UAMS & CAVHS
Medical Intensive Care
Rotation Curriculum
 Patient
Care
 Medical
Knowledge
 Practice-Based
Learning
 Systems-Based
Practice
 Professionalism
The Medical Intensive Care Rotation exposes residents to
patients with a broad variety of unstable, life-threatening
medical illnesses. Residents will learn the basic principles
of stabilization and treatment of critically ill patients and
work as part of the interdisciplinary teams to provide care
that is timely, appropriate and individualized for the patient
and family. The resident will develop an understanding of
the scientific and clinical principles of critical care medicine
and skills required for practice of critical care medicine
through opportunities to observe and manage patients.
R
Unit
 Interpersonal
and
Communication
Skills
Marcia L. Erbland, M.D
mlerbland@uams.edu
686-2225
1|P age
UAMS MICU & Acute Care Rotation, CAVHS MICU
l. TAXONOMY OF OBJECTIVES, TEACHING METHODS, AND
ASSESSMENTS
BDE ACE
b. Residents will display skill in the
interpretation of laboratory studies and
radiological imaging studies relevant to
the evaluation and management of
periopertative and trauma patients.
b. Residents will demonstrate
proficiency in integrating medical facts
B D E A C E and clinical data while weighing
alternatives and respecting patient
preferences.
c. Residents will demonstrate a
knowledge of procedural indications,
c. Residents will demonstrate
contraindications, necessary equipment, B D E A C E knowledge of maneuvers that can elicit
specimen handling, risk and discomfort
findings not otherwise present.
minimization.
d. Residents will assist PGY 1 residents
in skill acquisition and model
appropriate behaviors.
Teaching Method
Assessm ents
A.
Independent Reading
A. Direct and Indirect Observation
B.
Rounds
B. 360 Multirater Evaluation
C.
Conferences
C. Mini - CEX
D.
Direct Patient Care
D. In-Training Exam
2|P age
E. Rotation Evaluation
Assessments
Teaching
Methods
Objectives
Assessments
a. Residents will routinely adapt the
physical and procedures for patients
BDE ACE
with diminished levels of consciousness
or cooperation.
a. Residents will conduct a thorough
history and comprehensive physical
examination.
E. Resident/Attending Mentoring
PGY 3 Patient Care: To provide
compassionate and appropriate
treatment for patients admitted to the
hospital.
Teaching
Methods
Objectives
Assessments
PGY 2 Patient Care: To provide
compassionate, appropriate and
effective treatment for patients admitted
to the hospital.
Teaching
Methods
Objectives
PATIENT CARE Intensive Care
PGY 1 Patient Care: To provide
compassionate, appropriate and
effective treatment for patients admitted
to the hospital.
a. Residents will demonstrate extensive
knowledge and facility in performing
BDE ACE
procedures while minimizing risk and
discomfort to the patient.
b. Residents will demonstrate expertise
in integrating medical facts and clinical
data while weighing alternatives and
respecting patient preferences.
BDE ACE
c. Residents will demonstrate
B D E A C E knowledge of maneuvers that can elicit
findings not otherwise present.
BDE ACE
BDE ACE
DE
A
d. Residents will assist PGY 1 and PGY
2 residents in skill acquisition and
model appropriate behaviors.
DE
A
MEDICAL KNOWLEDGE Intensive Care
PGY 1 Medical Knowledge: To
understand biomedical, clinical and
socio-behavioral knowledge about
patient care in a hospital setting.
Teaching
Methods
Assessments
b. Residents will demonstrate basic
knowledge of the psychosocial and
emotional effects critical illness and end A B C
of life decision making on patients and
families.
DE
b. Residents will demonstrate advanced
knowledge of the psychosocial and
emotional effects of critical illness and
ABC
end of life decision making on patients
and families.
DE
b. Residents will demonstrate in-depth
knowledge of the psychosocial and
emotional effects of critical illness and
end of life decision making on patients
and families.
