With immersion into the curriculum the fellow experiences a multitude of clinical aspects of critical care, teaching, administration and research. This exposure will prepare the graduating fellow to attain the goal of functioning in either an academic center or in a community hospital environment. The specific educational objectives of this fellowship program are to enable fellows to investigate and evaluate, teach, and apply clinically the fundamental principles of critical care.
Upon completion of the Surgical Critical Care Fellowship Program, fellows will have developed:
- The ability to perform and teach critical care skills.
- A strong foundation of knowledge related to surgical critical care.
- The ability to demonstrate advanced decision making capability. The ability to become the leader of the multidisciplinary critical care team; i.e., administer the critical care unit.
- The ability to disseminate the appropriate information to patients and to their families. The ability to analyze, evaluate and perform critical care research.
Clinically, the fellow will be able to:
- Identify the indications for critical care admission and discharge.
- Perform and provide appropriate resuscitation, utilizing advanced techniques to any patient sustaining a life-threatening event.
- Identify indications for mechanical ventilation; manage, and wean patients off, mechanical ventilation by utilizing various techniques and ventilator modes.
- Perform, instruct the theory and techniques of CPR.
- Treat all forms of shock utilizing conventional and state-of-the-art techniques. Identify, treat and prevent multiple organ system failure.
- Identify, treat and prevent all life-threatening electrolyte acid-base disturbances.
- Identify, treat and prevent malnutrition utilizing advanced nutritional supplement methodologies.
- Perform and provide appropriate conscious sedation.
- Perform, instruct the theory and techniques for appropriate pain management and advanced sedation strategies.
- Perform, recognize the indications, contraindications and theories for invasive and noninvasive hemodynamic monitoring.
- Titrate inotropic and vasopressor drips based on hemodynamic monitoring.
- Initiate appropriate consultations with other specialists and construct a clinical plan for complex critical care problems.
- Determine cost effectiveness of various therapeutic interventions.
- Educate the health professional team, as well as, patients and patient’s families regarding critical care ethical issues.
- Educate and communicate to patients and their families all treatment options, outcomes and patient prognosis.
- Support emotionally and mentally the patients and their families through the trauma of critical illness.
- Recognize, manage and instruct the theories of acute and chronic renal failure.
- Recognize, manage and instruct the theories of coagulation disorders (acquired and congenital).
- Recognize, manage and instruct theories of acute and chronic neurologic disease and injury.
- Recognize, manage and instruct the theories of acute and chronic anemia.
- Recognize, manage and instruct the theories of GI disturbances such as GI hemorrhage, pancreatitis, diverticulitis and cholecystitis.
- Recognize, treat and monitor hypertension. Recognize, treat and monitor the theories on endocrine dysfunction related to DM, DI, adrenal and thyroid dysfunction.
- Recognize, treat and monitor the theories on infectious disease, especially as it relates to critical illness.
- Recognize, treat and monitor abdominal compartment syndrome. Perform a variety of bedside surgical procedures.
Administratively, the fellow will be able to:
- Triage critically ill patients appropriately.
- Make decisions regarding need for operative intervention.
- Participate in quality assurance processes such as mortality and morbidity conference, performance improvement conference.
- Develop patient safety monitoring and error restriction progress.
The achievement of these objectives is documented in several ways. Each fellow is required to keep a log of the critically ill patients that he/she has managed. Using this document, fellows maintain a record of their clinical activities during the training period; including their roles in the management of each patient, and a listing of major procedures, such as insertion of hemodynamic monitoring devices, endotracheal intubation and tube thoracostomy, among others.
Acquisition of the critical care cognitive skills will be assessed by the fellow’s active participation in teaching rounds, didactic lectures, journal clubs and required formal presentations. The achievement of the educational goals of this Surgical Critical Care Fellowship Program will be documented also by the results of the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) which the surgical critical care fellow is required to take during their training year. The detailed report received identifies objectively his/her strengths and weaknesses. This information is useful in identifying areas of each fellow’s surgical critical care curriculum, which might benefit from directed reading and specifically concentrated training and preparation for the surgical critical care exam.