The Fellow will be met with at the midway-point of their rotation and given feedback as well as their input on whether the above objectives were being met. If specific objectives have not been satisfied to that point, strategies to assure that they will be met by the end of the rotation will be discussed. The Fellow will also get intermittent feedback from the Resident Education Co-ordinator concerning the comments of residents concerning his/her performance.
These objectives will form the basis for the end-of-rotation evaluation. The Fellow should bring his copy of the objectives to the evaluation meeting with the program director. The Fellow’s final evaluation will be a composite of their overall performance in the unit as well as their presentations. Input will be sought from all the ICU Attendings, the ICU Head Nurse, and the residents.
All Fellows are expected to fill out evaluations on the rotation and on the ICU Attendings.
|
Objective |
Implementation and evaluation |
|---|---|
| Ensure the acquisition of knowledge on: | |
| 1) Clinical management of the critically ill of all types cared for in the unit. | Twice daily rounds with the Attending Intensivist Discussion of all consults and new admissions with the Attending Intensivist. Review and discussion of the literature relevant to cases. |
| 2) Peri-operative management of complex and high-risk cardiac surgery. | Twice daily rounds with the Attending Intensivist. Close collaboration with Cardiac Surgeons and the Cardiac Surgery Fellow. |
| 3) Indications, contraindications, complications and management of mechanical circulatory support devices including Intra-aortic balloon pumps, left and right ventricular assist devices, ECMO, and Implantatble Left Ventricular Assist Systems. | Major responsibility for the management of patients with these devices in close collaboration with the Attending Intensivist, Cardiac Surgeons and Fellow, and perfusionists. One core lecture to be given on this topic. |
| 4) Peri-operative management of organ transplant recipients. | Major responsibility for the management of these patients will be given to the ICU Fellow in collaboration with the ICU Attending, Transplant Surgeons, and the Transplant Immunologist. One core lecture will be given on peri-operative management of the liver transplant recipient. |
| 5) Innovative therapeutic modalities ( Nitric oxide, Partial Liquid ventilation). | Fellows will discuss indications, contraindications, possible complications, and management of patients on NO or PLV with Drs. Goldberg or Payen who have specific expertise in these areas. |
| 6) Toxicology. | Fellows should discuss all patients admitted with overdoses or toxicological issues with Dr. Melanson who has an interest in this area. One or two core lectures will be given on this topic. A series of lectures on toxicology are available on the ICU computer. |
| 7) Assessment of severe respiratory failure and respiratory system monitoring including lung mechanics, esophageal balloon and P0.1 techniques. | These techniques should be reviewed with Dr. Goldberg who has specific expertise in these areas. |
| 8) Hematological and oncologic disorders. | Close collaboration with hematologists and oncologists involved in care of the patient. |
| 9) Renal Replacement Therapy including CVVH-D, CAVH-D, and intermittent hemodialysis. | Responsibility for daily management and orders in close collaboration with the Nephrology Consult Service. Dr. Payen will also provide expertise in this area. |
| 10) Applied physiology and pathophysiology. | Cardiovascular physiology and pathophysiology relevant to patient care will be stressed on daily rounds by Dr. Magder who will also give lectures on the topic. Dr. Goldberg will emphasize respiratory physiology. |
| 11) Specific nutrition issues. | The Fellow will be responsible for the primary decisions concerning nutritional support in collaboration with the ICU nutritionist. |
| 12) Pharmacology. | Issues of drug indications, contraindications, interactions, efficacy, and cost are discussed daily on rounds with the ICU pharmacists. An extensive literature file is available in the ICU pharmacy. |
|
Objective |
Implementation and evaluation |
|---|---|
| Ensure the acquisition of skills by the fellow on: | |
| 1) Procedural aspects of critical care. |
Fellows will be trained in central vascular access, advanced airway
management and other procedures. They will be evaluated by Attending
Staff with objective structured evaluation forms. If further exposure is felt to be warranted then arrangements will be made to allow the Fellow time in the operating room. The Fellow will be responsible for supervising all resident performed procedures in the ICU and will be required to fill out a "procedure checksheet evaluation form" on each procedure and give immediate feedback to the resident. The Fellow will keep a procedure log of all procedures performed or supervised. |
| 2) Teaching. |
The Fellow will be expected to take a major role in leading discussion
during daily rounds. The Fellow will be expected to discuss bedside clinical topics in an evidenced-based manner with appropriate reference to recent literature and appraisal of the quality of the literature. The Fellow will be expected to give one lecture per month to the residents. The Fellow should be available to answer questions from the residents at all times. The Fellow will get feedback on his or her teaching from the Attendings. The residents will be asked to evaluate the Fellow’s teaching skills monthly. |
| 3) Communication skills. | The fellow will be included in discussions with families or the patient. Over time the Fellow will be given the opportunity to lead these discussions with feedback from the Attending. |
| 4) Interpersonal skills. | Input will be sought from the Head Nurse, residents, and Attendings from other services concerning the Fellow’s ability to interact and work with other team members. |
|
Objective |
Implementation and evaluation |
| Ensure competence in the scholarly and professional aspects of critical care: | |
| 1) Critical appraisal. |
The Fellow will be responsible for organizing and presenting at journal
club once per month. The fellow will be expected to identify areas of controversy during daily rounds, generate clinical questions, perform a literature search, and critically appraise the identified articles to answer the clinical question in an evidenced-based manner. A reference list of recent important papers will be provided. |
| 2) Quality assessment. |
The Fellow will be given primary responsibility for the monitoring and
reporting of all complications of therapy. The Fellow will be expected to participate in Mortality and Morbidity rounds each month. |
| 3) Ethical issues. |
Ethical issues will be discussed with the Attending Intensivist on daily
rounds. An ethicist will attend the Wednesday ICU Staff rounds and comment when appropriate. A Clinical Ethicist will round with the ICU team periodically. The Fellow will be encouraged to consult the Clinical Ethics Consult service and discuss individual cases when appropriate. The Fellow will be required to attend multi-disciplinary ICU Ethics rounds organized by the ICU Nurses and the Clinical Ethics Department. Didactic lectures will be given by a Clinical Ethicist. On OSCE type exam on ethical issues will be given once per year. |