New Application: Surgical Critical Care
Review Committee for Surgery
ACGME
515 North State Street, Suite 2000 Chicago, Illinois 60654  312.755.5000  www.acgme.org
SPONSORING INSTITUTION
1. How much protected time or direct or indirect salary support does the sponsoring institution provide
the program director? [PR I.A.1.]
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2. Does the sponsoring institution also sponsor ACGME-accredited programs in: [PR I.A.3.]
a) General surgery ..................................................................................................... ☐ YES ☐ NO
b) Pediatric surgery .................................................................................................... ☐ YES ☐ NO
c) Thoracic Surgery .................................................................................................... ☐ YES ☐ NO
d) Vascular Surgery.................................................................................................... ☐ YES ☐ NO
3. Describe the interaction between the residency programs in surgery, pediatric surgery, thoracic
surgery, and/or vascular surgery and the fellowship program. [PR I.A.3.a)]
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4. If the institution sponsors more than one critical care program, describe how the program director
coordinates interdisciplinary requirements to ensure that fellows meet the specific criteria of their
primary specialties. [PR I.A.4.]
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5. Does the sponsoring institution also sponsor ACGME-accredited residency programs in those
specialties that relate particularly to surgery, such as: [PR I.A.5.]
(Note: programs will not be cited for non-compliance with this requirement)
a) Anesthesiology ....................................................................................................... ☐ YES ☐ NO
b) Diagnostic radiology ............................................................................................... ☐ YES ☐ NO
c) Internal medicine .................................................................................................... ☐ YES ☐ NO
d) Pathology ............................................................................................................... ☐ YES ☐ NO
PROGRAM PERSONNEL AND RESOURCES
Program Director
1. Is the length of the program director’s appointment at least two years? [PR II.A.1.b)] .. ☐ YES ☐ NO
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
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2. Does the program director have a faculty appointment in good standing at the primary clinical site?
[PR II.A.2.d)] ................................................................................................................ ☐ YES ☐ NO
3. Describe how the program director interacts with faculty members to enhance the educational
opportunities for fellows. [PR II.A.3.e)]
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4. Does the program director direct or co-direct one or more of the critical care units in which the
clinical aspects of the educational program take place, and personally supervise and teach surgery
and surgical critical care fellows in that unit. [PR II.A.3.f)] ............................................ ☐ YES ☐ NO
Faculty
How often do faculty members participate in each of the following activities: [PR II.B.6.]
a)
b)
c)
d)
Organized clinical discussion ..................................................................................... [Frequency]
Rounds....................................................................................................................... [Frequency]
Journal clubs .............................................................................................................. [Frequency]
Conferences ............................................................................................................... [Frequency]
Other Program Personnel
Do staff members include specially-trained nurses and technicians skilled in critical care
instrumentation, respiratory function, and laboratory medicine? [PR II.C.1.] ...................... ☐ YES ☐ NO
Resources
1. Are the following available at each participating site? [PR II.D.1. - II.D.2.d)]
A simulation and skills laboratory
A critical care unit located in a
designated area within the
institution, constructed and
designed specifically for the care of
critically-ill patients
A common office space for fellows
that includes a sufficient number of
computers and adequate
workspace
Online radiographic and laboratory
systems
Software resources for production
of presentations, manuscripts, and
portfolios
Site #1
Site #2
Site #3
Site #4
☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO
☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO
☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO
☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO
☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO
2. Provide the average daily census for each intensive care unit to which fellows are assigned. [PR
II.D.2.e)]
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
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3. Briefly describe the care settings in which fellow education takes place. [PR II.D.3.]
(Limit response to 400 words)
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Medical Information Access
Identify whether the fellows have the following available for education and patient care each
participating site. [PR II.E.1.]
Internet access to full-text journals
Electronic medical reference
resources
Site #1
Site #2
Site #3
Site #4
☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO
☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO ☐ YES ☐ NO
EDUCATIONAL PROGRAM
Patient Care
1. Indicate the settings and activities in which fellows demonstrate competence in each of the
following critical care skills. Also indicate the method(s) used to assess competency.