ABC
DE
c. Residents will demonstrate basic skill
in the development of well-formulated
ABC
diagnoses for multi-problem patients.
DE
c. Residents will demonstrate
proficiency in the development of wellformulated diagnoses for multi-problem
patients.
DE
c. Residents will demonstrate expertise
in the development of well-formulated
diagnoses for multi-problem patients.
ABC
DE
Teaching
Methods
Assessments
Objectives
Teaching
Methods
Assessments
a. Residents will demonstrate an
understanding of the tools and
methodology for assessing their own
inpatient practices.
DE
AE
a. Residents will demonstrate the ability
to apply PBLI tools and methods to their
own practices.
DE
AE
a.
Residents will demonstrate skill in
incorporating novel PBLI tools and
methodology in the practices of all the
members of the inpatient team.
DE
AE
b.
Residents will demonstrate skill in
the utilization of the results of practice
analysis in improving the quality of their
inpatient care.
DE
AE
b.
Residents will demonstrate
ongoing application of PBLI in order to
achieve continuous quality improvement
in their inpatient practice.
DE
AE
b.
Residents will demonstrate
expertise in monitoring and improving
the performance measures of the
inpatient team.
DE
AE
Objectives
Objectives
PGY 3 Practice-Based Learning and
Improvement: Systematically analyze
resident inpatient practice using quality
improvement methods, and implement
changes with the goal of practice
improvement.
Assessments
PGY 2 Practice-Based Learning and
Improvement: Systematically analyze
resident inpatient practice using quality
improvement methods, and implement
changes with the goal of practice
improvement.
Teaching
Methods
PRACTICE-BASED LEARNING Intensive Care
PGY 1 Practice-Based Learning and
Improvement: Systematically analyze
resident inpatient practice using quality
improvement methods, and implement
changes with the goal of practice
improvement.
Objectives
DE
Teaching
Methods
ABC
Objectives
a. Residents will demonstrate in-depth
knowledge, stay current with new
medical knowledge, and exhibit
effective teaching methods.
Teaching
Methods
DE
Objectives
DE
ABC
Assessments
PGY 3 Medical Knowledge: To
understand biomedical, clinical and
socio-behavioral knowledge about
patient care in a hospital setting.
a. Residents will demonstrate advanced
knowledge of the pathohysiology,
diagnosis, prevention and management A B C
of a wide variety of conditions affecting
critically ill patients.
a. Residents will demonstrate basic
knowledge of the pathophysiology,
diagnosis, prevention and management A B C
of a wide variety of conditions affecting
critically ill patients.
Assessments
PGY 2 Medical Knowledge: To
understand biomedical, clinical and
socio-behavioral knowledge about
patient care in a hospital setting.
Teaching Method
Assessm ents
A.
Independent Reading
A. Direct and Indirect Observation
B.
Rounds
B. 360 Multirater Evaluation
C.
Conferences
C. Mini - CEX
D.
Direct Patient Care
D. In-Training Exam
E. Resident/Attending Mentoring
3|P age
E. Rotation Evaluation
ABE
Assessments
a. Residents will demonstrate the
a. Residents will demonstrate respect,
ability to teach and model respect,
compassion and integrity in
B D E A B E compassion and integrity in
BDE ABE
relationships with patients, families, and
relationships with patients, families, and
colleagues.
colleagues.
b. Residents will adhere to principles of
confidentiality, scientific and academic
integrity, and informed consent.
BDE ABE
c. Residents will demonstrate sensitivity
and responsiveness to patients and
colleagues in consideration of sex, age, B D E A B E
culture, religion, sexual preference, and
beliefs.
d. Residents will demonstrate
commitment to ethical principles
pertaining to the provision or
withholding of clinical care.
BDE ABE
Teaching Method
Assessm ents
A.
Independent Reading
A. Direct and Indirect Observation
B.
Rounds
B. 360 Multirater Evaluation
C.
Conferences
C. Mini - CEX
D.
