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Competency-based Goals and Expectations - Surgical Critical Care at MedStar Washington

There are six ACGME Competencies:

ACGME Competency 1: Patient Care

Upon completion of the Surgical Critical Care Fellowship, every physician will be able to:

  • Demonstrate advanced decision-making skill and sound medical judgment
  • Demonstrate skill in performing and teaching critical care procedures
  • Gather primary information through clinical exams and medical records, and to form an appropriate differential diagnosis and plan
  • Safely admit and discharge patients to and from the SICU
  • Resuscitate critically ill patients, using evidence-based guidelines and appropriate technology
  • Manage and wean patients from mechanical ventilation utilizing various techniques and ventilator modes
  • Perform and teach CPR and internal cardiac resuscitation
  • Treat all forms of shock utilizing conventional and current techniques
  • Identify, treat and prevent multiple organ system failure
  • Identify, treat and prevent all life-threatening electrolyte acid-base disturbances
  • Identify, treat and prevent malnutrition, utilizing advanced nutritional supplement methodologies
  • Perform conscious sedation
  • Perform and instruct the theory and techniques for appropriate pain management and advanced sedation strategies
  • Manage pain, anxiety, delirium and agitation using a current, evidence-based approach
  • Titrate inotropic and vasopressor drips based on hemodynamic monitoring
  • Utilize medications safely
  • Prevent and manage acute and chronic renal failure
  • Manage coagulation disorders (acquired and congenital)
  • Manage acute and chronic neurologic disease and injury
  • Manage GI disturbances, such as GI hemorrhage, pancreatis, diverticulitis and cholecystitis
  • Recognize, treat and monitor hypertension
  • Prevent and manage endocrine dysfunction related to DM, DI, adrenal and thyroid dysfunction
  • Manage infectious disease, especially core ICU conditions, such as bloodstream infection and pneumonia
  • Recognize, treat and monitor abdominal compartment syndrome
  • Manage traumatic brain injury, including interpretation of data from invasive monitors and laboratory tests
  • Manage complex surgical patients with multiple drains, monitors, and other devices

ACGME Competency 2: Medical Knowledge

Upon completion of the Surgical Critical Care Fellowship, the fellow will demonstrate:

  • A strong foundation of knowledge related to all aspects of Surgical Critical Care
  • Ability to identify indications for critical care admission and discharge
  • Understanding of the etiology, pathophysiology, and management of the different types of shock
  • An understanding of normal recovery from cardiovascular surgery, as well as complications such as hypotension, cardiac insufficiency, tamponade, arrhythmia, bleeding and Cerebrovascular Accident (CVA)
  • Knowledge of the fundamentals and controversies of different approaches to hemodynamic monitoring
  • An understanding of indications for mechanical ventilation, pros and cons of various ventilator modes, and indications for extubation or cessation of mechanical ventilation
  • An understanding of Advanced Cardiac Life Support (ACLS) protocols
  • Knowledge of pathophysiology and management of common arrhythmias
  • An understanding of the definition, pathophysiology and prognosis of multiple organ system failure
  • An understanding of the pathophysiology and management of electrolyte acid-base disturbances
  • An understanding of the principles of critical care nutrition, including diagnosis of nutritional deficiency; understanding of the pros and cons of different forms of nutrition and common metabolic consequences of therapeutic alimentation
  • An understanding of Indications and contraindications for conscious sedation
  • Knowledge of effects, risks and dosing strategies of sedative and analgesic medications
  • An understanding of the indications, effects, doses and complications of inotropic and vasopressor drips, based on hemodynamic monitoring
  • Appropriate knowledge of indications, risks and benefits of common ICU medications
  • An understanding of the causes, pathophysiology and management of acute and chronic renal failure, including hemodialysis and continuous renal replacement therapies
  • An understanding of the pathophysiology, diagnosis, and management of coagulation disorders (acquired and congenital)
  • An understanding of the pathophysiology of traumatic brain injury, as well as principles of management, including medication, monitors, and indications for intervention
  • An understanding of the diagnosis and management of common critical care GI disturbances, such as GI hemorrhage, pancreatis, diverticulitis and cholecystitis
  • An understanding of indications, choices, and risks of various types of antihypertensive medication
  • An understanding of the diagnosis and management of endocrine dysfunction related to DM, DI, adrenal and thyroid dysfunction
  • An understanding of critical care infectious disease, especially core ICU conditions such as bloodstream infection and pneumonia
  • An understanding of the pathophysiology, diagnosis, and management of abdominal compartment syndrome

ACGME Competency 3: Practice-based Learning and Improvement

Fellows must demonstrate familiarity with the scientific information pertinent to their patients' care. In addition, they must be able to evaluate the level of evidence supporting that knowledge. The venues for acquiring, disseminating and demonstrating this knowledge are individual reading and regular conference attendance/participation. It is expected that fellows will demonstrate a pattern of independent learning about their patients' illnesses.

