TRAUMA/SURGICAL CRITICAL CARE FELLOWSHIP

GENERAL GOALS AND OBJECTIVES FOR THE FELLOW IN TRAUMA/CRITICAL CARE SURGERY

Fellows will develop competence in all aspects of management of patients with critical illness and those acutely injured. Fellows will develop an understanding of the pathophysiology of critically ill surgical patients and trauma patients and apply the principles of airway evaluation/management, resuscitation, and develop an appropriate treatment plan.

ACGME Competency 1: Patient Care
Fellows are expected to

  • Develop advanced proficiency in the management of critically ill and acutely injured patients and the ability to triage patients
  • Develop acute and ongoing management of severely injured patients.
  • Participate in the intraoperative care of trauma patients who are transferred directly from the emergency department to the operating room for urgent surgical management
  • Develop advanced proficiency in the care of post-operative transplant, cardiac, burn and neurosurgical patients
  • Gain understanding into the critical care needs of pediatric patients
  • Demonstrate the use of appropriate resuscitation for patients in shock using evidence-based guidelines and appropriate technology
  • Manage the airway and wean patients from mechanical ventilation utilizing various techniques and ventilator modes
  • Demonstrate an understanding of the principles of sepsis and its management
  • Develop skills in the management of critically ill brain injured patients including management of intracranial hypertension and intracranial pressure monitoring and EEG monitoring
  • Demonstrate knowledge and the ability to manage critically ill patients with acid-base disorders and acute renal failure and the need for treatment with continuous renal replacement therapy or hemodialysis
  • Demonstrate an understanding of the principles of appropriate antibiotic usage and nutritional supports in critically ill surgical patients
  • Demonstrate an understanding of management of complex abdominal and extremity wounds as well as fistulas, stomas
  • Become familiar with the use of autotransfusion, use of massive transfusion as well as assessment of coagulation status and use of component therapy
  • Understand and interpret the displays from the ventilators, bedside monitors, continuous cardiac output monitors, cardiac ultrasound, transesophageal echocardiogram
  • Supervise invasive procedures in the SICU

Objective measures:

  • Document appropriately all management, assessment and treatment plans within the medical record
  • Maintain a log of patients cared for and operations performed
  • Participate in the triage of patients to and from the SICU
  • Recognize the need for appropriate consultations
  • Perform, supervise and document the following procedures:
    • Arterial line placement
    • Central venous line placement
    • Pulmonary artery catheter placement
    • Nasogastric tube placement
    • Urinary catheter placement
    • Bedside ultrasound
    • Defibrillation
    • Intubation
    • Chest tube placement
    • Continuous renal replacement therapy
    • Bronchoscopy
    • Tracheostomy
    • Percutaneous gastrostomy tube placement

     

 

ACGME Competency 2: Medical Knowledge
The fellows should be knowledgeable in the following areas:

  • Basic science and clinical principles related to cardiovascular physiology, pulmonary physiology, renal physiology, nutrition, metabolism, infection and wound healing
  • Trauma surgery principles including Advanced Trauma Life Support
  • Life support principles including Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced Life Support
  • The principles of pharmacologic management, including antibiotics, cardiovascular medications, fluids and electrolytes
  • The principles of critical obstetric and gynecologic disorders, critical pediatric disorders, transplantation, and inhalation and immersion injuries
  • Interpretation of SICU radiographic studies, including their indications and interpretation

Objective measures:

  • Supervise and run daily rounds with residents in the SICU
  • Discuss evidence based scientific studies relating to SICU and Trauma care during rounds
  • Present monthly at Trauma/Surgical Critical Care Grand Rounds
  • Present and/or run monthly Trauma/Surgical Critical Care journal club
  • Maintain current status in BLS, ACLS, PALS and ATLS
  • Become an ATLS instructor
  • Educational goals will be assessed by the results of the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) which the fellow is required to take during their training year

 

ACGME Competency 3: Practice-based Learning and Improvement
Fellows will be able to

  • Investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices
  • Effectively use technology to manage information for patient care and self-improvement
  • Master advanced technology and instrumentation as it relates to trauma and critical care
  • Facilitate all research protocols in the SICU and Trauma service

Objective measures:

 

    • Regular attendance and participation in daily Trauma and Surgical Critical Care morning report and weekly conference
    • Analyze complications as they relate to Trauma and Surgical Critical Care and present at monthly divisional Quality Improvement meeting
    • Attend and participate in monthly Surgical Intensive Care Unit divisional meeting as it relates to improvement in the day-day running of the service
    • Participate and complete and independent research project with the use of information technology, progress will be assessed bimonthly with the faculty mentor

 

ACGME Competency 4: Interpersonal and Communication Skills
Fellows will be able to

 

    • Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and all professional associates
    • Teach and educate residents and medical students with regard to Trauma and Critical Care Surgery
    • Maintain comprehensive, timely medical records and dictations

Objective measures:

 

    • Lead SICU rounds and trauma resuscitations and communicate the condition, the treatment plan and expected outcome which will be assessed with direct feedback and 360 degree evaluations
    • Teach medical students and junior residents during all rotations assessed with 360 degree evaluations
    • Dictations are reviewed, evaluated and countersigned by attendings

 

ACGME Competency 5: Professionalism
Fellows must

 

    • Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, confidentiality, informed consent and sensitivity to a diverse patient population
    • Demonstrate respect, compassion, and integrity; and a commitment to excellence and on-going professional development

Objective measures:

 

    • Appropriate timeliness to morning report, rounds, conferences, medical records and dress code which is included on quarterly attending evaluations
    • Compliance with existing duty-hour restrictions assessed monthly
    • Lead family meetings under direct supervision with regard to management and goals of care in a critically ill patient
    • Written assessment of communication skills will be assessed on the Palliative Care elective

 

ACGME Competency 6: System-based practice

  • Gain insight into the administrative issues involved in running a trauma or critical care unit including budgets, staffing, peer review, equipment and policies and procedures
  • Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value

Objective measures:

 

    • Attend and participate in monthly divisional meetings in Trauma and Surgical Critical Care to learn administrative issues
    • Document in the medical record long term quality of life following traumatic injury during patient follow-up during clinic visits
    • Performance in a quality patient care improvement project which will be discusses monthly at the divisional Surgical Critical Care meeting