Direct Patient Care
D. In-Training Exam
E. Resident/Attending Mentoring
4|P age
E. Rotation Evaluation
ABE
PGY 3 Professionalism: To carry out
responsibilities in a professional
manner.
Teaching
Methods
Objectives
Assessments
Teaching
Methods
Objectives
PGY 2 Professionalism: To carry out
responsibilities in a professional
manner.
Assessments
BD
BD
Assessments
c. Residents will maintain
comprehensive, timely and legible
medical records.
Teaching
Methods
ABE
a. Residents will demonstrate excellent
A B E team leadership and skill in creating a
climate for effective health care delivery.
Teaching
Methods
BD
Objectives
b. Residents will demonstrate effective
communication with other physicians
and health care professionals.
BD
Objectives
a. Residents will exhibit team
A B E leadership skills through effective
communication as a team manager.
Assessments
BD
PGY 3 Interpersonal and
Communication Skills: To have
communication with patients, families,
and other health care professionals in
the hospital.
Teaching
Methods
Teaching
Methods
a. Residents will display interpersonal
and communication skills that facilitate
the estabishment and maintainence of
professional relationships with patients,
families and members of the health care
team.
PROFESSIONALISM Intensive Care
PGY 1 Professionalism: To carry out
responsibilities in a professional
manner.
Objectives
Objectives
Assessments
INTERPERSONAL AND COMMUNICATION SKILLS Intensive
IntensiveCare
Care
PGY 1 Interpersonal and
PGY 2 Interpersonal and
Communication Skills: To have
Communication Skills: To have
communication with patients, families,
communication with patients, families,
and other health care professionals in
and other health care professionals in
the hospital.
the hospital.
a. Residents will demonstrate
excellence in maintaining an
atmosphere of respect, compassion
BDE ABE
and integrity in relationships with
patients, families, and colleagues within
the house staff team.
AE
BCD
AE
b. Residents will demonstrate
proficiency in utilizing health care
resources efficiently and prudently.
BCD
AE
c.
Residents will demonstrate
excellence in maximizing patient flow
while maintaining high quality care.
AE
c. Residents will demonstrate the
ability to apply evidence-based
BCD
strategies to prevention, diagnosis, and
disease management.
AE
b. Residents will demonstrate skill in
mobilizing resources (nutritionists,
consulatants, etc.) to optimize health
care delivery.
Teaching Method
Assessm ents
A.
Independent Reading
A. Direct and Indirect Observation
B.
Rounds
B. 360 Multirater Evaluation
C.
Conferences
C. Mini - CEX
D.
Direct Patient Care
D. In-Training Exam
E. Resident/Attending Mentoring
5|P age
E. Rotation Evaluation
Teaching
Methods
a. Residents will demonstrate
excellence in advocating and facilitating
BCD
patients' engagement with the health
care system in all of its dimensions.
Objectives
Assessments
AE
Objectives
BCD
Teaching
Methods
AE
Objectives
Teaching
Methods
PGY 3 Systems-Based Practice:
Understand and access the systems
based practice of UAMS and CAVHS in
order to provide optimal care.
a. Residents will demonstrate
proficiency in advocating and
facilitating patients' engagement with
the health care system in all of its
dimensions.
a. Residents will demonstrate an
understanding of the contexts and
systems in which health care is
BCD
provided, and demonstrate the ability to
apply this knowledge to improve and
optimize health care.
Assessments
PGY 2 Systems-Based Practice:
Understand and access the systems
based practice of UAMS and CAVHS
in order to provide optimal care.
BCD
Assessments
SYSTEMS-BASED PRACTICE Intensive Care
PGY 1 Systems-Based Practice:
Understand and access the systems
based practice of UAMS and CAVHS
in order to provide optimal care.
II. LEARNING AND TEACHING TOOLS
Teaching Methods:
Independent Reading: Each resident will read independently to answer questions about
patient care that arise during the rotation. The resident may use primary literature or other
resources suggested by preceptors.
