VA ICU: R2
Friday, February 12, 2016
Stanford University General Surgery Residency Program
VA ICU Rotation: Goals and objectives for R-2 Residents
Rotation Site Director: Juliana Barr, MD
Description
The ICU rotation at the VA Palo Alto Health Care System (VAPAHCS) offers a broad experience to surgical residents in the care of
critically ill patients with high acuity surgical and medical diseases and processes. The VAPAHCS is the tertiary referral center for
VA Region 21, admitting the highest acuity of critically ill patients to the 15 bed Medical-Surgical ICU (MSICU) in the region.
Surgery Residents on this rotation are exposed to ICU patients from all of the major surgical subspecialties (e.g., cardiothoracic,
general, vascular, neurosurgery, ENT, urology, orthopedics, and plastics), with the exception of burn, trauma, and solid organ
transplant ICU patients.
Goals
The goals of the VA ICU rotation are to enable PGY-2 Surgery residents:
 Develop adequate knowledge and experience in the evaluation and management of critically ill surgical and medical patients.
 Refine procedural skills commonly required in the care of these patients.
 Experience and understand the day-to-day function of critical care units.
Objectives
The VA ICU rotation has the following objectives:
 The VA ICU Service is multidisciplinary service which consists of Medical Students, Internal Medicine Interns, PGY-2 and 3
Residents from Surgery, Anesthesia, and Medicine, Critical Care Medicine Fellows from Anesthesia, Medicine, and Pulmonary
and Critical Care Medicine, and ICU Attendings with Anesthesia and Pulmonary Critical Care Backgrounds. This Service is part
of a larger multidisciplinary ICU Team which in addition to physicians includes ICU Nurses, Respiratory Therapists, Pharmacists,
Dieticians, and Social Workers. This diverse ICU Team gives Surgery Residents broad exposure to a wide variety of disciplines
involved in the care of critically ill patients, and is unique to their residency experience.
 The PGY-2 Surgery Resident shares primary responsibility for the care of all medical and surgical ICU patients admitted to the 15
bed MSICU with other members of the ICU Team, and in the case of surgical ICU patients, they share that responsibility with the
primary Surgical Service. Residents admit and round on all patients in the ICU, writing notes, presenting patients during twice
daily ICU rounds, performing procedures, requesting consults, and discussing care plans with patients and their health care
surrogates. In the case of surgical ICU patients, residents coordinate the daily care plan with the patient’s surgical team as well.
 The Resident gains knowledge of general critical care principles through: 1) in-depth discussions during daily bedside ICU rounds
with a board-certified ICU attending physician and critical care fellows; 2) daily didactic ICU lectures; 3) monthly
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VA ICU: R2
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Friday, February 12, 2016
multidisciplinary ICU Simulator sessions; and 4) by independent reading of the electronic ICU syllabus provided to all residents
and other on-line or hard copy critical care resources.
Residents will take in-house call together with an intern every third night, and they are expected to cross-cover and to manage all
MSICU patients during their nights on call, as well as to supervise the intern they are on call with. Residents are also expected to
carry the Code/Rapid Response Team Pager at night, and to be the first responders for unstable patients outside of the ICU. The
Residents take call with a Critical Care Fellow and an ICU Attending who take call from home, who are immediately available to
Residents should they be needed for any reason.
Because the Residents are paired with the same ICU attending for an entire week and with ICU Fellows for the entire month,
teaching and feedback is individualized to the needs of the Residents. Residents are evaluated in the 6 core competencies (Medical
knowledge, Patient care, Interpersonal communication skills, Practiced-based learning, Professionalism, and Systems based
practice) using specific web-based evaluation forms. An outline of core competencies with rotation objectives, instructional
activities, and evaluations is below.
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VA ICU: R2
Friday, February 12, 2016
Specific goals and objectives for PGY-2 Surgery Residents
GOALS
Core Competencies
Medical Knowledge:
To acquire and apply
knowledge of basic
and applied clinical
sciences that relate to
the practice of adult
critical care medicine.
Patient Care:
To provide
compassionate,
timely, appropriate,
and effective care of
critically ill adults.
R-2 OBJECTIVES
1. Resident knows and applies the basic
and clinical sciences appropriate to
the practice of Critical Care such as
physiology, pharmacology, and
specific disease processes (see below).
2. Resident demonstrates an
investigatory and analytic approach to
patients with critical illnesses.
3. Resident prioritizes patient’s disease
related states, issues and designs a
care plan accordingly, and anticipates
potential complications and
prevention.
1. Resident performs an adequate
assessment of surgical and medical ICU
patients including: 1) performing an
appropriate physical exam and
extracting a relevant history from
patients, their health care surrogates,
and other providers; 2) the appropriate
acquisition and evaluation of relevant
laboratory data; and 3) performing
necessary therapeutic and diagnostic
procedures.
2. Resident acquires knowledge and
understanding of the following critical
care management principles:
a. indications for and techniques used
1.
2.
3.
4.
INSTRUCTIONAL
ACTIVITIES
In-depth discussions of
critical care diseases and their
management during daily
bedside ICU rounds with a
board-certified ICU attending
physician and critical care
fellows.
Daily didactic ICU lectures.
Monthly multidisciplinary
ICU Simulator sessions.
Independent reading of the
electronic ICU syllabus
provided to all residents and
other on-line or hard copy
critical care resources.
1. In-depth discussions of
specific critical care diseases
and their management during
daily bedside ICU rounds
with a board-certified ICU
attending physician and
critical care fellows.
2. Daily didactic ICU lectures.
3. Monthly multidisciplinary
ICU Simulator sessions.
