ANEU-4014 - Acting Internship in Critical Care Medicine - Surgical and Neurosurgical Intensive Care Units

ANEU-4014 - Acting Internship in Critical Care Medicine - Surgical and Neurosurgical Intensive Care Units

Elective Title: Acting Internship in Critical Care Medicine - Surgical and Neurosurgical Intensive Care Units
Course Number: ANEU-4014
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: N/A
Responsible Faculty Director: William Whitehead, MD, PhD Periods Offered: 1-13 including holiday period 8 
Coordinator: Kathryn Gwinn Other Faculty:
Location to Report on First Day:
SICU, 8C Jennie Sealy Hospital

1. To evaluate a patient in respiratory distress, demonstrate effective bag-mask ventilation, and insert intravenous line for resuscitation. 2. To evaluate a patient with hypotension and initiate appropriate therapy. Order appropriate diagnostic tests for patients with hypotension & evaluate effectiveness of therapeutic intervention. 3. To evaluate a patient with arrhythmia, develop differential diagnosis & order appropriate tests; demonstrate use of automated external defibrillator. 4. To demonstrate airway management and resuscitation in decompensated patient in the critical care environment.

1. To prepare the medical student for the practice of critical care medicine, by instruction in the diagnosis and management of the critically ill patient. 2. To evaluate the severity of diseases in critically ill patients and to recognize, prioritize, and treat life threatening derangements. 3. To learn basic and advanced principles of airway management, oxygen transport, respiratory therapy and institution, management and weaning of mechanical ventilation; nutritional support and antimicrobial therapy and management of sepsis and multiple system organ failure, and techniques for invasive and non-invasive hemodynamic monitoring.

Description of course activities
The student will gather and organize data on two or more critically ill patients and present this data during rounds. Activities will encompass those found in ANEU-4003, and also include: 1. learning and demonstrating basic ultrasound techniques in the SICU; 2. presenting an article from current critical care literature (once per week); and 3. Students will be supervised by residents, fellows, & faculty at a ratio of 1 student to 2-5 residents, fellows, & faculty. 4. There will be a paucity of invasive procedures performed by students due to the wide variety in the need for such procedures as well as the high acuity of our patient population.

Type of students who would benefit from the course
Students planning a career in Anesthesiology, Surgery, Emergency Medicine, or Internal Medicine.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 6:45 4:00
Tuesday 6:45 4:00
Wednesday 6:45 4:00
Thursday 6:45 4:00
Friday 6:45 4:00
Saturday n/a n/a
Sunday n/a n/a

 Average number of patients seen per week: 5-10
 Call Schedule: n/a

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time n/a
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Residents, fellows and SICU faculty.
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    SOAP presentation format. Also each student will present a topic relevant to critical care of their choosing (and faculty approval), and give a didactic presentation to the ICU team for 20 to 40 minutes, as described above.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Daily progress or procedure notes.
  B. Format - What guidelines are set for the student's written work?
    Unit admissions, progress and note forms / PowerPoint, handouts or chalkboard description may be used for the case presentation
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    Resident, fellow, and faculty consultation; and student-initiated current literature review.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Current cases, assigned topics, and student-selected,
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
    Verbal feedback will be given by faculty, fellows and residents

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    Advanced clinical skills include history and physical examination of critically ill patients, including hemodynamic monitoring and mechanical ventilation management; and the incorporation of ultrasound in clinical management and decision making in the ICU.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Exposure may occur to advanced airway management, hemodynamic management, ACLS and ATLS protocols.

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    The AI is expected to gather and interpret patient information, develop a management plan, and to implement basic steps in the plan, similar to an intern. The AI does not take call or carry more than two patients.

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    This course will help prepare students primarily by exposure to diverse surgical critically ill patients in a structured format.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Midpoint feedback will be provided at the request of the student. Remediation of deficiencies will be agreed upon by the student and will include a remediation plan.

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    The AI student will be exposed to 3-4 faculty per month; the faculty is on service for seven days consecutively; on an hour to hour basis, the student will have more interaction with the residents and fellows.