Fellows are allowed four weeks of vacation per year. The Surgical Critical Care Fellowship goal is to train surgeons in the subspecialty of surgical critical care. This fellowship will prepare the graduating fellows to function in either an academic center or in a community hospital environment. This will be accomplished by exposing the surgical critical care fellow to a multitude of clinical aspects of critical care, teaching, administration, and research. The specific educational objectives of this fellowship program in surgical critical care are to enable fellows to investigate and evaluate, teach, and clinically apply the fundamental principles of critical care.
Upon completion of the Surgical Critical Care Fellowship, every physician 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 (ie. administer the critical care unit).
- The ability to disseminate the appropriate information to patients and 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 and manage and wean patients from mechanical ventilation using various techniques and ventilator modes.
- Perform and instruct the theory and techniques of CPR.
- Treat all forms of shock using 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 using advanced nutritional supplement methodologies.
- Perform and provide appropriate conscious sedation.
- Perform and instruct the theory and techniques for appropriate pain management and advanced sedation strategies.
- Perform and 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.
- Use medications safely and determine cost effectiveness of various therapeutic interventions.
- Educate the health professional team as well as patients and patient families regarding critical care ethical issues.
- Educate and communicate to patients and their families all treatment options, outcomes and patient prognosis.
- Emotionally and mentally support 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 the 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, pancreatis, 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.
- Triage critically ill patients appropriately.
- Participate in quality assurance processes such as Mortality and Morbidity Conference and Performance Improvement Conference.
- Develop patient safety monitoring and error restriction progress.
The achievement of these objectives is documented in several ways.
Each resident is required to keep a log of the critically ill patients whom he or she has managed. Using this document, residents 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 will be documented also by the results of the Multidisciplinary Critical Knowledge Assessment Program (MCCKAP) which the surgical critical care fellow is required to take during their training year. The detailed report received clearly identifies objectively his or 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.