Rounds: Each resident will participate in daily attending rounds.
Morning Report: Residents will attend an hour-long morning report session that is conducted
daily depending on the rotation location and resident assignment (MICU Team, or VA CR).
Conferences: The resident will participate in all regularly scheduled departmental conferences
including grand rounds and core conferences.
Direct Patient Care: Hands-on direct and ongoing contact with patients.
Resident/Attending Mentoring: Mentoring by upper level residents, MICU fellows and
attendings will provide an ongoing process of feedback regarding resident performance.
Assessment Tools:
Direct and indirect observation by senior residents and attending: Direct
observation will include scheduled formal observations with feedback. Indirect
observation will include informal, ongoing and daily casual observation.
Rotation Evaluation: Rotation evaluation is a biweekly assessment based on
the specific goals and objectives of the rotation as organized by competency
to be completed by the attending physician.
360 Multi-rater Evaluation: The 360 Multi-rater evaluation measures Professionalism,
and Interpersonal and Social Skills. Raters include nurses and staff.
Mini CEX: Assesses the clinical skills of residents. In this exercise, the attending physician
directly observes a discrete resident-patient interaction and provides immediate feedback.
In- Training Exam (ITE): Developed by the American College of Physicians
and co-sponsored by the Association of Program Directors in Internal
Medicine and the Association of Professors of Medicine, the Internal Medicine
In-Training Examination is designed to give residents an opportunity for selfassessment, provide program directors the opportunity to evaluate their
programs and identify areas in which residents need extra assistance.
Educational Resources
Department of Medicine Reference Library
UAMS Library (hard copy and on-line references)
Internet resources
Ill. ENCOUNTERS AND VENUES
Patient Characteristics
At University Hospital there is a diverse patient population, male and female, of all ages from
adolescent to geriatric, representing most ethnic and racial backgrounds, from all social and
economic groups. The University Hospital is a tertiary referral center that also serves as a
primary health care facility for the local population of Central Arkansas.
At Central Arkansas Veterans Healthcare System, patients are predominantly male, with over
half over 65 years of age. With the increased return of soldiers from Iraq and Afghanistan,
Veterans Hospital is admitting more young veterans with PTSD and suicidal behaviors.
6|P age
CAVHS is also a referral center for Arkansas, as well as for parts of several adjoining states,
and thus receives patients with relatively complex medical problems.
Types of Clinical Encounters
The resident will evaluate inpatients admitted to the MICU having both acute and chronic
disorders, many of which are emergent and part of catastrophic, life threatening illnesses.
These include, but are not limited to: sepsis, respiratory failure due to any cause, drug
overdose, drug or alcohol withdrawal, gastrointestinal bleeding, severe electrolyte and
metabolic derangements, diabetic ketoacidosis and fulminant hepatic failure. Residents are
supervised by faculty intensivists. The critical role of collaboration by other members of the
health care team, such as nurses and respiratory therapists is emphasized.
Venues
University Hospital, UAMS, Little Rock AR
Central Arkansas Veterans Healthcare System, Little Rock AR
lV. SUPPORTIVE MATERIALS
Reading List
Harrison’s Principle’s of Internal Medicine, Fauci, A. S. (editor), 18th ed., McGraw Hill.
All resident work sites contain computers with Internet access to “Up to Date”, MedLine, New
England Journal of Medicine, Micromedex, MD Consult, clinical practice guidelines, and
various electronic versions of standard medical text books.
V. POLICIES Policies are available at http://www.uams.edu/dim/residency_program/
Vl. SCHOLARSHIP
Understanding and participation in scholarship is an essential component of residency
education. Developing research competency including understanding of how research is
conducted, evaluated, explained to patients and applied to patient care is supported
throughout conferences, grand rounds and mentoring activities. All senior residents participate
in presentation of research studies as part of the Friday Residents’ Conference. Residents
also present posters, author journal articles and present original research at national and local
conferences.
7|P age