University of Alberta
Division of Critical Care Medicine
GNH ICU “COMMUNITY ICU” ELECTIVE ROTATION
Welcome to the Grey Nuns Hospital Intensive Care Unit! This rotation should represent a stepping-stone
in your evolution as a Critical Care practitioner—It is your opportunity to develop your interpersonal and
management skills, and begin to function as an independent Consultant. As adult learners, this rotation
should be specifically tailored by you, to ensure that you receive the optimal clinical experience necessary to
further your professional development. The aim of this rotation is to inspire confidence, and encourage
autonomy. As such, it should be recognized that the skill set required may seem different than much of what
you have drawn upon to date. At many points, you will in fact be working independently—however, you are
not alone! As Attending Physicians, we are committed to providing you with an appropriate level of graded
responsibility, while ensuring that you have the proper amount of clinical and administrative support. We are
always available, at all times. That being said, it is our intention to withdraw (as much as possible) from the
daily operation of the ICU, and function only as directed by you. You are encouraged to field (or participate in)
all “Critical Care Line” calls, and take a lead role in all discussions with other Consultants and family members.
Over time (should you feel comfortable doing so) we even encourage you to assume the role of first-call
“junior” Attending Physician.
Your time here at the Grey Nuns Hospital may be your first and only exposure to a variety of endovascular
procedures for both ruptured and unruptured aortic aneurysms; as such, you are encouraged to seek time in
the Surgical or Radiographic suites in order to observe these procedures, if desired. Additionally, as you are
likely to experience significantly more “down-time” than you may be used to on any of the tertiary care units,
we encourage you to utilize this time appropriately for personal study, research, or other professional
development activities. It is suggested that you chose a specific topic or article that you would like to review in
detail, and inform the Attending Physician at the beginning of each week. Any subsequent opportunity for
personal study may then be spent discussing the topic in question.
Most importantly, please do not hesitate to bring any questions or deficiencies to our attention
immediately—we are just as likely to learn from you (or with you!!) as you are from us. We hope your
experience here is a rewarding one, and we look forward to working with you.
Sincerely,
Dr. D. Stollery
Dr. A. Liu
Dr. C. Torok-Both
Dr. M. Ewanchuk
Dr. S. Duggan
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Rotation Objectives:
During a senior-level rotation at the Grey Nuns Community Hospital, the Critical Care Fellow is expected to:
Medical Expert:
 Consolidate procedural skills related to central venous and arterial lines; endotracheal intubation,
bronchoscopy; tracheostomy; and manipulation of mechanical ventilators and vasoactive agents.
 Demonstrate an ability to teach other allied health professionals to perform similar tasks as needed
(such as endotracheal intubation and arterial cannulation) in the absence of the Attending Intensivist.
 Develop and understanding of the particular challenges and considerations faced when attending to
the extremely unstable vascular surgery patient.
 Develop an appreciation for the emerging role of conservative endovascular therapies in the
management of patients with vascular disorders.
Communicator/health advocate:
 Communicate effectively with other Consultants, Respiratory Therapists, Nurses, and other allied
health professionals.
 Communicate with families who may be dysfunctional, angry or litigious using appropriate language,
displaying empathy, and answering questions in an understandable manner.
 Develop an awareness for the varying Spiritual perspectives which patients and their families may
possess, while working in an environment with a particular spiritual bias.
 Offer advice to other healthcare professionals regarding the optimal resuscitation and transportation of
unstable patients seeking admission to the ICU via the province-wide Critical Care Line.
 Prepare documents that are accurate, timely and legible.
Manager/Collaborator:
 Be involved in discussions with other Intensivists, Consultants, the Unit Manager and Bed
Coordinators regarding how best to optimize patient care and manage the limited resources available.
 Prioritize activities and mobilize other skilled assistants both during the day-to-day operation of the
Intensive Care Unit, and during times of crisis.
 Develop an understanding for which patients should receive consideration for transfer to a tertiary
facility for more definitive care (such as the patient in fulminant hepatic failure).
