Service: sicu, pgy 2 – sinai

SERVICE: SICU, PGY 2 – Sinai
Competencies:
Goals and Objectives:
Patient Care:
During this rotation, the resident should learn and practice to:  Demonstrate caring and respectful behaviors when interacting with patients and their
families; demonstrate sensitivity to gender, age, ethnicity, religion, value systems and
other potential differences of patients and their families; practice according to the  Gather patient and case specific essential, comprehensive multi-source and accurate
information about their patients for initial or peri-operative work-up and patient
 Using all available resources, under the guidance by the SICU attending, make informed decisions about diagnostic and therapeutic interventions based on patient
information, up-to-date scientific evidence and clinical judgment; evaluate and implement priorities in patient care and incorporate preventive measures  Under the guidance of the SICU attending and in collaboration with other designated SICU expert personnel, develop and carry out patient management plans
 Under the guidance of the SICU attending and in collaboration with other designated SICU expert personnel monitor closely the patients clinical progress, review and react
to variances in patient progress or response to therapeutic interventions; Communicate
the details and changes of patient care, progress and complications to the SICU  Under close and direct supervision by the SICU attending counsel and educate
patients and their families on the state of the patient’s disease, necessary diagnostic
tests, operative procedures medical management  Use information technology (hospital computer system) to support patient care decisions and patient education (electronic patient record, electronic radiology studies, online educational resources, including literature research)  Work closely with other healthcare professionals, including those from other
disciplines (Nephrology, Endocrinology, Cardiology, Pulmonology, Critical Care pharmacist and nutritionist, respiratory therapy, mid-level providers, nurses, SICU office taff, etc.), to provide patient-focused and optimum outcome driven care  Ensure that the needs of the patient and team supersede individual preferences
when managing patient care; incorporate evidence-based medicine into patient care whenever possible; comply with changes in clinical practice and standards given by the Objectives:
During the rotation, the resident should:  Under one-on-one supervision by the SICU attending, perform competently and/or
assist in procedures (both in the inpatient and outpatient setting) considered essential
for the area of practice, including:
a. arterial lines (radial, femoral, +/- brachial), central venous catheters (internal
jugular, subclavian, femoral - for monitoring, nutrition, hemodialysis), pulmonary
artery catheters
b. endotracheal intubation (oral, +/- nasal), tracheostomy
c. bronchoscopy
d. gastroduodenoscopy and percutaneous endoscopic gastrostomy
e. complex dressing changes (abdomen, soft tissue wounds, etc.) under anesthesia
 Under supervision by the SICU attending and in collaboration with experienced SICU mid-level provider(s), participate in the pre- and post-operative surgical
management of severely ill patients with and without multiple organ failure;
participate in daily morning and afternoon patient rounds on the SICU service at Sinai a. Complete (or have completed) and pass(ed) Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS), and Fundamentals of Critical
Care Support (FCCS) training
b. Serve on the code team and the trauma team for initial resuscitations; Diagnose cardiac arrest and rhythm disturbances; apply closed chest cardiac massage (CPR); c. Recognize and manage airway obstruction; perform endotracheal and
nasotracheal intubation; Perform cricothyrotomy and tracheostomy; Manage d. Determine the indication, dosage, contraindications, and method of administration of the medications commonly required in the therapy of critically ill patients (see
ICU pharmacology) in individual patients and clinical situations e. Perform pulmonary artery catheterization, including determining catheter position
by pressure wave recording and electrocardiographic monitoring and chest film f. Manage cardiogenic and distributive and obstructive shock; control external
 Under supervision by the SICU attendings and in collaboration with experienced SICU mid-level provider(s) manage post-operative surgical complications, including
wound and systemic infection, SIRS, sepsis and organ failures(s), bleeding, and death  Attend SICU didactic lectures and literature review sessions at least 85% of the
