MICU
Dr.____________________________,
You are assigned to the MICU for the month of________________________.
Schedule: Contact the LSU Medicine Chief Resident 568-5600, 2 weeks prior to
your rotation to receive your schedule and/or make any schedule requests. Call: Your
call will be every third night. Every attempt will be made to provide each resident with
one full weekend off. Weekends are managed by two of the three call teams. Each
resident must have 1 day in 7 free of all duties.
The maximum continuous duty period for interns is 16 hours. The maximum continuous
duty period for residents is 24 hours, after which the resident may no longer assume
responsibility for new patients, but may stay inhouse for transfer of care or conference
for up to six hours. Any duty hour violation must be reported immediately to your
program director or anonymously to the Duty Hour hotline: 599-1161.
Responsibilities: The MICU upper level ER resident will function as a team
leader responsible for the care of patients in the MICU. Additionally, the ER resident is
responsible for all consults in MER/AR/FT and floor for MICU admission when the ER
team is on call. The MICU resident must also respond to all codes within the hospital.
The MICU intern will work closely with the upper level resident as a member of the
MICU ER team. The resident is responsible for supervision, education and directions for
the call team.
Conference: You are required to attend EM conference and Journal Club. Please
remind you staff the day before each event.
Extras: All procedures must be recorded and turned in at the end of the month.
Supervision: You will be supervised by Critical Care Faculty.
Evaluations: Via NewInnovations.
Meals: The resident’s responsibility.
LSU Emergency Medicine Residency Program
MCLANO University Hospital MICU Rotation
GOALS and OBJECTIVES
What follows are the goals and objectives for the University Hospital MICU rotation, that
will range from a 2 week to 1 month rotation, as assigned by the Program Director. The
rotation will take place at the MCLANO University Hospital. The year of training is
typically PGY 1 and 3.
OBJECTIVES:
The educational objectives of the MICU rotation is to provide residents with an
opportunity to experience and learn about the initial evaluation and management of
MICU patients in the community setting and to become proficient in the diagnosis and
treatment of: CHF, pulmonary edema, pneumonia, pneumothorax, pulmonary embolus,
ARDS, respiratory distress, asthma, COPD, AMI, acute coronary syndrome,
cardiomyopathym, pericarditis, HTN, stroke, pancreatitis, acute renal failure, hepatitis,
pyelonephritis, acute hepatic failure, toxicologic emergencies, acute drug overdose,
consultation, living wills, do not resuscitate, rehabilitation, IV access, induction and
paralytic agents. Hemodynamic monitoring, airway and ventilator management,
sedative/hypnotic agents. .
GOALS:
Residents will act as a part of the MICU team in a community hospital, under the
supervision of a staff physician. The resident will participate in the management of
MICU patients, to include evaluation, admission management of all MICU requests from
the floor and emergency department as well as patients already in the MICU. The
resident is responsible for the daily management and disposition planning of all patients
admitted by his/her team. Rounds occur daily with the ICU staff, pulmonary fellow and
cardiology staff. The resident is responsible for attending and leading all in house
cardiac arrests and subsequent management.
The clinical and didactic experiences used to meet those objectives include evaluation of
ICU patients, in the ED and in the ICU, along with bedside teaching. This rotation
experience is part of the greater emergency medicine curriculum, including weekly
didactics concerning critically ill and injured patients (part of the overall didactic
curriculum).
The feedback mechanisms and methods used to evaluate the performance of the
resident include an end of rotation global evaluation. Immediate feedback may also be
given to the resident, and any significant problems will be discussed during the rotation
with the LSU EM administration.
The resources and facilities in the institution that will be available to each resident
include computer access to Up To Date and the LSU Library services, including current
texts in ICU care. The residents will have access to the resources of the hospital
including call rooms, medical texts, medical records, and meals.
The clinical experiences, duties and responsibilities the resident will have on the
rotation: Residents will act as a part of the ICU team in under the supervision of a staff
physician.
