Advanced Clinical ICU Rotation (PGY4/CA3)
Description:
This is a critical care rotation of one-month duration during the PGY-4/CA-3 academic year and serves as an advanced clinical anesthesiology resident rotation. The location of training is at the University of Kentucky Chandler Medical Center, primarily, but not exclusively, in the Cardiothoracic Intensive Care Unit (CTICU). The focus of education for the PGY-4/CA-3 anesthesiology resident will be the acute care management of cardiovascular and respiratory abnormalities of patients in an environment of increased responsibility. The PGY-4/CA-3 resident will have completed at least two months of ICU rotations in the pediatric or adult ICU and at least two months of cardiothoracic anesthesiology prior to this rotation.  Additionally, the PGY-4/CA-3 resident may share responsibility with the Critical Care Attending Staff in educating and supervising the PGY-2 anesthesiology resident on the SICU rotation.  The department of anesthesiology residency program director approves the rotations for individual anesthesiology residents and oversees the rotations provided by each service. The anesthesiology critical care attending staff is responsible for appropriate faculty teaching, over-site, and resident evaluation for this rotation.
Prerequisites:
Residents who have successfully completed the PGY-4/CA-3 year and have performed satisfactorily on a minimum of two months intensive care medicine rotations and two months of cardiothoracic anesthesiology who possess an acceptable level of clinical experience and fund of knowledge to participate in this rotation.
Goals:
The primary goal of the CT ICU rotation, is to provide PGY-4/CA-3 anesthesiology resident physicians with an opportunity to develop the knowledge, skills, experience, judgment, and attitudes to provide optimal care to the critically-ill patient in a learning environment with increased clinical and supervisory responsibility.
At the completion of this rotation, the PGY-4 resident will be able to:
• Obtain a focused medical/surgical history appropriate for CTICU admissions
• Perform a focused physical examination appropriate for CTICU admissions
• Assess CTICU patients' acute medical/surgical conditions
• Make appropriate use of diagnostic studies and tests in the CTICU setting
• Integrate information to develop appropriate differential diagnoses with minimal assistance from the CTICU attending staff
• Implement treatment plans for patients in the CTICU
• Perform technical procedures including arterial line placement, central venous line placement, pulmonary artery catheterization, emergent airway management/intubation with minimal assistance from the CTICU attending staff
• Develop ventilator optimization and weaning strategies based on ventilator-derived, hemodynamic, laboratory and radiographic information
• Understand and effectively utilize data from invasive hemodynamic monitors such as the central venous or pulmonary artery catheters
• Apply an understanding of respiratory and cardiovascular physiology to the care of patients in the CTICU
• Understand the role of TTE and TEE in the critical care of surgical patients
• Lead clinical rounds and, when applicable, provide junior residents and nursing staff with didactic information pertinent to the care of patients in the CTICU
Educational Objectives:
(1) Patient Care
• Provide patient care that is compassionate, appropriate, and effective for CTICU patients and their families
• Demonstrate the ability to obtain a focused history appropriate for CTICU admissions
• Perform a focused physical examination appropriate for ICU admissions
• Integrate information to develop appropriate differential diagnoses
• Develop and implement an acute care treatment plan with minimal assistance from faculty
• Be able to effectively lead discussions on teaching rounds
• Be exposed to and develop experience with cardiopulmonary resuscitation, central venous and arterial catheters, mechanical support of ventilation, pharmacologic support of circulation, fluids/transfusion therapy, and nutritional therapy
(2) Medical Knowledge
• Understand the pathophysiology and management of cardiothoracic critical care conditions including: respiratory insufficiency, myocardial dysfunction, myocardial dysrhythmias, postoperative complications following cardiothoracic procedures, and cardiac and pulmonary transplantation
• Integrate information and with minimal assistance from faculty and develop an appropriate differential diagnosis
• Understand ACLS principles as applicable to cardiothoracic critical care patients
• Appropriately utilize hemodynamic monitoring in CTICU decision-making
• Appropriately utilize inotropes, vasopressors, and vasodilators in the management of hemodynamic instability in the CTICU
• Understand the basics of epicardial pacing, mechanical assistance devices (IABP), and chest tube management
• Understand and appropriately utilize modes of mechanical ventilation and airway management in the CTICU
• Understand and appropriately utilize coagulants and anticoagulants in the perioperative management of CTICU patients
(3) Practice-Based Learning and Improvement
• Will locate, appraise and assimilate evidence from scientific studies related to acute care patients
• Will use information technology to manage patient information, access on-line medical information to support their education and apply this information in critical care clinical decision making in the CTICU
• Will facilitate the learning of students, nurses, and other health care professionals
(4) Interpersonal and Communication Skills
• Work efficiently with other members of the CTICU health care team
• Effectively exchange information with patients, their families, and other health professionals
• Write legible, organized notes which effectively communicate a plan of care
(5) Professionalism
• Demonstrate sensitivity and responsiveness to patients' and their families' cultures, age, gender and disabilities
• Demonstrate respect/compassion when talking with patients and family members
• Wears appropriate attire
• Demonstrate a commitment to ethical practices including confidentiality of patient information, informed consent, and equal treatment
• Adhere to hospital policies on infection control and hand-washing
• Attend all educational conferences required by the intensive care attending staff for residents on the SICU rotation
(6) Systems-Based Practice
• Utilize laboratory/diagnostic imaging testing in a cost conscious manner
• Appropriately utilizes consultation with other health care professionals and formulates appropriate question(s) to be posed to consultants
• Understand ICU billing codes and documentation
• Facilitate the efficient admission, care, and transfer of CTICU patients  
Resident Assessment
Competencies will be assessed by the following methods:
1. Direct observation by anesthesiology critical care faculty of resident patient care, medical knowledge, and interpersonal and communication skills. The anesthesiology critical care faculty writes the final evaluation based on the following interactions:
• Record review by CTICU faculty of resident’s notes in charts
• Resident's daily oral presentation of patients to CTICU team
• Resident's daily management of patients with multiple severe medical problems
• Resident's skill at performing procedures (arterial lines, central lines, pulmonary artery catheters, emergent intubations)
• Resident's interactions with families, CTICU staff, and consultants
• Resident's attendance and input at conferences
• Resident's ability to lead clinical rounds and provide junior residents and nursing staff with didactic information pertinent to the care of CTICU patients
• Content and quality of resident conference with CTICU staff
2. A global rating form will be used at the end of the month to evaluate the resident on the six General Competencies based on direct observation and feedback from faculty, residents, nurses, and other health care providers when appropriate. This evaluation will be provided to the anesthesiology program director in a timely manner for quarterly review of resident performance.
• The anesthesiology critical care faculty will discuss the end of the month evaluation with the resident
• Any issues regarding unsatisfactory resident performance will be immediately communicated to the resident and to the anesthesiology program director