RESOURCES (B4)
1
2014
PRE-SURVEY QUESTIONNAIRE
STANDARD B4: RESOURCES
"There must be sufficient resources including teaching faculty, the number and variety of
patients, physical and technical resources, as well as the supporting facilities and services
necessary to provide the opportunity for all residents in the program to achieve the educational
objectives and receive full training as defined by the Royal College specialty training
requirements."
Program
Critical Care Medicine (adult)
University
Date of Review (month/year)
Sites Participating in this Program:
Where the resources to provide "full training" are not available at the sponsoring university, several
different types of interuniversity affiliations may be negotiated. It should be noted that the exchange of
residents between two fully accredited programs does not require an interuniversity affiliation.
Coordination of Adult and Pediatric Subspecialty Programs
a)
Is this university accredited for:
Adult Critical Care Medicine
Pediatric Critical Care Medicine
b)
If the university is accredited for both programs, describe the extent to which the two programs are
integrated in the following areas:
1)
Program administration
2)
Academic program
3)
Clinical program
4)
Technical and/or laboratory skills
RESOURCES (B4)
2
2014
1. Teaching Faculty
List by teaching site the members of the teaching faculty who have a major role in this program, including members from other
departments. In indicating a subspecialty, use as a criterion whether he or she is considered by colleagues as a subspecialist and
functions academically and professionally as one.
Teaching Site
Name
University Rank
Specialty
Qualifications
Subspecialty
(If any)
What percentage of faculty listed above have been practicing in the specialty/subspecialty:
< 15 years
%
> 25 years
%
Nature of Interaction with Resident
(e.g. clinical, teaching, research)
RESOURCES (B4)
2.
3
2014
Financing of the program
a) Describe the source of funding for residency positions in this program.
b) How is the program funding the following?
i.
Resident travel to conferences?
ii. Practice examinations ie/ The Society of Critical Care Medicine Multidisciplinary Critical Care
Knowledge Assessment Program?
iii. Computers and dedicated office space for the residents?
iv. Courses such as ACLS and ATLS?
c) How is the Program Director supported to run the program? Comment on resources available,
money available, and if the Director has protected time to devote to the program.
3.
a.
General Critical Care Data
Demographic Data for each ICU where residents rotate
Complete the following table for a 12-month period. Specify the 12-month period used, the source of
data, and which ICU acuity scoring system was used (APACHE score, MPM, SAPS etc) in the comments
section. Add rows as needed to include all units where residents rotate for primary ICU experience.
Standard deviations can be included in the table if the data is available. Only full ICU beds should be
counted. If there are lower acuity beds (stepdown unit) attached to the ICU these should be described
in the comments section. Open or closed refers to the management functioning of the unit. In a closed
unit the ICU team is responsible for all orders and all admission and discharge decisions. Open units
allow non-ICU services to write orders and make admission/discharge decisions.
Unit
Name
Number
of ICU
beds
Open
or
Closed
unit
Number of
admissions
Average
Patient
Age
Average
LOS
Number of
Mechanically
Ventilated
Patients
Number
of
Patients
requiring
CRRT
Average
acuity
score
ICU
mortality
(%)
RESOURCES (B4)
4
2014
Comments:
b.
Narrative description of units where residents train
i. Provide a written description of the purpose of each unit in the training program and a description
of the patient populations that dominate each particular unit.
ii. Do you feel that your residents receive adequate exposure to the common admitting diagnostic
categories?
4.
Specific ICU activities important for training residents
a)
Nutritional
i. Describe the training that residents in Critical Care Medicine receive to evaluate the nutritional
status of patients, to determine current deficiencies, and how to provide the appropriate nutrition
in the most effective manner, be it enteral or parenteral, to sustain the patient throughout the
period of critical illness.
ii. Does a dietician attend daily rounds in the unit?
iii. What percentage of patients admitted to each ICU receives total parenteral nutrition during their
ICU stay?
b)
Trauma
Complete the following table. Include the 12-month period used and the source of data in the
comments section.
Type of Trauma centre
Number of trauma
victims with Injury
Severity Score greater
than 16
Number of trauma
victims admitted
to ICU
RESOURCES (B4)
5
2014
Comments:
i.
Does your trauma centre have a designated trauma team?
ii. Comment on the involvement of critical care residents in the management of trauma patients on
your trauma team and in your primary trauma unit:
c) Toxicology
Complete the table below by recording the number of toxicologic emergencies responsible for ICU
admission in each of your units. Specify the 12-month period used and the source of data.
Intensive Care Unit
Toxicologic Emergency Admissions
TOTAL
i.
Is there a liaison with a poison control centre?
ii. Describe any additional toxicology training available and the opportunities available for Critical
Care Medicine residents to receive toxicology training.
d) Burns and Electrical Injuries
i.
How do you ensure that your residents receive training in the management of patients with
burns and electrical injuries?
e) Transplantation
i.
Which of the following types of transplantation programs are operating in your centre?
Cardiac Transplant
Lung Transplant
Bone Marrow Transplant
Hepatic Transplant
Renal Transplant
Other (specify)
No Transplant programs in operation
ii. Which type of transplant patients are admitted to ICU in the immediate post transplant period?