Professional:
 Develop crisis and resource management skills; including the ability to remain focused and direct a
team toward a singular goal.
 Demonstrate integrity, honesty, compassion, punctuality and conscientiousness.
 Possess insight into one’s own strengths and weaknesses; including when to seek advice from other
professionals (both on- and off-site) and accept feedback when appropriate.
Scholar:
 Outline potential areas of research and quality improvement within a community ICU setting.
 Identify the challenges faced by Intensivists and other allied health professionals in seeking to provide
care in a community ICU environment.
 Demonstrate an awareness and critical appraisal of the available medical literature.
 Demonstrate an ability to locate medical information using a variety of clinical informatics
 Demonstrate an ongoing learning strategy, and indicate resources utilized during the rotation.
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Rarely meets
Inconsistently meets
Generally meets
Sometimes exceeds
Considerably exceeds
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EXPECTATIONS: (for rotation/level of training)
Could not evaluate
Does not apply
A. MEDICAL EXPERT
a) Basic science knowledge
b) Clinical knowledge (see knowledge areas below)
c) History and physical examination complete, accurate, & organized
d) Demonstrates good clinical judgment
e) Recognition and management of emergency situations
Comments (especially relating to ratings 0, 1 and 4 requested):
B. COMMUNICATOR
a) Communicates effectively with other health care professionals
b) Communicates effectively with patients and their families
c) Prepares documentation that is accurate, legible and timely
Comments (especially relating to ratings 0, 1 and 4 requested):
C. COLLABORATOR
a) Interacts effectively with other health professionals
b) Consults and delegates appropriately
Comments (especially relating to ratings 0, 1 and 4 requested):
D. MANAGER
a) Makes cost-effective use of health care resources
b) Sets realistic priorities, and uses time effectively in order to optimize
professional performance
c) Demonstrates an awareness of the principles of quality assurance
Comments (especially relating to ratings 0, 1 and 4 requested):
E. HEALTH ADVOCATE
a) Intervenes on behalf of patients with respect to their care
b) Recognizes and responds appropriately in advocacy situations,
particularly with regard to patient safety and quality improvement
c) Identifies socio-economic determinants of health
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Comments (especially relating to ratings 0, 1 and 4 requested):
F. SCHOLAR
a) Develops & implements an ongoing and effective personal learning
strategy
b) Assesses & critically appraises health & medical information
c) Uses information effectively in clinical decision-making
d) Teaches effectively in a number of clinical environments
Comments (especially relating to ratings 0, 1 and 4 requested):
G. PROFESSIONAL
a) Demonstrates integrity, honesty, compassion and respect for
spiritual and cultural diversity
b) Fulfills medicolegal & professional obligations of the specialist
c) Demonstrates reliability and conscientiousness
d) Understands & applies the principles of bioethics in clinical
situations
e) Is aware of personal limitations, and seeks advice when necessary
f) Assesses own performance in light of professional standards, and
has insight into personal challenges in attaining these standards
Comments (especially relating to ratings 0, 1 and 4 requested):
KNOWLEDGE AREAS, PROCEDURES, AND TECHNICAL SKILLS
The Resident should demonstrate knowledge and technical proficiency in
each of the following:
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a. Routine endotracheal intubation
b. Care of the patient requiring mechanical ventilation
c. Care of the patient requiring prolonged ventilation and weaning
d. Care of the patient requiring tracheostomy
e. Care of the patient with vascular illness (aneurysm, dissection, rupture)
f. Brain death determination
g. Organ donor management and transfer
h. Resuscitation of the patient with undefined shock
i. Resuscitation and transfer of the patient with multi-system trauma
j. Care of the patient following high risk surgery
k. Arterial cannulation
l. Central venous cannulation
m. General radiographic interpretation
n. Management of the patient requiring immediate radiological testing
Has this resident met the core objectives of this rotation?
Yes
No
Evaluator (Print): ____________________ Signature: ____________________
This Evaluation was discussed with me: YES / NO (Circle One) Signature of Fellow: ____________________
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