Competency Based Curriculum

 

 

 

Program: Internal Medicine

 

Program Director: Mohamed Siddique, MD

Specialty/Course: Medical Intensive Care Rotation for PGY-2 & 3

Curriculum Coordinators: 1. Hassan Makki, MD

 

 

Administrative Support: Robin Pastorious

 

Date Revised: 05/20/08

 

 

 

 

Competency

 

Objectives

Specific

 

Educational Experiences

Knowledge/ Skills

Integration/Application

 

 

Assessment

Tools

 

 

Patient Care

that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

1.       Learner based learning.

  1. Residents should be able to examine patients efficiently and accurately

3.       Provide residents with an understanding of the social impact of critical illness and the contribution of patient behavior to these problems.

4.      The resident should understand the appropriate ordering and performance of diagnostic studies

5.      Residents should be able to supervise interns for patient care and procedures.

 

1. Assesment of patients with critical illness.

 

2. Integration of the history, physical                                      examination and

laboratory data along with imaging.

 

3. Case Presentation to ICU attending.

 

4. Daily management of critically ill   patients with emphasis on recognition of  change in the condition of patients in  the critical care unit and implementation  of management’s decision under the  direct supervision of an ICU Attending.

 

5. On call Cross coverage of all ICU pts.

 

 

 

 

 

  1. Rotation evaluation by ICU attending
  2. Mini-CEX (ABIM)#
  3. 360-degree survey*

 

 

 

 

 

 

 

Medical Knowledge

about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
  1. Demonstrate working knowledge of initial therapy for common and serious medical problems
  2. Commitment to continuous learning
  3. Develop comprehensive understanding of complex medical problems

4.        Demonstrate analytical         thinking

1.      Critical Care Attending will hold teaching rounds on a daily basis.

2.       Residents will be asked to review the literature and share their readings with the Critical Care Team.

3.      Directed Reading

 

 

 

1.Rotation evaluation by ICU attending

2.Mini-CEX (ABIM)#

3. 360-degree survey

 

 

 

 

 

 

Interpersonal and Communication Skills

That result in effective information exchange and teaming with patients, their families, and other health professionals

 

  1. Communicate effectively with attending faculty
  2. Demonstrate effective patient/family interviewing skills
  3. Establish excellent relationships with patients/families
  4. Able to educate and counsel patient/families
  5. Improve listening skills
  6. Able to maintain comprehensive, timely, legible medical records

 

 

 

1.      Interaction  with families of patients who are critically ill

  1. Post call and management rounds by the Critical care attending.
  2. Interaction with Sub-specialty attendings and other services.

 

 

 

 

1. Rotation evaluation by ICU attending

2.Mini-CEX (ABIM)

3.Chart audits by faculty and CMR

4.360-degree survey*

.

 

 

 

 

 

Professionalism

As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
  1. Treat patient and families with respect and consideration
  2. Treat nursing and other health care professional with respect
  3. Understand issues of race, religion, sexual orientation, disability, age, culture, gender etc. in patients and other health care providers
  4. Always respect patients’ autonomy
  5. Serve the interest of the patients
  6. Maintain trust by managing conflicts of interest
  7. Always be honest with patients
  8. Always maintain patients’ confidentiality
  9. Strive to improve patients’ quality of care

     10.  Maintain appropriate relations with patients
  1. Daily interaction with health care professionals
  2. Peer-group discussion
  3. Faculty Role modeling

4.      Interaction  with families of patients who are critically ill

 
  1. Monthly rotation evaluation by attending
  2. ABIM Praise Cards and Early warning Cards
  3. Mini-CEX (ABIM)#
  4. 360-degree survey*

 

 

 

 

 

 

 

Practice-Based Learning and Improvement

That involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

 

 

  1. Learn to accept feedback from others
  2. Regularly self-assess
  3. Use information technology to manage information, access on-line medical information and support their own education on a regular basis

      5.Facilitate learning of others

 

 

  1. Post call and management rounds by the Critical care attending.
  2. Use of standard order sets/clinical pathways to promote optimal cost effective care
  3. Self-directed inquiry
  4. Interactive computer programs

 

 

 

 

 

1.Rotation evaluation by ICU attending

2.Mini-CEX (ABIM)

3.360-degree survey*

 

 

 

 

 

 

Systems-Based Practice

As manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal valueof optimal value

 

  1. Participate efficiently in multidisciplinary discharge planning
  2. Practice cost-effective care
  3. Learn to minimize patient care errors

   4. Advocate for patients within the health care system

 

  1. Daily interaction with nurse care coordinator
  2. Multidisciplinary health care team rounds
  3. Net learning
  4. M & M conference

 

 

  1. 360-degree survey*
  2. Monthly rotation evaluation by attending

 

 

 

 

IMPORTANT TOPICS COVERED DURING ROTATION.

