Surgery Critical Care Selective

An orientation for all students rotating on Critical Care Selective is held by Dr. Matthew Sharpe on the first day of the rotation. Attendance is required.

This page covers some of the important things to bear in mind during your Critical Care experience in Surgery. It is our goal to help you reach the goals the Graduation Competencies of the University of Kansas School of Medicine.

• Download Critical Care Selectives Skills Procedures (Word)
• Download Critical Care Selective Reading Assignments & Support Material
• Click here to access Faculty/Office Contact Directory

1. Professional attire and demeanor are required during the rotation

The ultimate goal of medical school is to teach the art and science of medicine. It is important that you envision yourself as a practicing physician (not just a fourth-year medical student) and adopt the habits of a medical professional.

You should ask yourself what you would do in the critical care situations you are exposed to as if you were the physician actually making the decision.

• Dress in appropriate street clothes to wear to work each day.
• Remember that scrub clothes are appropriate attire for the operating room and for times spent on-call.
• Retain respect for patients, peers, and co-workers despite long hours, stressful situations and great demands put upon you.

2. Student duties for patient care

You are expected to see your patients and be prepared for rounds. Each student is to have at least one free weekend consistent with the Medical Student Duty Hours Policy.

On-call requirements and weekend duties are determined by each service. Check with your service to determine what is expected of you.

3. Rounds

Patients whom the student encounters as an inpatient should receive a complete History and Physical Exam with assessment and plan by that student.

Regarding rounds on inpatients, the student is expected to be able to deliver an oral presentation of the complete H&P during the first 24 hours of hospitalization and provide updates of developments during each subsequent set of rounds. The H&P is presented orally but in varying degrees of detail depending on time, service, resident, attending and patient problem.

4. Orientation and Simulations

Attendance at Orientation and Skills Labs (simulations) is required. Students are freed from clinical duties during the simulation sessions. Some rotations have conferences, attendance at which is required.

5. Reading and preparation

Students are expected to read the Critical Care Selective Reading Assignments which can be accessed from the link at the top of this page.

In addition to these readings, it is essential that the student read about the disease processes affecting his/her patients. The best way to assimilate the fund of knowledge necessary to be a successful physician is to observe a finding or disease entity in a patient and then read about it in a textbook or journal.

Each time a student reads about a clinical disease entity, he/she should attempt to assimilate information in the following categories: incidence, etiology, pathophysiology, symptoms, signs, differential diagnosis, diagnostic testing, natural history of the disease, treatment (medical, surgical, etc.) including techniques and dosages, prognosis based on treatment or non-treatment, and incidence and type of complications as a result of treatments.

6. Recording Patient Encounters

The School of Medicine requires students to log and synch patient encounters on an electronic device.

Summary

Every student is welcomed to the Surgery Critical Care Selectives and we hope that each student has a valuable learning experience.

Course management is under the direction of Matthew Sharpe, M.D. Simulations are under the direction of Emily Diederich, M.D.

Critical Care Selective Objectives and Graduation Competencies:

Critical care selectives will provide exposure to a number of core symptom complexes considered crucial to the management of the patient with critical illness.

Core Critical Care Principles:

The student will be able to discuss the core principles of critical care management including, DVT and stress ulcer prophylaxis, nutrition, pressure wound and skin care, delirium, sedation and pain management as they pertain to each critical sub-specialty. (PC4, PC5)

Organ System Compromise:

Develop an integrated approach to evaluating and discussing the patient with either single or multi-organ compromise, including but not limited to cardiac, renal, gastrointestinal, pulmonary, neurologic, infectious and hematologic. Describe how each system functions independently or dependently of each other in regards to the specific critical illness. (SBP2)

Respiratory Dysfunction:

Recognize patients with respiratory distress, manifested as an inability to either oxygenate or to ventilate and discuss etiologies of respiratory failure based on different patient populations. The student should exhibit a general understanding of invasive and noninvasive means of mechanical ventilation.

Hemodynamic Compromise:

Manage patients with hemodynamic instability admitted for monitoring and treatment of arrhythmias, hypotension or hypertension. Describe the different types of shock states including cardiogenic, distributive (septic) and hypovolemic and discuss the importance of maintaining the physiologic balance of oxygenation and tissue perfusion in caring for these patients.

Metabolic Compromise:

Recognize and discuss management of patients with complications of renal failure including acid-base imbalance, volume overload and electrolyte abnormalities.

Palliative Care:

Evaluate the critically ill patient in regards to terminal illness and end-of-life issues. The student will be exposed to family meetings that will deal directly with palliative care issues.