Competency Area
Circulatory: performance of
invasive and noninvasive
monitoring techniques, and the
use of vasoactive agents and
management of hypotension and
shock; application of transesophageal and transthoracic
cardiac ultrasound and
transvenous pacemakers,
dysrhythmia diagnosis and
treatment, and the management
of cardiac assist devices
[PR IV.A.2.a).(2).(a).(i)]
Endocrine: performance of the
diagnosis and management of
acute endocrine disorders,
including those of the pancreas,
thyroid, adrenals, and pituitary
[PR IV.A.2.a).(2).(a).(ii)]
Gastrointestinal: performance of
utilization of gastrointestinal
intubation and endoscopic
techniques in the management
of the critically-ill patient; and
management of stomas, fistulas,
and percutaneous catheter
devices
[PR IV.A.2.a).(2).(a).(iii)]
Settings/Activities
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Assessment Method(s)
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Competency Area
Hematologic: performance of
assessment of coagulation
status, and appropriate use of
component therapy
[PR IV.A.2.a).(2).(a).(iv)]
Infectious disease: performance
of classification of infections and
application of isolation
techniques, pharmacokinetics,
drug interactions, and
management of antibiotic
therapy during organ failure;
nosocomial infections; and
management of sepsis and
septic shock
[PR IV.A.2.a).(2).(a).(v)]
Monitoring/bioengineering:
performance of the use and
calibration of transducers and
other medical devices
[PR IV.A.2.a).(2).(a).(vi)]
Neurological: performance of
management of intracranial
pressure and acute neurologic
emergencies, including
application of the use of
intracranial pressure monitoring
techniques and
electroencephalography to
evaluate cerebral function
[PR IV.A.2.a).(2).(a).(vii)]
Nutritional: performance of the
use of parenteral and enteral
nutrition, and monitoring and
assessing metabolism and
nutrition
[PR IV.A.2.a).(2).(a).(viii)]
Renal: performance of the
evaluation of renal function; use
of renal replacement therapies;
management of hemodialysis,
and management of electrolyte
disorders and acid-base
disturbances; and application of
knowledge of the indications for
and complications of
hemodialysis
[PR IV.A.2.a).(2).(a).(ix)]
Respiratory: performance of
airway management, including
techniques of intubation,
Settings/Activities
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Assessment Method(s)
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Surgical Critical Care
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
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Competency Area
endoscopy, and tracheostomy,
as well as ventilator
management
[PR IV.A.2.a).(2).(a).(x)]
Settings/Activities
Assessment Method(s)
2. Indicate the settings and activities in which fellows demonstrate competence in the application of
each of the following critical care skills. Also indicate the method(s) used to assess competency.
Competency Area
Circulatory: transvenous
pacemakers; dysrhythmia
diagnosis and treatment, and
the management of cardiac
assist devices; and use of
vasoactive agents and the
management of hypotension
and shock
[PR IV.A.2.a).(2).(b).(i)]
Neurological: the use of
intracranial pressure monitoring
techniques and
electroencephalography to
evaluate cerebral function
[PR IV.A.2.a).(2).(b).(ii)]
Renal: knowledge of the
indications for and complications
of hemodialysis, and
management of electrolyte
disorders and acid-base
disturbances
[PR IV.A.2.a).(2).(b).(iii)]
Miscellaneous: performance of
the use of special beds for
specific injuries, and
employment of skeletal traction
and fixation devices
[PR IV.A.2.a).(2).(b).(iv)]
Settings/Activities
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Assessment Method(s)
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Medical Knowledge
Indicate the settings and activities in which fellows demonstrate advanced knowledge in the following
aspects of critical care, particularly as they relate to the management of patients with hemodynamic
instability, multiple system organ failure, and complex coexisting medical problems. Also indicate the
method(s) used to assess knowledge.
Area of Knowledge
Biostatistics and experimental
design
[PR IV.A.2.b).(1).(a)]
Cardiorespiratory resuscitation
Settings/Activities
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Assessment Method(s)
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Surgical Critical Care
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
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Area of Knowledge
[PR IV.A.2.b).(1).(b)]
Critical obstetric and gynecologic
disorders
[PR IV.A.2.b).(1).(c)]
Critical pediatric surgical
conditions
[PR IV.A.2.b).(1).(d)]
Ethical and legal aspects of
surgical critical care
[PR IV.A.2.b).(1).(e)]
Hematologic and coagulation
disorders
[PR IV.A.2.b).(1).(f)]
Inhalation and immersion injuries
[PR IV.A.2.b).(1).(g)]
Metabolic, nutritional, and
endocrine effects of critical
illness
[PR IV.A.2.b).(1).(h)]
Monitoring and medical
instrumentation
[PR IV.A.2.b).(1).(i)]
Pharmacokinetics and dynamics
of drug metabolism and excretion
in critical illness
[PR IV.A.2.b).(1).(j)]
Physiology, pathophysiology,
diagnosis, and therapy of
disorders of the cardiovascular,
respiratory, gastrointestinal,
genitourinary, neurological,
endocrine, musculoskeletal, and
immune systems, as well as of
infectious diseases
[PR IV.A.2.b).(1).(k)]
Principles and techniques of
administration and management
[PR IV.A.2.b).(1).(l)]
Trauma, thermal, electrical, and
radiation injuries
[PR IV.A.2.b).(1).(m)]
Settings/Activities
Assessment Method(s)
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Practice-based Learning and Improvement
1. Briefly describe one planned quality improvement activity or project that will allow fellows to
demonstrate the ability to analyze, improve, and change practice or patient care. Describe planning,
implementation, evaluation, and provisions of faculty member support and supervision that will
guide this process. [PR IV.A.2.c).(1)] (Limit response to 400 words)
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Updated 2/2015
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2. Briefly describe one example of a learning activity in which fellows engage to develop the skills
needed to locate, appraise, and assimilate evidence from scientific studies and apply it to their
patients' health problems. [PR IV.A.2.c).(2)] (Limit response to 400 words)
The description should include:
 Locating information
 Appraising information
 Assimilating evidence information (from scientific studies)
 Applying information to patient care
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Interpersonal and Communication Skills
1. Briefly describe one learning activity in which fellows demonstrate interpersonal and communication
skills that result in the effective exchange of information and collaboration with patients, their
families, and health professionals. [PR IV.A.2.d)] (Limit response to 400 words)
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2. Briefly describe one learning activity in which fellows demonstrate effective skills in teaching the
specialty of surgical critical care. [PR IV.A.2.d).(1)] (Limit response to 400 words)
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Professionalism
Briefly describe the learning activity(ies), other than lecture, by which fellows demonstrate a
commitment to carrying out professional responsibilities and an adherence to ethical principles.