Cardiopulmonary arrest                 

Hypertensive Emergency and shock

Respiratory Failure

Gastrointestinal Bleeding

Coma and its management

Seizures

Drug overdose and poisoning

ARDS

Pulmonary thromboembolism

     Major Liver diseases        

Septic, cardiogenic, hypovolemic shock

Non-cardiogenic pulmonary edema (Acute respiratory distress syndrome –ARDS)

Malignant/accelerated hypertension

Aortic dissection

Acute respiratory failure due to asthma, COPD

Pulmonary embolism

Gastrointestinal bleeding (upper and lower)

Coma

Status epilepticus

Disorders of temperature regulation

o       Hypothermia

o       Hyperthermia

Overdose/poisoning

Cerebrovascular accident/subarachnoid hemorrhage

Meningitis

Diabetic ketoacidosis, hyperosmolar nonketotic coma

Endocrine emergencies including: thyroid storm, myxedema, Addisonian crisis

Disseminated Intravascular Coagulopathy

Heat stroke and heat exhaustion

Uremic renal failure

Hypoxemia and hypoventilation

Severe acid-based abnormalities

Special skills and techniques

 

Establishment and maintenance of open airway in nonintubated, unconscious, paralyzed patients

 

Pressure-cycled, volume-cycled, time-cycle and flow-cycled mechanical ventilation

 

Use of reservoir masks and continuous positive airway pressure masks for delivery of supplemental oxygen, humidifiers, nebulizers, and incentive spirometry

 

Weaning and respiratory care techniques

 

Management of pneumothorax (needle insertion and drainage systems)

 

Maintenance of circulation

 

Arterial puncture and blood sampling

 

Insertion of central venous, arterial, and pulmonary artery balloon flotation catheters

 

Basic and advanced cardiopulmonary resuscitation

 

Cardioversion

 

Pulmonary function tests to assess respiratory mechanics, gas exchange, and respiratory drive,

including spirometry, flow volume studies, lung volumes, diffusing capacity, arterial blood gas

analysis, and exercise studies

 

Diagnostic and therapeutic procedures, including thoracentesis, pleural biopsy, flexible fiber-optic

bronchoscopy, and related procedures

 

Calibration and operation of hemodynamic recording systems

Ventilatory support, weaning, and respiratory care techniques

 

 

 

Resource Materials

 

Recommended Textbooks:      

o       The ICU book by Marino (publishers: Lea and Febiger)

o       The ICU manual :Depat Of Medicine.

o       Textbook of Critical Care by Schoemaker, Ayers, Grenvik Holbrook (publishers: Sanders)

o       Critical Care Medicine-The Essentials by Marini and Wheeler (publishers: Williams and Wilkens)

o       Essentials of Critical Care Pharmacology by Chernow (publishers: Williams and Wilkens)

o       Intensive Care Radiology: Imaging of the Critically Ill by Goodman and Putman (publishers: Saunders)

o       Procedures and Techniques of Intensive Care Medicine by Rippe, Irwin, Fink, Cerra, Curley, Heard (publishers: Little, Brown)

 

 

Key Articles:

 

Complete Bibliography:

                                                      ACID  BASE  DISORDERS

 

Riley LJ, Ilson BE, Narins RG:  Acute metabolic acid-base disorders.  Critical Care Clinic, 5: 699-724, 1987.

 

Kruse JA, Carlson RW.  Lactate metabolism.  Critical Care Clinics, 5: 725-746, 1987.

 

Kreisberg RA: Lactate homeostasis and lactic acidosis.  Annals of Internal Medicine, 92 (Part l): 227-237, l980.

 

Oh MA, Carroll HJ:  Disorders of sodium metabolism: Hypernatremia and hyponatremia.  Critical Care Medicine, 20:94-l03, l992.

 

Morganroth ML:  Six steps to acid-base analysis: Clinical applications.  A systematic approach to sorting out complex disorders.  The Journal of Critical Illness, 5:460-469, 1990.

 

 

ASPIRATION

 

Wynne JW, Modell JH: Respiratory aspiration of stomach contents.  Annals of Internal Medicine 87: 466-474, l979.

 

Bartlett JG, Gorbach SL, Finegold SM: The bacteriology of aspiration pneumonia.  The American Journal of Medicine, 56: 202-206, l974.

 

 

DROWNING

 

Cicale MJ, Block AJ: Management of near-drowning on the scene and in the hospital. J. Crit Illness 1: 19-32, 1986

 

 

ENDOCRINE DISORDERS

 

Kreisberg RA: Diabetic ketoacidosis: An update.  Critical Care Clinic, 5: 817-834, 1987.