Medical Knowledge:
Residents must demonstrate 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. Objectives:
At the end of the SICU rotation, the resident should be able to understand the concerns and principles of management for patients with severe illness (related to comorbidities, the acute disease process and post-operative complications) in the peri-operative period. The resident should be able to assess the level of care and monitoring needed for any given patient and which patient will require admission to the surgical intensive care unit. The resident should understand the complexities of single and multiple organ dysfunctions and their management and the protocol-driven, multi-specialist approach to minimize complication related to critical illness.  Administration
a. Describe the criteria for predicting pre-operatively the patient’s need for
- Pre-existing disease states (cardiac, pulmonary, hepatic or renal, etc.) - Operation-specific requirements for post-operative intensive care management b. Review and interpret the relationship of physicians, nurses, mid-level providers, specialists and administrators in managing patients assigned to the ICU c. Discuss the value of an interdisciplinary approach to health care for the critically
ill surgical patient in an open, intensivist driven unit. Include consideration of these - Surgery and surgical specialty “primary” providers - Physical therapy, occupational therapy - Medical consultants (Medicine, Cardiology, Nephrology, Endocrinology, Pulmonology, Infectious Disease, Neurology, etc.) - Religious support staff, social work, case management - Family and friends as caregivers and support d. Understand the principles of scarce resources and costs associated with ICU
care and with inappropriate allocation of level of care (over-and-under allocation)
 The patient as a human being
a. Understand the psycho-social issues associated with critical illness and temporary
or permanent loss of self-control in the ICU, i.e., inability or limitation to communicate; immobility; inability to take care of own affairs; issues of dignity b. Understand that psycho-social and physical effects can persist after (successful) discharge from the ICU and hospital for a prolonged period of time and/or permanently (prolonged rehabilitation, disability, cognitive and mood disturbances, c. Care for the mentally incapacitated or the incompetent patient:
- Understand the effects of pain, medications, critical illness and disruption of
normalcy/bio-rhythm on the patient’s capacity to understand complex
issues/concepts, and make sound medical decisions - Understand the evaluation of competency and proper use of surrogates
(family, friends, guardians) and the concept and limitations of the healthcare power of attorney for medical decision–making/informed consent in ICU patients d. Understand the need for support by family and friends and the psychosocial
and economical stress these individuals are exposed to e. Understand the influences of cultural, ethnic and religious beliefs with regard to
decision-making for supportive and end-of-life care f. Understand the need for comprehensive, patient/family adjusted regular
communication on patient status, progress, planned procedures, prognosis,
g. Dealing with a “difficult” family: Understand that physician transference/counter
transference; insufficient or divergent communication; and insensitivity to the patient/family’s cultural, ethnic and religious needs and insufficient non-medical
 End-of-life care
a. Understand the concepts of futility of care, brain death, (persistent) vegetative
state and evidence-driven prognosis
b. Understand the concepts and limitations of advanced directives
c. Understand the difference and options for supportive care (full/limited), comfort
care and withdrawal of care
- (removal of) Fluid and nutritional support - “Non medical” support (social work, psychology, religious, privacy, etc.) d. Understand the meaning and options for DNR (Do Not Resuscitate) and DNI (Do
Not Intubate) orders; understand the published outcomes (survival, neurologic) with cardio-pulmonary resuscitation in critically ill patients; understand the influences that cultural, ethnic and religious beliefs have on such decisions e. Understand the concepts involved with organ and tissue donation:
- Current state of organ donation in the State of Maryland / United States - Physician vs. Transplant Resource Specialist approach of the family - Brain death vs. non-heart-beating donor - Exclusion criteria for organ and/or tissue donation - Evaluation process of the prospective donor and ICU “organ” supportive care  ICU patient evaluation
