Objectives and Expectations for Rotating Residents in
ICU
The CanMeds format has been used to categorize the objectives. Some of the behaviors
and knowledge should be present when the resident starts the rotation, all should be
achieved at the end of an 8-12 week rotation.
The behaviors, skills and knowledge items below are basic elements that the Section of
Critical Care expects for all residents upon completion of 8-12 weeks of ICU regardless
of base training program. Training programs may have other specific goals and
objectives for their residents during Critical Care rotations.
You should consult your own program director to see what their expectations are. The
Critical Care Section believes that residents rotating in ICU should be capable of
everything below by the end of 8-12 weeks in the units:
Medical Expert/Clinical Decision Maker
General Requirements
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Demonstrate diagnostic and therapeutic skills for ethical and effective patient
care.
Access and apply relevant information to clinical practice.
Follow protocols implemented in the unit and adhere to established unit standards.
Specific Requirements
At the end of 8-12 weeks of ICU rotations the resident will be able to do the
following:
o Elicit, present, and document a history that is relevant, concise, accurate
and appropriate to the patient's problem(s).
o Perform, interpret the findings of, present, and document a physical
examination that is relevant and appropriate.
o Select medically appropriate investigative tools, interpret the results of
common diagnostic tests and demonstrate an understanding of their cost
effectiveness, limitations and complications.
o Formulate a comprehensive patient problem list, synthesize an effective
diagnostic and therapeutic plan and establish appropriate follow up.
Specific ICU Knowledge
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Able to recognize common rhythm disturbances
Able to interpret blood gases and assess acid-base status
Can provide basic ventilator orders for most patients
Can classify shock and outline hemodynamic patterns
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Awareness of the ethical principles pertinent to critically ill patients
especially end of life care, and issues around withdrawing and
withholding life support.
Familiar with airway management and indications for intubation.
Can use inotropes and vasopressors appropriately
Can interpret an electrocardiogram and recognize important lifethreatening findings.
Specific Skills
 Capable of basic airway management (bag/mask ventilation and
uncomplicated intubation)
 Able to place central line with appropriate technique
 Able to place arterial line with appropriate technique
 Understands principles of ACLS and can apply them in a patient resuscitation.
Communicator
General Requirements
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Establish a professional relationship with patients and families.
Obtain and collate relevant history from patients, and families.
Listen effectively.
Discuss appropriate information with patients and families and other
members of the health care team.
Specific Requirements
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Demonstrate consideration and compassion in communicating with
patients and families.
Demonstrate skills in:
 providing clear, concise and timely verbal and written
communication as applied to progress notes, sign over of patient
care and discharge planning;
 communication with patients and families regarding informed
consent, the medical condition, plan of treatment, prognosis,
primary and secondary prevention, adverse events, medical
uncertainty, medical errors, end of life wishes, autopsy and organ
donation; and
 communication with other health care professionals regarding all
aspects of patient care.
Specific ICU items
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Personally examine and review each of their assigned patients before
morning rounds.
Able to present the history and physical findings of critically ill patients to
the attending physician in an organized concise manner.
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o
Identify the problems in a critically ill patient and generate a problem list.
o
Write daily progress notes on assigned patients. The notes are expected
to be legible and should identify the relevant daily events and issues for
each patient.
Outline their plan to address the problems identified for each patient they
are involved with.
o
Collaborator
General Requirements
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Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
Specific Requirements
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Develop an ability to work effectively and harmoniously with other health
care workers.
Identify and describe the role, expertise and limitations of all members of an
interdisciplinary team required to optimally achieve a goal related to patient
care, a research problem, an educational task, or an administrative
responsibility.
Effectively participate in interdisciplinary rounds, demonstrating the ability to
accept, consider and respect the opinions of other team members, while
contributing personal specialty-specific expertise.
Manager
General Requirements
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Utilize personal resources effectively in order to balance patient care,
continuing education, and personal activities.
Allocate finite health care resources wisely.
Work effectively and efficiently in a health care organization.
Utilize information technology to optimize patient care, and life long
learning.
Specific Requirements
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Utilize appropriate time management for effective patient care,
administrative duties and scholarly activities.
Implement patient care practices considering available health care
resources.
Able to complete the tasks discussed on rounds in a timely manner.
Able to seek help appropriately and appreciate their personal
limitations.
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Health Advocate
General Requirements
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Identify the important determinants of health affecting patients.
Contribute effectively to improved health of patients and communities.
Recognize and respond to those issues where advocacy is appropriate.
Specific Requirements
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Educate patients and families about and promote the importance of
long-term healthy behaviours and preventive health care (e.g.
smoking cessation, screening tests, vaccinations, exercise, and
nutrition).
Respect and empower patient autonomy.
Promote equitable health care.
Apply the principles of quality improvement and quality assurance.
Appreciate the existence of global health advocacy and initiatives
for elimination of poverty and disease, (e.g. tuberculosis, malaria,
Acquired Immune Deficiency Syndrome), the role of advocacy
groups and funding agencies.
Scholar
General Requirements
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Develop, implement, and monitor a personal continuing education
strategy.
Critically appraise sources of medical information.
Facilitate learning of patients, students, and other health professionals.
Specific Requirements
o Should read around their cases and recognize gaps in their knowledge base
o Should be aware of the medical literature in their clinical decision making
and understand how to search and critically appraise the medical literature.
o Demonstrate the ability to teach medical students, residents, patients,
colleagues and other health care professionals.
Professional
General Requirements
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Deliver highest quality care with integrity, honesty and compassion.
Exhibit appropriate personal and interpersonal professional behaviours.
Practice medicine ethically consistent with the obligations of a physician.
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Specific Requirements
o Should have exhibited appropriate personal and interpersonal professional
behaviors. This includes keeping attending physicians appraised of
relevant events, interacting appropriately with the nursing staff, and being
available to the unit when needed while on call.
o Recognize, analyze and attempt to resolve in clinical practice ethical
issues such as truth telling, consent, advanced directives, confidentiality,
end-of-life care, conflict of interest, resource allocation, research ethics,
interactions with the pharmaceutical industry.
o Recognize and know how to deal with unprofessional behaviours in
clinical practice, taking into account local and provincial regulations.
o Evaluate one's abilities, knowledge and skills, recognize one's limitations
and use appropriate strategies to maintain and advance professional
competence.
o Know and understand the professional, legal and ethical codes to which
physicians are bound.
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