 

Chin, R:  Case Study, Adrenal Crisis.  Critical Care Clinics, Vol. 7, No. l, 23-42, January l991.

 

Crapo LM, Reaven G: Hyperosmolar nonketotic diabetic coma.  Medical Grand Rounds, 2: 344-356, l983.

 

Myers L, Hays J:  Myxedema Coma.  Critical Care Clinics  7: 43-56, l99l.

 

Reasner CA, Isley WL:  Thyrotoxicosis in the critically ill.  Critical Care Clinics, Volume 7: 57-74, 1991.

 

 

ENVIRONMENTAL

 

Sprung CL, Portocarrero CJ, Fernaine AV, Weinberg PF:  The metabolic and respiratory alterations of heat stroke. Arch Intern Med, l40: 665-669, 1980.

 

Reuler JB: Hypothermia.  Pathophysiology, clinical settings, and management.  Ann Intern Med, 89: 5l9-527, 1978

 

Curley FJ, Irish RS: Disorders of temperature control: Part I.  Hyperthermia.  Part II Hyperthermia, Part III hypothermia.  J. Intensive Care Med, l: 5-l4; 9l-l00; 270-288, 1986

 

Guze BH, Baxter LR: Neuroleptic malignant syndrome. NEJM, 3l3: l63-l66, 1985.

 

 

ETHICS

 

Council on Scientific Affairs and Council on Ethical and Judicial Affairs.  Persistent vegetative state and the decision to withdrawn or withhold life support.  JAMA , 263: 426-30, 1990.

 

Wanzer SH et al.  The physician's responsibility toward hopefully ill patients---A second look.  N Engl J Med, 320: 844-49, 1989.

 

Luce JM.  Ethical principles in critical care.  JAMA, 263: 696-700, 1990.

 

 

GI DISORDERS

 

Schaffner JA: Acute gastrointestinal bleeding. J. Intensive Care Med, l: 289-296, 1986.

 

Ranson JHC: Etiological and prognostic factors in human acute pancreatitis: A Review. Am J. Gastroenterolol 77: 633-638, l982.

 

Ranson JHC, Turner JW, Roses DF, et al: Respiratory complications in acute pancreatitis.  Ann Surg l79: 557, l974.

 

Reynaert MS: Current therapeutic strategies in severe acute pancreatitis .  Intensive Care Medicine, l6: 352-362, 1990.

 

Wilcox CM, Spenney JG: Stress ulcer prophylaxis in medical patients: Who, What, and How Much.  American Journal Gastroenterology, 83: ll99-l2l0, 1988.

 

Kerlan RK, LaBerge JM, Gordon RL, Ring EJ: Transjugular intrahepatic portosystemic shunts. AJR, 164:1059-1066,1995.

 

 

HEMATOLOGIC DISORDERS

 

Bowie EJW, Owen CA: Hemostatic failure in clinical medicine. Seminars in Hematology,  l4: 341-360, l977.

 

Bartholomew JR, Bell WR: Thrombotic thrombocytopenic purpura. J Intensive Care Med, 1: 341-355, 1986.

 

 

Bick RL: Disseminated Intravascular Coagulation and Related Syndromes: A clinical review.  Seminars in Thrombosis and Hemostasis, l4:299-338, l988.

 

 

HEMODYNAMIC  ASSESSMENT

 

Wiedemann HP, Matthay MA, Matthay RA: Cardiovascular-pulmonary monitoring in the Intensive Care Unit (Part I). Chest, 85: 537-547, l984.

 

Wiedemann HP, Matthay MA, Matthay RA: Cardiovascular-pulmonary monitoring in the Intensive Care Unit (Part 2):  Chest, 85: 656-667, l984.

 

Manny J, Grindlinger GA, Dennis RC, et al: Myocardial performance curves as guide to volume therapy. Surgery, Gynecology & Obstetrics. 149: 863-873,l979.

 

Sharkey SW: Beyond the wedge: Clinical physiology and the swan-ganz catheter. American J. Medicine, 83: lll-l22, 1987

 

Broaddus VC, Berthiaume Y, Biondi JW, Matthay MA: Hemodynamic management of the adult respiratory distress syndrome.  J Intensive Care Medicine, 2: 190-213, l987.

 

Amin DK, Shah PK, Swan HJC: Deciding when hemodynamic monitoring is appropriate. J. Critical Illness, 8: 1053-1061, 1993.

 

Mermel LA, Maki DG: Infectious complications of Swan-Ganz pulmonary artery catheters. Am J Respir Crit Care Med 149:1020-1036,1994.

 

 

HYPERTENSIVE  CRISIS

 

Calhoun DA, Oparil S: Treatment of hypertensive crisis.  NEJM 323: ll77-ll83, 1990.

 

Ram CVS, Hyman D: Hypertensive crisis. J Intensive Care Med 2: 151-162, 1987.