- Understand, perform and document the critical elements of a comprehensive
history to include all comorbidities and prior results of workup (PFTs, EKG,
ECHO, cardiac catheterization, stress testing, laboratory data, etc.), prior medications and dosage, allergies, etc.) - Understand the importance of communication of operative details (length of
OR, what [exactly] was done, blood loss, blood products and fluid therapy, anesthetics used, any complications, etc. - Understand, perform and document the critical elements of a comprehensive
and organ specific physical examination
- Assess, document and communicate differential diagnoses, their (potential)
interaction and resultant need for monitoring, management and overall level of  Severity of illness scoring
- Understand the concepts and limitations behind the major severity of illness and organ dysfunction scores (SOFA, APACHE, MODS, SIRS, ISS, RTA, - Use scoring (over time) in conjunction with other data to predict patient - Understand concept of benchmarking against collective data to assess unit performance and improvement measures (APACHE, Project Impact, NNIS,  Organ assessment and management of organ failure(s)
- Heart and vascular system
- Understand the anatomy and physiology of the heart and vascular system
and its adaptation/failure in response to volume alteration, inflammatory mediators, cardiovascular drugs and ischemia - Myocardial function and afterload (Frank Starling mechanism, electromechanical coupling, ventriculo-arterial coupling), hemoglobin and percent saturation, changes in pH, temperature, 2,3-diphosphoglyceride - Oxygen consumption: normal body and tissue demands for blood flow, oxygen uptake (extraction ratio) and CO2 production, RQ-concept, changes in metabolic demand due to temperature, hormones/mediators, - Understand the cardiac performance changes with ischemia (stunned
myocardium, infarct), severe acidosis, sepsis, valvular dysfunction (AS, AI, MS, MI, TR), pulmonary hypertension, chronic dilatation, etc. - Understand the effects of inflammatory mediators, ischemia, catecholamines on the pulmonary and systemic vasculature (different physiologic regions);
understand the concept of auto regulation in certain vascular beds
- Understand the various non-invasive and invasive cardiovascular
monitoring techniques and their limitations: clinical exam, NIBP, arterial
line, CVP, pulmonary artery catheter (PAP, PCVW, CO, SV, SVR), ABG, SvO2, lactate and base deficit, urine output, etc.; define the information obtained from the use of these devices and specify: 1) which information is directly/indirectly measured or calculated, 2) the accuracy and 3) cost of obtaining the information, and 4) review the hemodynamic principles - Understand the influence of major cardiovascular active medications on the heart, vasculature and perfusion (see ICU pharmacology) - Understand the definition and grading of (congestive) heart failure, its
major etiologies and effect on acute and long-term outcomes in critically ill patients; understand the link of cardiac failure to other organ failure - Discuss the common etiologies of pulmonary hypertension, its
pathophysiologic effects on the right heart and severity dependent management options (calcium antagonists, vasodilators, nitrates, prostacycline, inhaled nitric oxide, etc.) - Understand the fundamental anatomy and physiology of the lung and its
adaptation to disease/basic expression of failure (clinical signs and - Understand the concepts of ventilation/perfusion (mis-)match and its
- Understand the concepts of West-zones and influences of patient position
(upright, supine, prone), intra-thoracic pressure, etc. on them - Understand reactions of pulmonary vasculature to alveolar hypoxia,
inflammatory mediators, global hypoperfusion, hypercarbia, systemic - Relate to common pulmonary diseases/conditions: COPD, pulmonary
fibrosis, atelectasis, pulmonary embolism, (large) pleural effusion), etc.; oxygen delivery: cardiac output, perfusion pressure and varying preload, - Understand the common causes of acute respiratory failure (including
exacerbation of chronic failure) and the fundamentals of their medical - Asthma (reactive airway disease), COPD - Kyphoscoliosis, restrictive chest wall disease, disruption of thoraco- abdominal mechanisms post-surgery (open abdomen, increased intra- - Hemo-/pneumothorax, large pleural effusion - CNS disorders, peripheral neuropathy and myopathy, sedative-narcotic - Describe the commonly used indications for initiation (and termination) of
ventilation support, including:
- Indications and commonly acceptable values for initiation of mechanical - Evaluation of airway; evaluation of adequacy of thoracic pump (muscle strength); evaluation of lung parenchymal characteristics (arterial blood - Analysis of commonly used pulmonary values (e.g., tidal volume [Vt], maximum ventilatory volume [MVV], compliance static and dynamic, functional residual capacity [FRC], PEEP, auto PEEP, airway pressures - Indications and commonly acceptable values for weaning from mechanical ventilation (neuro-status and muscular strength, minute ventilation, RVR - Understand the concepts of ventilator management
- NIBP vs. PIPB (mask and endotracheal intubation) - Fundamental modes of ventilation and their advantages and limitations
(AC or VC or CMV, (S)IMV +PSV, PC, BIPAP, CPAP, APRV, basics of - Understand the concepts of Acute Lung Injury (ALI): Baro-/Volu-
trauma, O2-toxicity, inflammatory mediators, etc., and the concept of lung-protective ventilation strategies, ventilator-associated pneumonia - Understand the concept of PEEP and its effects on ventilation/perfusion,
- Understand the concept of ARDS, including common causes (systemic
and local) and management (ventilation and oxygenation strategies, prone- position ventilation, use of anti-SIRS drugs, antibiotic therapy, use of - Understand the need for VAP prevention, pulmonary physiotherapy
and organized ventilator weaning to improve outcomes
- Understand fundamental principles of the management of the long-term - Understand the basic anatomy and physiology of the kidney, including
renal perfusion, glomerular filtration, proximal and distal tubular function, loop of Henle and collecting duct function; understand the hormonal functions of the kidney (renin-angiotensin, aldosterone, vitamin D, etc.) - Understand the fundamentals of the evaluation of kidney function:
- Urine output, urine analysis, gravity, urine osmolality and electrolyte - Understand the definition, clinical signs and symptoms (including laboratory) of renal dysfunction and failure and its major causes in SICU patients
- Ischemia/under perfusion, including intra-abdominal hypertension - Inflammatory and toxic (medication, auto immune) - Understand the implications of renal failure on other organ systems: heart,
lung, CNS, bone and bone marrow, etc., drug metabolism and elimination (see - Understand management of patients with high output syndromes (renal or
central diabetes insipidus, cerebral salt wasting, polyuric renal failure, - Understand role of kidney (and lung) in acid-base disturbances
- Identify, define and classify (using ABG and other laboratory tests) the major categories of acid-base disturbance (metabolic acidosis and/or alkalosis, respiratory acidosis and/or alkalosis) in the context of the patient’s altered physiology; cite common clinical scenarios for their - Renal tubular acidosis (differentiate between Type I and II) - Discuss the identification and correction of complex acid-base problems - Hyperchloremic, metabolically-acidotic patient - Hypochloremic, metabolically-alkalotic patient - Stuporous, dehydrated, hypo- and hypernatremic patient - Patient with central diabetes insipidus - Hyponatremic, volume overloaded patient with carbon dioxide retention - Diagnosis and management of electrolyte disturbances (Na, K, Mg, PO4,
Ca, etc.) using conjunction of history, physical and laboratory testing - Understand the fundamentals of renal replacement therapy (RRT):
- Intermittent vs. continuous, basic modes of hemofiltration and dialysis, - Common complications of RRT (bleeding, electrolyte and acid-base disturbance, access-related problems, hypothermia, volume changes, etc.) - Use of continuous RRT/hemofiltration in other disease processes (sepsis, - Understand the basic anatomy and physiology of the liver, including hepatic
(dual) perfusion; understand complex involvement in metabolic and hormonal pathways, and waste product excretion; understand involvement in hemostasis - Understand the definition, clinical signs and symptoms (including laboratory) of liver dysfunction and failure (including fulminant) and its major causes in
- Ischemia/under perfusion, including intra-abdominal hypertension - Inflammatory and toxic (medication, auto immune) - Understand the implications of hepatic failure on other organ systems:
heart, lung, CNS, bone and bone marrow, etc. drug metabolism and elimination - Understand the fundamentals of hepatic support therapy (nutrition, gut
decontamination, correction of coagulopathy, therapy for portal hypertension, - Understand the concepts of gut dysfunction in severe illness, including: ileus,