Upon completion of the Surgical Critical Care Fellowship, fellows will demonstrate:

  • A pattern of self-directed learning, related to issues pertaining to patients under their care
  • Facility with current medical information sources, such as online search engines and databases, as well as print and e-journals
  • An ability to use synthesize different types of evidence into safe care

ACGME Competency 4: Interpersonal and Communication Skills

Fellows are required to consistently communicate with patients, families and other health care professionals. The quality, quantity and attitude of communication are all important, both verbal and written. Fellows are required to effectively use and teach Amalga, Problem Tracker, Line Tracker, and other relevant communication tools.

Upon completion of the Surgical Critical Care Fellowship, every physician will have demonstrated:

  • Competence in written and verbal communication
  • Fluency in appropriate medical software and communication tools
  • Ability to educate the health professional team, as well as patients and patient families, regarding critical care ethical issues
  • The ability to disseminate the appropriate information to patients and to their families
  • Educate the health professional team, as well as patients and patient families, regarding critical care ethical issues

ACGME Competency 5: Professionalism

Fellows must maintain the highest standards of ethical behavior, with a commitment to continuous, high-quality patient care. The professional behavior extends to all patient care interactions as well as all interactions with other health care personnel. The fellows must demonstrate sensitivity to the diversity of ages, genders, cultures and relationships.

The professionalism expected also encompasses the individual professional behavior necessary to maintain the function of the hospital and training program, including timely medical documentation, completion of licensing and credentialing requirements, documentation of work-hours and adherence to the ACGME Duty Hours requirements.

Upon completion of the Surgical Critical Care Fellowship, every physician will demonstrate:

  • Compliance with existing duty-hour restrictions
  • Effective and timely contribution to the medical record
  • Ability to educate patients and their families all treatment options, outcomes and patient prognosis
  • Appropriate dress, grooming and behavior
  • An understanding of, and commitment to, patient privacy

ACGME Competency 6: System-based practice

Fellows must access the health system resources necessary to practice high-quality, cost-effective patient care. This includes understanding the roles of various specialists and other health care professionals in the care of their patients. Fellows must fulfill their important role in the care of patients on other services that are evaluated and followed as consult patients. They should understand the ways that the timing of their care and documentation affects the function of the medical center.
Upon completion of the Surgical Critical Care Fellowship, the fellow will:

  • Demonstrate understanding of how critical care outcomes are related to a multidisciplinary system of care
  • Initiate appropriate consultations with other specialists, and construct a clinical plan for complex critical care problems
  • Demonstrate understanding of protocols and how they impact quality and safety
  • Lead multidisciplinary rounds
  • Demonstrate an ability to prioritize the recommendations of different specialties to optimize overall patient outcomes
  • Have the ability to analyze, evaluate and perform critical care research
  • Have the skill necessary to manage ethical and psychosocial challenges of critical care
  • Initiate appropriate consultations with other specialists, and construct a clinical plan for complex critical care problems
  • Utilize medications safely, and determine cost effectiveness of various therapeutic interventions
  • Triage critically ill patients appropriately, understanding the needs of patients, units and the institution
  • Participate in quality assurance processes, such as Mortality and Morbidity conference, performance improvement conference
  • Develop patient safety monitoring and error restriction progress
  • Complete a safety-related research project

Documentation:

The achievement of these objectives is documented in several ways:

  • Each resident is required to keep a log of the critically ill patients that he/she has managed. Using this document, residents maintain a record of their clinical activities during the training period, including their roles in the management of each patient, and a listing of major procedures, such as insertion of hemodynamic monitoring devices, endotracheal intubation and tube thoracostomy, among others.
  • Acquisition of the critical care cognitive skills will be assessed by the fellow's active participation in teaching rounds, didactic lectures, journal clubs and required formal presentations.
  • The achievement of the educational goals of this Surgical Critical Care Fellowship will be documented also by the results of the Multidisciplinary Critical Knowledge Assessment Program (MCCKAP), which the Surgical Critical Care Fellow is required to take during his or her training year. The detailed report received clearly identifies objectively his/her strengths and weaknesses. This information is useful in identifying areas of each fellow's surgical critical care curriculum, which might benefit from directed reading and specifically concentrated training.

Director: Christine Trankiem, MD
Applications and inquiries can be submitted by Email: WHCTraumaAdmin@medstar.net
Phone: 202-877-5190
Fax: (202-877-3173
Address: 110 Irving St. NW
Washington, D.C. 20010