 

 

INHALATION  INJURIES

 

Cahalane M, Demling RH: Early respiratory abnormalities from smoke inhalation. JAMA 251: 771-773, 1984.

 

Crapo RO: Smoke-Inhalation injuries. JAMA 246: 1694-1696, 1981.

 

Ilano AL, Raffin TA: Management of carbon monoxide poisoning. CHEST 97: 165-169, 1990.

 

Haggerty MA, Soto-Greene M:, Reichman LB:  Caring for victims of toxic gas inhalation.  Emergency treatment and in-hospital management.  The Journal of Critical Illness 2(7):77-87, l987.

 

 

MECHANICAL  VENTILATION

 

Grum CM, Morganroth ML: Initiating mechanical ventilation. Journal of Intensive Care Medicine, 3: 6-20, l988.

 

Morganroth ML, Grum CM: Weaning from mechanical ventilation. Journal of Intensive Care Medicine, 3: 109-120, l988.

 

Powner DJ:Pulmonary barotrauma in the intensive care unit. J Intensive Care Med 3: 224-232, 1988.

 

Zwillich CW, Pierson DJ, Creagh CE, et al: Complications of assisted ventilation. A prospective study of 354 consecutive episodes.  American Journal of Medicine,  57: 161-170, l974.

 

Stauffer JL, Olson DE, Petty TL: Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of l50 critically ill adult patients.  American journal of Medicine.70: 65-75, l98l.

 

Schuster DP: A physiologic approach to initiating, maintaining, and withdrawing mechanical ventilatory support during acute respiratory failure.  The American Journal of Medicine, 88: 268-278, l990.

 

Johnson M, Cane RD: The technique of inverse ratio ventilation. The Journal of Critical Illness, 7: 969-973, 1992.

 

Esteban A, Frutos F, et al: A comparison of four methods of weaning patients from mechanical ventilation. NEJM, 332: 345-350, 1995.

 

 

NEUROLOGIC  DISORDERS

 

Levy DE, Bates D, Caronna JJ, et al:  Prognosis in non-traumatic coma. Ann Intern  Med 94: 293-30l, 1981.

 

Maiese K, Caronna JJ: Coma following cardiac arrest: A review of the clinical features, management, and prognosis. J Intensive Care Med 3: l53-l63, 1988.

 

Black PM: Brain death. NEJM 299: 338-344, (part 1)1978, and NEJM 299: 393-401, (part 2) 1978.

 

Riela, AR:  Management of Seizures.  Critical  Care Clinics, Volume 5, No. 4, October l989, pp. 863-879.

 

Tunkel AL, Scheld WM: Acute therapy of bacterial meningitis.  J Intensive Care Med 6: 229-237, 1991.

 

Smith MC, Bleck TP:  Techniques for evaluating the cause of Coma.  The Journal of Critical Illness, 2l:5l-57, December l987.

 

Smith MC, Bleck TP:  Sorting through the differential diagnosis of Coma.  The Journal of Critical Illness, 2(l2): 39-48, l987.

 

Diringer MN: Intracerebral hemorrhage: Pathophysiology and management. Critical Care Medicine, 21:1591-1603,1993.

 

 

NUTRITION

 

Lemoyne M, Jeejeebhoy KN: Total parenteral nutrition in the critically ill patient.  Chest, 89: 568-575, l986.

 

Pingleton SK, Harmon GS:  Nutritional management in acute respiratory failure.  JAMA 257: 3094-3909, 1987.

 

 

OBSTETRIC  EMERGENCIES

 

Dildy GA III, Cotton DB: Management of severe preeclampsia and eclampsia. Critical Care Clinics, 7: 829-850, 1991.

 

Mabie WC: Acute Fatty Liver of Pregnancy. Critical Care Clinics   7: 799-808,1991  (HELLP syndrome)

 

Zamora CA, Sahn SA: Critical care in the pregnant patient (Part I) (Part II).  Pulmonary and Critical Care Update, 6(l6): 1-9, 6(17): 1-10, 1991.

 

Cefalo RC: Drugs in pregnancy-Which to use and which to avoid. Drug therapy,Hospital, May 30-41, 1983.

 

Martin JN, Stedman CM: Imitators of preeclampsia and HELLP syndrome.  Obstetrics and Gynecology Clinics of North America, l8:l8l-l97, l99l.

 

Maikranz P, Katz AI: Acute renal failure in pregnancy.  Obstetrics and Gynecology Clinics of North America, l8:333-342, 1991.

 

Barton JR, Sibai BA: Care of the pregnancy complicated by HELLP syndrome. Obstetrics and Gynecology Clinics of North America, l8:l65-l79, 1991.

 

 

PHARMACOLOGIC