4. Independent reading of the
electronic ICU syllabus
provided to all residents and
other on-line or hard copy
critical care resources.
EVALUATION
1. Weekly feedback provided by
the 4 ICU Attendings and
ICU Fellows who worked
with that Resident.
2. A single composite Rotation
Evaluation of the Resident
completed by the ICU
Residency Site Director, with
input from the ICU
Attendings and Fellows.
(https://stanford.medhub.com)
1. Weekly feedback provided by
the 4 ICU Attendings and
ICU Fellows who worked
with that Resident.
2. A single composite Rotation
Evaluation of the Resident
completed by the ICU
Residency Site Director, with
input from the ICU
Attendings and Fellows.
(https://stanford.medhub.com)
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VA ICU: R2
Friday, February 12, 2016
b.
c.
d.
e.
f.
g.
h.
i.
for central IV and arterial line
access;
pathophysiology of and principles
of hemodynamic management in
shock and in acute hypertensive
states;
pathophysiology and management
of acute multi-organ system failure;
pathophysiology and management
of coronary ischemia, congestive
heart failure, and structural heart
disease.
pathophysiology and principles of
managing acute respiratory failure,
including appropriate use of oxygen
delivery systems, indications for
endotracheal intubation and
tracheostomy, principles and
applications of invasive and noninvasive modes of mechanical
ventilation, and ventilator weaning
and extubation;
diagnosis and treatment of common
atrial and ventricular arrhythmias;
pathophysiology and management
of acute renal failure, acid-base, and
fluid and electrolyte disorders,
including indications for
hemodialysis;
principles of critical care nutrition
and the implications of malnutrition
in ICU patients;
pathophysiology and management
of acute hepatic diseases and
chronic cirrhosis;
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VA ICU: R2
j. pathophysiology, diagnosis, and
treatment of acute coagulopathic
states and indications for anticoagulation therapy;
k. pathophysiology and the diagnosis
and treatment of infectious diseases,
including strategies for the
prevention of device-related
infections in ICU patients;
l. pathophysiology and management
of acute endocrine disorders in ICU
patients;
m. pharmacology and management of
pain and agitation in ICU patients.
1. Resident provides patients and their
Interpersonal
health care surrogates with timely
Communication
Skills:
updates on the patient’s condition,
Residents must
assuring concordance with the goals of
communicate in a way
care specified and agreed upon by both
that leads to effective
the patient or their health care surrogate
information exchange
and all members of the ICU Team.
of a critical care plan
2. Resident communicates and works
to patients, their
effectively with other members of the
families, and other
ICU Team (e.g., ICU nurses, RTs,
critical care providers.
dieticians, etc.), consultants, and the
primary surgical service (for SICU
patients).
Friday, February 12, 2016
Daily instruction and mentoring
of communication and teamwork
skills by ICU Attendings and
Fellows.
1. Weekly feedback provided by
the 4 ICU Attendings and
ICU Fellows who worked
with that Resident.
2. A single composite Rotation
Evaluation of the Resident
completed by the ICU
Residency Site Director, with
input from the ICU
Attendings and Fellows.
(https://stanford.medhub.com)
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VA ICU: R2
GOALS
Core Competencies
Practice-based learning and
improvement:
In order to improve patient
care practices, residents must
be able to critically evaluate
their own performance as well
as appraise and incorporate
clinical scientific evidence.
Professionalism:
Residents must show a
commitment to professional
responsibilities, adherence to
ethical principles, and
sensitivity to diversity.
Systems-based Practice:
Resident must be able to
demonstrate an awareness of
and responsiveness to the
system of health care and the
ability to effectively call on
system resources to provide
optimal care.
Friday, February 12, 2016
R-2 OBJECTIVES
1. Identify impact of complications on the
recovery of the critically ill patients
2. Use information technology to
assimilate current medical literature as it
relates to the Medical-Surgical ICU
patient population.
3. Learns attention to detail in critically ill
patients
1. Resident acts with sensitivity and
responsiveness to patient’s culture, age,
gender, and disabilities.
2. Resident displays appropriate demeanor,
even in adverse situations.
3. Resident obtains proper consent and
confirms advanced directives, if present
4. Resident maintains accountability to
patients, medical professionals, and
society.
5. Resident becomes a life long learner.
1. Resident learns to use ICU protocols to
improve quality of care.
2. Resident acts as an organizational
problem solver for patients.
3. Resident understands how care for
patients in the ICU enables the hospital
to deliver a wide range of patient care.
4. Resident understands how ICU practice
affects staffing and health care costs
INSTRUCTIONAL
ACTIVITIES
Teaching in the ICU by
ICU Attendings and
Fellows.
Teaching in the ICU by
ICU Attendings and
Fellows.
Modeling in ICU by
attending faculty and
fellow. VA ICU
Policies and Procedures
distributed at the
beginning of the
rotation as part of the
ICU syllabus.
EVALUATION
1. Weekly feedback provided by
the 4 ICU Attendings and ICU
Fellows who worked with that
Resident.
2. A single composite Rotation
Evaluation of the Resident
completed by the ICU
Residency Site Director, with
input from the ICU Attendings
and Fellows.
(https://stanford.medhub.com)
1. Weekly feedback provided by
the 4 ICU Attendings and ICU
Fellows who worked with that
Resident.
2. A single composite Rotation
Evaluation of the Resident
completed by the ICU
Residency Site Director, with
input from the ICU Attendings
and Fellows.
(https://stanford.medhub.com)
Weekly feedback by attending and
Rotation evaluation by each ICU
attending
(https://stanford.medhub.com)
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