Over the course of their three to four month rotation at the Royal Victoria Hospital Intensive Care Unit a graded level of responsibility will be given to the Critical Care Fellow. By the end of the rotation the Fellow will be expected to assume primary responsibility for the daily operation of the ICU including the patient assignments to residents, supervision of residents, unit admission and discharge decisions, and review of all consults. Fellows will be expected to play an increasingly more prominent role during daily patient rounds, eventually becoming the primary leader of rounds. This means they will become responsible for directing discussion concerning patient status, treatment decisions, and teaching points.
The Fellow will be expected to initiate and lead academic discussion in an evidenced-based manner with appropriate reference to recent medical literature. The Fellow will also be responsible for organizing journal club once per month and giving one didactic lecture per month to the residents. The Fellow will be given primary responsibility for the teaching and supervision of technical procedures by the residents and is expected to fill out an evaluation form and provide feedback to the resident for each procedure performed.
The Fellow will be expected to play an important role in Continuous Quality Improvement. He or she will be responsible for monitoring and recording all complications of therapy. The Fellow will be expected to acquire a strong working knowledge of physiology and pathophysiology and be able to apply this knowledge and teach it at the bedside. By the end of the rotation the Fellow will be expected to assume major responsibility for communication with patients and their families.
In addition, the Fellow will be expected to gain added experience, familiarity, and competence with the following:
- Peri-operative management of complex and high-risk cardiac surgery.
- Mechanical hemodynamic support – Intra-aortic balloon pumps, right and left ventricular assist devices, implantable left ventricular assist systems.
- Innovative therapeutic modalities – Nitric Oxide, partial liquid ventilation.
- Peri-operative management of organ transplant recipients – heart, heart-lung, liver, pancreas.
- Toxicology.
- Assessment of severe respiratory failure and respiratory system monitoring including lung mechanics, esophageal balloon and P0.1 techniques.
- Hematological and oncologic disorders.
- Modes of dialysis and hemofiltration including Continuous Veno-Veno Hemofiltration.