The relationship that will exist between emergency medicine residents and faculty on
the service: The overall goals of resident education and patient care will govern the
relationship between faculty and residents. Residents will receive 24 hour supervision
while on the rotation. All patient care and medical charts will be reviewed and signed by
the faculty each day and prior to patient discharge.
Duty hours for this rotation will not exceed an average of 80hrs/week, call not to exceed
24 hours, and will include 1 in 7 days off.
This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.
Specific Competency Based Goals & Objectives based on Level of Training:
1. While in the MICU, the resident will demonstrates skill in “Data Gathering” that
includes but not limited to:
a. PGY1: Perform an appropriate focused history and physical exam and
ordering and interpretation of ancillary tests (* PC, MK, ICS, PR)
b. PGY3: Gather essential and accurate information from all available
sources. Challenges assumptions. Able to establish rapport in order to
obtain historical data in difficult situations. (* PC, IPC SBP & PR)
2. While in the MICU, the resident will demonstrates skill in “Problem Solving” that
includes but not limited to:
a. PGY1: Generate an appropriate and complete differential diagnosis for an
undifferentiated patient. Appropriate organization of data collection in
relation to patient management decisions. (* PC, MK, PBL)
b. PGY3: Generate an expanded differential diagnosis including possible
atypical presentations. Able to supervise and teach problem-solving skills
to lower level residents. (* PC, MK, PBL)
3. While in the MICU, the resident will demonstrates skill in “Patient
Management” that includes but not limited to:
a. PGY1: Development of a basic treatment plan and timely recognition and
appropriate emergency stabilization of the unstable patient (* PC, MK,
SBP)
b. PGY3: Institutes appropriate advanced treatment plans autonomously.
Multitasks, appropriately utilizes resources, facilitates triage of patient
care in the MICU. (* PC, MK, ICS, PR, SBP)
4. While in the MICU, the resident will demonstrates skill in “Medical Knowledge”
appropriate for level of training that includes but not limited to:
a. PGY1: Demonstrates a basic fund of medical knowledge. Seeks the
scientific basis for their patient care decisions (*MK, PBL)
b. PGY3: Demonstrates an advanced fund of knowledge and challenges
assumptions using problem-based learning techniques. (*MK, PBL)
5. While in the MICU, the resident will demonstrates technical proficiency in
“Procedural Skills” consistent with level of training that includes but not limited
to:
a. PGY1: lumbar puncture, closely supervised intubations and central
venous access(*PC)
b. PGY3: Conscious sedation, ultrasound, and direction of medical
resuscitation, generally supervised intubations and central venous access
(*PC)
6. While in the MICU, the resident will demonstrate appropriate “Interpersonal
and Communication Skills” that includes but not limited to:
a. PGY1: Demonstrates effective information exchange with patients, their
families, and professional associates (*ICS, PR)
b. PGY3: Works effectively with others as a leader. Demonstrates
appropriate conflict resolution skills (*ICS, PR)
7. While in the MICU, the resident will demonstrate appropriate “Professionalism”
that includes but not limited to:
a. PGY1: Introduces self to patient and/or family. Respectful of patient’s
privacy and confidentiality (*PR)
b. PGY3: Demonstrates respect, compassion, and integrity. Models
compassionate approach to patient care in all circumstances. (*PR)
8. While in the MICU, the resident will demonstrates an understanding of a
“Systems-Based Practice” that includes but not limited to:
a. PGY1: Understands basic resources available for care of the MICU
patient. Utilizes the consultation process appropriately (*SBP, PC)
b. PGY3: Makes appropriate bed triage decisions. Makes appropriate stepdown and transfer decisions. (*SBP, PC)
9. While in the MICU, the resident will demonstrate “Practice Based Learning and
Improvement” skills that includes but not limited to:
a. PGY1: Uses appropriate information resources (ie, texts, online web sites,
etc.) for care of patient (* PBL, PC)
b. PGY3: Facilitates the learning of professional associates. Applies
knowledge of scientific studies to care (* PBL, MK, PC)
(* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICSInterpersonal and Communication skills, PR-Professionalism, SBP-Systems Based
Practice, PBL-Practice Based Learning and Improvement).