malabsorption/diarrhea, acute intestinal ischemia and bleeding, the concepts of bacterial translocation, stress gastritis and ulcer disease, peudomembranous - Understand the concepts of stress ulcer prophylaxis and therapy in severely
ill patients (H2-blockers, PPI, Carafate, early enteral nutrition - Outline the indications and methods for providing nutritional support by
- Discuss indications, selection of formulations, cost, route of administration of parenteral versus enteral forms of nutrition
- Explain complications (and benefits) of parenteral and enteral routes of
feeding and select methods to avoid the complications - Discuss major types of feeding formulations ([semi-]elemental, immuno-
nutrition, utility/disutility of disease-specific nutritional formulations, etc.) and their use in critically ill patients - Interpret findings associated with abnormalities in levels of glucose, chloride, sodium, phosphate, magnesium, trace metals/elements and vitamins in the critically ill patient receiving enteral or parenteral feedings; - Estimate protein calorie requirements for patients of varying degrees of
illness, and be able to analyze adequacy of nutritional support using - Prepare recommendations for elderly patients under these same conditions
- Discuss the concepts of (selective) gut decontamination, its use, benefits and
- Discuss use of prokinetic agents in gut dysfunction; management of high output loss states from the gastrointestinal tract and cardiac and metabolic - Discuss the implications of (antibiotic related) C. difficile colitis in critically ill patients, including antibiotic therapy, gut rest vs. feeding, anti-diarrheal agents - Describe the initial evaluation, ongoing, acute monitoring and long-term management of possible neurologic or behavioral abnormalities occurring in - Brain death: diagnosis, involvement of social work, transplant resource - Endocrine
- Hypothyroidism and hyperthyroidism in the critically ill
- Hyperparathyroidism/hypoparathyroidism
- Adrenal cortical excess (Cushing’s disease and syndrome) and adrenal cortical
deficiency states (Addison’s disease)
- Disturbance of glucose metabolism and diabetes mellitus
- Importance of tight glucose control for prevention of infections and overall - Use of subcutaneous vs. IV insulin, intermittent dosing vs. continuous - Immune system/bone marrow
- Definition of SIRS and sepsis; fundamental understanding of the immune
reaction to trauma, infection, stress; understanding of the benefits and
potentially harmful sequelae of immune system activation; understanding of the dynamic nature and basic time course of the immune response in critically - Immunosuppression of critical illness: the role of hyperglycemia, steroids,
(multiple) organ dysfunction, infection, etc. - management and prevention - AIDS and critical illness
- Discuss the evaluation and treatment of the following bleeding disorders:
- The role of blood vessels, platelets, fibrin cascade and degeneration in - Disseminated intravascular coagulopathy (DIC), common causes and therapy - Thrombocytopenia as a failure of production, accelerated destruction or - Hemophilia A, Von Willebrand’s disease, idiopathic thrombocytopenia purpura (ITP) and thrombotic thrombocytopenia purpura (TTP) as causes of - Heparin or Coumadin therapy misapplication - The role of protein C, S, ATIII and lupus circulating anticoagulant, and their - Diagnosis and management of anemia
- Erythropoietin, iron (IV/enteral, potential complications and risk of - Transfusion: Outline the clinical and laboratory indications, common
problems and complications for transfusion of the following blood products: - Specific clotting factor concentrates (VIIa, VIII, IX, XII) - Nosocomial infections, SIRS, sepsis – management and prevention
- SIRS and sepsis: definition, common etiologies in the SICU patient,
supportive therapy ****(see organ support therapies)******, source control therapy and antibiotics, novel strategies of support, including activate Protein C, crystalloid vs. colloid and isotonic vs. hypertonic resuscitation, use of vasopressin in septic hypotension - BSI and line infections: CDC recommendations for prevention diagnosis
- Nosocomial and ventilator-associated pneumonia: diagnosis (CDC-NNIS
criteria: qualitative vs. quantitative sputum cultures, BAL/PSB), patient and unit specific empiric and culture guided antibiotic therapy, adjunct therapy (immune support, pulmonary physiotherapy), prevention (CAS, Peridex, - UTI: CDC guidelines for prevention, diagnosis and therapy
- Surgical site infections: CDC guidelines for prevention, diagnosis and
therapy; considerations for pre-operative prevention - Influence of iatrogenic or pre-existing immune deficiency
