Capable of eliciting a suitable history from patients, families or other health professionals that is relevant to the assessment and care of a critically ill patient Able to recognize the severity of illness and respond in a timely manner to care for critically ill patients Capable of selecting and prioritizing diagnostic tests Capable of performing procedural skills (under appropriate supervision) that are relevant to the care of ICU patients such as placement of arterial lines, central lines and endotracheal intubation. Communicator: At the completion of the ICU rotation, the urology resident will be: Capable of establishing a meaningful therapeutic relationship with patients and families in an emergency setting. This will be achieved by speaking honestly, respectfully and with patience as well as listening effectively Capable of conveying relevant medical information to patients and families in a manner that is understandable and encourages shared decision-making Able to address challenging encounters including delivering bad news Capable of producing verbal and dictated consultations to other clinicians that are thorough but succinct 1. During direct patient care, the residents will have multiple opportunities to assess and speak to patients in the presence of the ICU physician. Issues related to communication will be explicitly discussed and developed with the attending at an appropriate time. 2. All written reports (consults, OR reports, discharge summaries) will be reviewed by the attendings and feedback given.
Collaborator: At the completion of the ICU rotation, the urology resident will: Be capable of describing the roles and responsibilities of other health care professionals that interact with patients and families in the ICU department Understand inter-professional team function and demonstrate that they can work with others to minimize team conflict and optimize patent-centered care Be able to consult effectively with other physicians and health care providers. In particular, the resident will be able to discuss a patient with another physician, on the phone or in person, in a succinct, professional and respectful manner 1. Residents will be required to work closely with nurses, other physicians, patients and families to help patients transit through the health care system. The ICU physician will evaluate their interaction with the various healthcare providers. 2. The residents will receive particular instruction on the importance of clear and constructive communication with other specialists and family practitioners to optimize patient care. Dictated reports and direct verbal communication with referring physicians will be emphasized and carefully discussed between ICU physician and resident. Manager: At the completion of the ICU rotation, the urology resident will understand the role physicians play in: Health care expenditures and have a practical knowledge of cost-appropriate care for common emergency conditions Health care systems (Emergency Services including 911 operators, BC Bed Line, Ambulance services, Paramedical Emergency Services) 1. Using case-based teaching, the resident will receive explicit instruction on the cost effective use of diagnostic tests. 2. Using case-based teaching, the resident will receive explicit instruction on prioritizing patients waiting for assessment and treatment.
Health Advocate: At the completion of the ICU rotation the urology resident will be : Able to advocate health promotion and disease prevention to patients at appropriate moments during an emergency consultation Knowledgeable regarding the availability of community support groups and patient advocacy groups for common medical and surgical conditions Knowledgeable regarding patients at risk for non-compliance and patients with barriers to access of care and be able to address these issues constructively 1. Using case-based teaching as it arises in the course of the clinic; these competencies will be explicitly discussed. 2. Written and verbal reports from the resident will be evaluated by the ICU physician and Health Advocacy issues will be reviewed with feedback given. Professional: During the ICU rotation: The urology resident will demonstrate gracious acceptance of advice and feedback. The urology resident will demonstrate punctuality and commitment to any reasonable deadlines required by the service. The urology resident will demonstrate a commitment to appropriate personal behaviors, personal health and sustainable practice.