[PR IV.A.2.e)] (Limit response to 400 words)
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Systems-based Practice
1. Briefly describe the learning activity(ies) through which fellows demonstrate an awareness of and
responsiveness to the larger context and system of health care, as well as the ability to call
effectively on other resources in the system to provide optimal health care. [PR IV.A.2.f)] (Limit
response to 400 words)
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2. Briefly describe one learning activity through which fellows will be able to administer a surgical
critical care unit and appoint, educate, and supervise specialized personnel; establish policy and
procedures for the unit; and coordinate the activities of the unit with other administrative units within
the hospital. [PR IV.A.2.f).(1)] (Limit response to 400 words)
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Curriculum Organization and Fellow Experiences
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
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1. Will at least five of the required eight months of clinical activities in a surgical intensive care unit be
in a unit in which a surgeon is director or co-director? [PR IV.A.3.a).(1).(a)]................. ☐ YES ☐ NO
If “NO”, provide explanation:
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2. Will there be more than two months in a non-surgical intensive care unit, such as medical, cardiac,
or pediatric units? [PR IV.A.3.a).(2)] ............................................................................. ☐ YES ☐ NO
If “YES”, provide explanation:
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3. Summarize the regularly-scheduled didactic program based on the core knowledge content and
areas defined as a fellow’s outcomes in the specialty. [PR IV.A.3.b)]
(Limit response to 400 words)
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4. Will fellows keep two written records of their experience: a summary record documenting the
numbers and types of critical care patients; and an operative log of numbers and types of operative
experiences, including bedside procedures? [PR IV.A.3.d)] ......................................... ☐ YES ☐ NO
If “NO”, provide explanation:
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5. Will a chief resident in surgery and a fellow in surgical critical care have primary responsibility for
the same patient? [PR IV.A.3.e)] .................................................................................. ☐ YES ☐ NO
If “YES”, provide explanation:
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FELLOW FORMATIVE EVALUATION
Will the semiannual assessment include a review of case volume, breadth, and complexity, and the
required written records maintained by fellows? [PR V.A.2.d)] ........................................... ☐ YES ☐ NO
FELLOW DUTY HOURS IN THE LEARNING AND WORKING ENVIRONMENT
Clinical Responsibilities
1. Indicate whether surgical teams include the following: [PR VI.E.2.]
a)
b)
c)
d)
Attending surgeons ................................................................................................ ☐ YES ☐ NO
Residents at various PG levels ............................................................................... ☐ YES ☐ NO
Medical students (when appropriate) ...................................................................... ☐ YES ☐ NO
Other health care providers .................................................................................... ☐ YES ☐ NO
2. Describe how the work of the caregiver team is assigned to team members. [PR VI.E.3.]
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Updated 2/2015
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3. As fellows progress through levels of increasing competence and responsibility, will work
assignments will keep pace with their advancement? [PR VI.E.4] ................................ ☐ YES ☐ NO
Teamwork
1. Describe how the program director will ensure fellows collaborate with fellow surgical residents, and
especially with faculty members, other physicians outside of their specialty, and non-traditional
health care providers, to best formulate treatment plans for an increasingly diverse patient
population. [PR VI.F.2.]
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2. Describe how the program director will ensure fellows assume personal responsibility to complete
all tasks to which they are assigned (or which they voluntarily assume) in a timely fashion. Describe
how these tasks are completed in the hours assigned, or, if that is not possible, how fellows learn
and utilize the established methods for handing off remaining tasks to another member of the team
so that patient care is not compromised. [PR VI.F.3.]
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3. Will lines of authority be defined by the program, and assure that all residents have a working
knowledge of expected reporting relationships to maximize quality care and patient safety?
[PR VI.F.4] ................................................................................................................... ☐ YES ☐ NO
If “NO”, provide explanation:
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Maximum Frequency of In-House Night Float
1. How many months, in succession, of night float are fellows assigned in each year of the program?
[PR VI.G.6.b)] .............................................................................................................................. [ # ]
2. How many months of night float are fellows assigned in each year of the program? [PR VI.G.6.b)]
.................................................................................................................................................... [ # ]
3. How many months are there between each night float rotation? [PR VI.G.6.d)] ........................... [ # ]
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 2/2015
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