- Use of preventive antibiotics (anti-fungals) and complications of
(prolonged) antibiotic use
- ICU fever work-up: outline the principles of post-operative fever with
respect to causes, empiric diagnostic modalities and specific therapy. How useful are these principles when considering the elderly patient?  Shock
- Types, history, clinical signs and symptoms
- Cardiogenic (volume overload, MI, cardiac contusion, CHF, etc.) - Hypovolemic (trauma, 3rd spacing, fever, diarrhea/vomiting, etc.) - Distributive (septic, anaphylactic, neurogenic, adrenal insufficiency, etc.) - Obstructive (cardiac tamponade, tension pneumothorax, pulmonary - Propose an algorithm for diagnosing cause of shock state and initiating appropriate treatment utilizing progressively invasive methods of monitoring - Graded invasive monitoring *******(see organ support therapies)********
- Early goal-directed therapy
- Measures of organ perfusion (ABG, SvO2, lactate, base excess, organ - Crystalloid vs. colloid, isotonic vs. hypertonic resuscitation, use of blood - Novel therapies
 Cardiac arrest
- Discuss the pathophysiology and mechanism of arrest, for the following:
- Acute myocardial infarction, acute dysrhythmia - Hypovolemic shock (blood loss, dehydration), hemorrhagic shock (non- - Anaphylactic shock (envenomation, drug related) - Outline the surgical house staff role on the “code team”
- Demonstrate proficiency in cardiopulmonary resuscitation according to ACLS
 ICU pharmacology
- The resident should develop a fundamental understanding of the following classes of drugs and their use in critically ill patients, including dosage, duration of action, common side effects and interactions, altered metabolism and excretion in (hepatic and renal) organ dysfunction, monitoring of drug levels and - Anti-hypertensive agents/‘Cardio-protective’ agents/antiarrhythmic agents - Agents for gastric protection (H2 blocker, PPI, Carafate, antacids) - Hemopoetics (Erythropoietin, Iron, Vitamin B12, Folate, etc.) and (anti- )clotting agents (aspirin, Plavix, heparin(oids), warfarin, vitamin K, Factor - Hormones (corticosteroids, mineralocorticoids, thyroid hormone, etc.) - Sedatives, narcotics and non-narcotic analgesics and antipyretics  Prevention and management of common complications
- Stress gastritis and ulcer
- Patients at risk: previous ulcer disease, (neuro-)trauma, burn, sepsis, etc. - Prevention/Therapy: H2-blockers, PPI, Carafate, early enteral nutrition, etc. - DVT and PE
- Patients at risk: (GI) cancer, obesity, trauma/orthopedic procedures, etc. - Use of compressive stockings and or (sequential-) compression devices vs. use of heparin(oids) and/or warfarin or anti-platelet agents - Complications of anticoagulation therapy - Diagnosis and management of PE, indications for (emergent) surgical inter- vention (filters, thromboembolectomy, intra-pulmonary lysis therapy, etc.) - Myocardial ischemia
- Preventive beta-blocker (and other) therapy - Diagnosis of acute ischemic syndromes and management (medical, - Catheter-related infections (see BSI)************************
- ICU psychosis
- (Protocol driven) goal-directed sedation and analgesic management; utility of - Management of acute delirium and psychosis - Skin breakdown/decubitus ulcer
- Anemia of critical illness
- Provider contamination (universal precautions, infection control)
 ICU laboratory and radiographic testing
- Considerations for goal-directed, cost-sensitive care in the workup and  ICU procedures (see patient care competency)
 The elderly ICU patient: Analyze and use examples to describe the significance of
the following characteristics that are different and/or more frequent in the older - Vague, imprecise symptoms, atypical disease presentation - Different normal values for common diagnostic tests - Likelihood of decreased functional reserve  Novel and investigational approaches in ICU technology and management
 Outline the unique problems of the following surgical subspecialties in critical care
Objectives – General:
 Complete the reading assignment (see literature list)
 Attend all ( 85%) conferences, M&M conferences, Grand Rounds/other
educational activities of the Department of SICU during the rotation
 Take a post-rotation self-assessment test with at least 75% correct answers
Practice-based
Goals and Objectives:
Learning and
Residents must be able to investigate and evaluate their patient care practices, appraise Improvement:
and assimilate scientific evidence, and improve their patient care practices. Residents are  Self assessment: Analyze practice experience during the rotation, as well as own