RESOURCES (B4)
6
Cardiac Transplant
Lung Transplant
2014
Hepatic Transplant
Renal Transplant
Bone Marrow Transplant
None routinely admitted to ICU
iii. If you admit recently transplanted patients to ICU complete the following table. In the
comments section indicate what 12 month period you are using, what the source of the data is,
and what units are admitting the patients.
Type of transplant
Number of admissions per year
TOTAL
Comments:
iv. Describe any additional training related to transplant care.
f)
Organ and Tissue Donation
Complete the following table including all Intensive Care Units that routinely receive residents from
your program. Provide data over a 12-month period. Use the comments section to specify the 12month period used and the source of data. Add rows as needed to include all units.
Unit/Hospital
Number of patients
who were declared
brain dead
Number of
patients who
were organ
donors
Total
i.
Does your program coordinate with a regional or provincial Tissue and Organ Donation Program?
ii. Describe any additional training related to Tissue and Organ Donation.
g)
Patient Transport
i.
Do your trainees participate in a Patient Transport Program?
YES
NO
RESOURCES (B4)
7
2014
ii. Describe the organization of patient transfers into the tertiary critical care units in your city.
What is the role of the Critical Care Medicine resident in this process? Are they involved in the
decision to transfer to or from the tertiary unit?
iii. What training do residents in your program receive regarding transport of critically ill patients?
h)
Research and Epidemiology
i. List staff with expertise in epidemiology and biostatistics and provide their qualifications.
ii. How do your residents receive teaching related to epidemiology and biostatistics?
iii. Describe any opportunities for residents to gain experience in high risk scoring systems (e.g.
Injury Severity Scores), and patient evaluation systems (e.g., APACHE, TISS, etc.).
iv. Do your residents participate in a regular regional morbidity and mortality process? Please
explain their involvement.
v. Do your units have a dedicated ICU database? Describe how you obtain demographic and
outcome data if you do not. Describe the data collected and the data collection process if you
use an ICU database.
vi. Do your residents participate in a scholarly project (e.g., collaborative research, quality
improvement, guidelines development, research in training) during their training?
vii. Are your residents supported to present the findings of their scholarly project?
i)
Biomedical Ethics
i.
Is there an ethicist available for consultations in the Intensive Care Unit?
Describe his/her role.
ii. Does the ethicist participate in:
YES
NO
RESOURCES (B4)
8
2014
Teaching conferences?
YES
NO
Case discussions?
YES
NO
iii If applicable, describe any opportunities provided for instruction in coping with the moral and
ethical issues which impact on patients, their families, and the Critical Care Medicine specialist.
iv. What instruction and experience do residents get around end of life care and withdrawal of life
support?
v. Describe any opportunities that provide residents with experience in the medico-legal
considerations specific to the critically ill patient.
j)
Care of the Chronically Ill Patient
i.
k)
Supporting Diagnostic and Laboratory Services
i.
l)
What instruction and experience do your residents receive in managing chronically ill patients in
your units?
Are there any limitations for the Critical Care Medicine program in areas of pathology,
biochemistry, microbiology, or diagnostic imaging?
Procedural Skills
Upon completion of training, residents must be proficient in both the diagnostic and therapeutic use
of the following procedural skills. Does your training program provide sufficient exposure to the
following procedures?
Skill/Procedure
Endotracheal intubation
Tracheostomy tube replacement
Fiberoptic bronchoscopy in the
intubated patient
Arterial line insertion
Central venous line insertion
Pulmonary artery catheter insertion
and cardiac output measurements
Cardiopulmonary resuscitation
Sufficient
Insufficient
RESOURCES (B4)
Skill/Procedure
9
Sufficient
2014
Insufficient
Defibrillation
Elective cardioversion
Transcutaneous pacer application
Intra-abdominal pressure monitoring
Declaration of brain death
Temporary hemodialysis catheter
insertion
Lumbar puncture
Paracentesis
Thoracentesis
Ultrasound assessment for vascular
access
Thoracostomy tube insertion
i.
Provide a comment for any procedures deemed insufficient.
ii. Are there any limitations in the availability of equipment needed for any of the procedures
identified above? If so, please identify how these limitations affect the training opportunities for
your residents.
5.
Information/Space Resources
a) Do residents have free 24/7 access to on-line libraries, journals and other educational
resources? Yes
No
Partially
If “No” or “Partially”, please explain.
b) Do residents have adequate space to carry out their daily work?
Yes
No
Partially
If “No” or “Partially”, please explain.
c) Are technical resources required for patient care duties located in the work setting?
Yes
No
Partially
If “No” or “Partially”, please explain.
d) Do facilities allow resident skills to be observed?
Yes
No
Partially
If “No” or “Partially”, please explain.
e) Do facilities allow for confidential feedback/discussions?
Yes
No
Partially
If “No” or “Partially”, please explain.
RESOURCES (B4)
6.
10
2014
Summary of Adequacy of Resources
Comment on the adequacy of the resources in the overall clinical program, with particular reference
to the relationship between such resources and the number of residents dependent upon them.
Identify any areas where deficiencies of staff, suitable patients, or essential facilities are affecting
adversely the training of residents, indicating measures under consideration to correct such
deficiencies.
Editorial revisions - February 2012; November 2012
Revised – SC – April 2014