Critical Care Medicine Didactic Educational Plan

The critical care medicine (CCM) fellows participate in the didactic sessions of the general CCM course as both participants and instructors.  The lectures that fellows attend reinforce their basic knowledge of CCM, and the lectures that they provide enable them to solidify their CCM concepts.

Faculty Sessions

Faculty address advanced topics with the fellows during one-on-one or very small group (2 – 4 participants) sessions. These topics include:

Advanced Techniques in Respiratory Monitoring and Mechanical Ventilatory Support

• Lung protective strategies for Acute Lung Injury(ALI)/Acute Respiratory Distress Syndrome(ARDS)
• Biochemical mediators of ALI/ARDS
• Pharmacologic agents for support and enhancement of lung function (nitric oxide, - agonists, anti-cholinergic agents, etc.)
• Respiratory complications and support of acute and chronic spinal cord injury and other neuromuscular disease
• Respiratory evaluation and support of patients with advanced hepatic disease/failure

Advanced Techniques in Hemodynamic Monitoring and Support

• Current invasive, minimally-invasive, and non-invasive approaches to hemodynamic monitoring of the unstable patient
• Hemodynamic support of the brain injured patient
• Cardiovascular support of patients with advanced hepatic disease/failure

Infection Management in the Immunocompromised Patient

• Fungal infections:  prevention, diagnosis and management
• Anti-viral therapy
• Other opportunistic infectious processes (i.e., PCP)

Special Considerations in the Neurologically Injured Patient

• Neurologic (brain & spinal cord) protection in the acute phase of injury
• Ethical & legal issues in the declaration of brain death
• Advanced management of patients with complex neurovascular disease

Hepatic & Renal Disease Management

• Evaluation and management of hepato-pulmonary syndrome
• Considerations in and management of renal replacement therapy
• Diagnosis and management of coagulopathies associated with end-stage liver disease

Clinical Practice Management

• Payment practices and billing methods (CPT Codes, RUC process, etc.)
• Medical Direction: responsibilities and requirements
• Medical liability and risk management

Simulation Education Program

An important aspect of the didactic program for Critical Care Medicine Fellows focuses on computerized clinical simulation.  Our goals in this endeavor are to provide an in-depth experience sufficient for the trainee to acquire the skills and competency of a specialist in Critical Care Medicine in the areas of instruction developed to date.

Objectives:
1. Understand the indications and contraindications of tube thoracostomy insertion.
2. Demonstrate competency in the technique of tube thoracostomy insertion.
3. Command a working knowledge of the principles and set-up of tube thoracostomy drainage systems.
4. Demonstrate the ability to instruct others in tube thoracostomy placement.

Objectives:
1. Demonstrate competency in the technique of fiberoptic laryngotracheobronchoscopy.
2. Demonstrate technical skills commensurate with a Critical Care Specialist in fiberoptic laryngotracheobronchoscopy.
3. Command a solid working knowledge of airway anatomy to permit targeted diagnostic and therapeutic procedures.

Objectives:
1. Demonstrate an advanced working knowledge of mechanical ventilatory equipment and monitoring procedures required to ensure proper patient management and ventilator function.
2. Formulate and execute a plan of care focused on complex mechanical ventilatory support for various clinical scenarios.

Objectives:
1. Recognize the clinical manifestations of all major shock syndromes.
2. Identify and implement management techniques appropriate for specific shock classifications.
3. Direct the critical care team in the comprehensive care of a patient exhibiting shock.
4. Oversee the management of invasive monitoring systems to ensure accuracy of data utilized in directing patient care.

Advanced methods of oxygen therapy

Objectives:
1. Identify pulmonary conditions that will and will not respond to oxygen therapy.
2. Provide a comprehensive assessment of the pulmonary system.
3. Assess the need for and appropriate use of high-flow vs. low-flow oxygen delivery systems.
4. Understand and impart the limitations and abilities of the various oxygen delivery systems.
5. Formulate and execute a plan of care to meet the changing oxygen demands of a critical care patient.

Emergency and therapeutic placement of pacemakers

Objectives:
1. Demonstrate knowledge of the indications and contraindications for pacemaker support, both transthoracic and transvenous (all types).
2. Set up and execute the application of emergency transthoracic and transvenous pacemakers.
3. Command a working knowledge of the equipment and monitoring procedures necessary to ensure successful application of an emergency pacemaker, both transthoracic and transvenous.

Philosophical Perspective

Subspecialty fellowship education remains a privilege for the Department of Anesthesiology’s Section of Critical Care Medicine at Northwestern University which strives to provide trainees with facility in the most complex behaviors of Bloom’s cognitive, affective and psychomotor domains.

In congruence with this goal, extensive personal discussion has occurred between the Program Director of the Anesthesiology Critical Care Medicine Fellowship Program, Anesthesiology Critical Care Medicine Faculty, current Anesthesiology Critical Care Medicine Fellows and previous Anesthesiology Critical Care Medicine Fellows. The following is a brief synopsis of these discussions with an overall educational philosophy based on each of these domains:

Cognitive Domain

A complex critical care medicine didactic plan has been created to assure that the trainee has the basic critical care medicine core knowledge necessary for the successful practice of anesthesiology critical care medicine.

Additionally, synthesis (Level 5) and evaluation (Level 6) behaviors must be a goal of our program. Thus, integration of the anesthesiology critical care medicine fellow into such functions as NMH Respiratory Care Quality Management, NMH Cardiopulmonary Resuscitation Quality Management, Friday Morning Department of Anesthesiology Grand Rounds lecture series topic presentation and Anesthesiology Patient Safety Simulator Center Resident Conference presentation will help to achieve such behaviors in our trainees.

Affective Domain

Organization and characterization shall be sought by utilizing as leaders of intensive care unit daily rounds.  Evidence based medicine should be emphasized and utilization of patient care protocols with a charge to fellows to identify issues related to protocols and their implementation should occur.  Issues should be reported to the NMH Critical Care Medicine Leadership via this section’s representative, Dr. Michael L. Ault.  Additionally, fellows should be given the opportunity to attend these Critical Care Medicine Leadership meetings to understand the process by which these protocols are developed, monitored and modified.

Psychomotor Domain

Adaptation and origination should be the behaviors which we strive to achieve.  To achieve these behaviors, fellow utilization as a teaching resource for procedures performed by residents in difficult circumstances should be utilized.  Additionally, one of the anesthesiology critical care medicine fellow’s primary on-call tasks shall be provision of technical support to residents who encounter challenging technical scenarios.  Additionally, the fellow should be utilized as the primary resource for highly complex procedures such as thoracostomy tube insertion, diagnostic bronchoscopy and therapeutic bronchoscopy with anesthesiology critical care medicine attendings as the appropriate resource for performance of these procedures in challenging scenarios.