performance-based on interaction with SICU attending(s) and other key SICU staff; accept and use constructive criticism to improve performance in the six core  Medical knowledge: Self-directed and under mentorship of the SICU attending staff,
locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems; Use evidence based medicine approach to patient care whenever possible; apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness; use information technology to manage information, access online medical information and support their own education; facilitate the learning of students and other healthcare professionals on the SICU service by sharing pre-existing and newly acquired knowledge (general and case-based) on rounds and during formal educational activities. Residents are encouraged to ask/question the SICU attending staff and/or other SICU surgery related expert providers for clarification of unclear  Participate in the management of SICU patients as outlined in the patient care
competency; during the rotation the resident should become familiar/proficient with the bedside management of critically ill surgical patients, their common problems/complications and the management thereof.  Perform/participate in SICU related operations and procedures as outlined in patient
Goals and Objectives:
Interpersonal and
Residents must be able to demonstrate interpersonal and communication skills that result Communication
in effective information exchange and teaming with patients, their patient’s families and professional associates. Residents are expected to:  Develop interpersonal skills necessary to communicate effectively with patients,
patient families, nursing staff, mid-level healthcare providers, ancillary staff, medical students, fellow residents and attending staff in the complex multi-specialty  Contribute to creating an atmosphere of collegiality and mutual respect with all
providers involved in the care of patients  Develop effective listening, questioning and documentation skills
 Demonstrate ability to work effectively as a member of a team
 Demonstrate ethically sound behavior (see also Professionalism)
 Share personal knowledge with other members of the team to foster an environment
Goals and Objectives:
Professionalism:
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. Residents  Demonstrate adherence to institutional and departmental standards and policies
 Demonstrate respect, compassion, integrity and ethical behavior consistent with
the values of the department and institution; develop and sustain sensitivity toward
differences of age, gender, culture, religion, ethnicity or other diversities in both co-  Demonstrate ability to appropriately take on, share and delegate responsibilities
with regard to patient care; balance own rights and privileges appropriately with responsibilities and accountability resulting from being a member of a team dedicated  Demonstrate commitment to excellence and on-going professional development
 Under attending and other SICU staff guidance, develop skill to resolve potential
problems and conflicts that occur in a complex corporate environment using the
appropriate channels and methods of communication to maximize patient care and  Evaluate and formulate a response to ethical questions, including:
a. The need for organ donation and the identification of potential donors. b. Decisions about whom to resuscitate and to what degree. c. Care for the mentally incapacitated or incompetent patient. d. Dealing with a difficult family and futility of care. e. Identifying and interacting with alternate religious/cultural beliefs. Goals and Objectives:
Systems-based
Residents must demonstrate an awareness of and responsiveness to the larger context and Practice:
system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:  Understand how choices in patient care and other professional practices affect other healthcare professionals, the healthcare organization and the larger society and how these elements of the system affect their own practice: a. Average cost of ICU daily care, individual and cohort cost related to nosocomial infection and other complications related to critical care b. The relevance and components of clinical pathways and how to deal with deviation.  Practice cost-effective healthcare and resource allocation that does not compromise  Know how to partner with healthcare managers (SICU coordinator, social work, case management, PT/OT and Rehabilitation medicine, etc.) and other healthcare providers (PMD, Specialty Providers in and out of the hospital) to assess, coordinate and improve healthcare for the individual patient and cohorts of patients

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