Critical Care Course Objectives:

Patient Care - Students are expected to achieve the knowledge, skills, attitudes and behaviors to enable them under supervision to demonstrate increasing clinical capabilities as they progress toward residency, specifically to:

• Performs an efficient and focused comprehensive history and physical exam and presents an appropriate plan of care for critically ill patients. (PC1, PC2, PC3, PC6)
• Observe and participate in procedural opportunities pertinent to each selective such as central and arterial line placement and endotracheal intubation. (PC6)
• Act at a resident level when assuming care for new admissions, writing orders and discussing cases directly with fellows and attendings. ( PC2, PC4)

Medical Knowledge:

Students will be able to use an appropriate fund of knowledge of current and evolving concepts and practices in critical care.

• Select and interpret pertinent clinical information including radiographic, pharmacologic and laboratory data. (MK1)
• Appropriately use documentation, protocols, data storage and retrieval pertaining to each critical care sub-specialty and the electronic medical record (O2) (MK1)
• Attend weekly didactic conferences and patient-based learning experiences specific to the sub-specialty critical care selective.
• Participate in clinical skills assessments and simulated patient encounters. (MK3)

Practice-Based Learning/Improvement:

Students should demonstrate critical and analytic thinking, awareness of the limitations of their knowledge and skills, and commitment to continuous learning and development. (PBL2, PBL4)

• Demonstrate the integration of evidence-based medicine and similar strategies into solving clinical problems. (MK1, MK2, MK3, PBL1)
• Use electronic medical record and other information technology to support clinical practice and personal education. (MK1, MK2, MK3)
• Use analysis of experiences to improve performance and continuously update personal clinical knowledge and skills. (MK1, MK2, MK3, PBL2, PBL3, PBL4, SBP4)

Interpersonal and Communication Skills:

The care of the critically ill patient is complex and multidisciplinary. It is important that students refine their ability to display interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and other health professionals in a concise, accurate and respectful manner. (ICS1, ICS2, ICS3, ICS4)

Professionalism:

It is important that those caring for critically ill patients integrate the concepts of altruism, accountability, excellence, duty, service, honor, integrity and respect for others into all aspects of their care. (P1, P2, P3, P4)

• Understand informed consent and patient confidentiality. (ICS4)
• Discuss the importance of a culturally sensitive, patient and family centered approach to care, which integrates the emotional and spiritual needs of the patient and family, especially in relation to serious progressive illness or end of life. (ICS1, ICS2, P2, P4)

System-Based Practice:

Students will be prepared to function effectively in teams and within organizational structures. They will demonstrate the ability to call on system resources to provide optimal care. (SBP1, SBP3, SBP5)

Critical Care Selective Course Objectives:

Recognize and intervene appropriately in common medical and surgical crises:

Medical Crises:

1. Respiratory failure (hypoxic and hypercarbic)
2. Hemodynamic compromise {arrhythmias, shock [hypovolemic, loss of vascular resistance (ex: septic), cardiogenic] hypertensive crisis}
3. Electrolyte and acid/base emergencies

Neurologic Crises:

1. Coma, seizure, mental status changes

Surgical Crises:

1. Hemorrhagic Shock
2. Burn resuscitation

Skills acquired during the critical care selective should include:

• Appropriate determination of patient admission and discharge criteria for ICU level care
• Acquisition and interpretation of basic laboratory, radiologic and hemodynamic monitoring data required during medical/surgical crises
• Fundamental familiarity with central and peripheral intravenous access, art4rial lines and Swan-Ganz catheters
• Initiate basic airway management and mechanical ventilation modalities

Simulation Objectives

The Objective: This course was designed to ensure that all students in the selective have the opportunity to practice directing the initial management of an acutely decompensating patient before internship begins. Our hope is that this experience will not only serve as a review of some of the underlying pathophysiology, but also as an opportunity to begin to get comfortable in the role of decision maker.

The Environment: You will be providing care in a patient room of a general hospital ward. You will find a standard hospital bed, a patient monitor with a blood pressure cuff and pulse oximeter. In order to cycle the blood pressure, you will need to press 'start' on the monitor. There are also various oxygen devices as well as a crash cart and defibrillator available should you need them.

The Patient: The computer-controlled mannequin is equipped to demonstrate pupil reactivity, breath sounds, heart sounds, and palpable pulses as well as to carry on a conversation with you. The patient has a PICC line in place should you need IV access.

The Care Team: You will be serving as the physician on call covering our patient. There will be an actor in the room who will play the role of the patient's primary nurse. He/she can also provide the services usually performed by the respiratory therapist (pulmonary medications, oxygen delivery devices...). Our actors do their best to stay in character during the scenario, and ask that you do the same.

Patient History and Testing: The primary nurse for the patient will provide you with the patient's history. If you would like to order laboratory tests, EKGs, or radiology exams, you can give the verbal order to the nurse and she will provide you with results once they are available.

The Confidentiality Pledge: We are all here to learn in hopes of providing better care for our future patients. We know that it can feel awkward to work in this artificial environment. We also know that despite our best efforts to make the scenarios realistic, there are many things that are different from 'real-life' and those things may interfere with your ability to care for our patient as you normally would. Nonetheless, please do your best to buy-in to the experience. In order to encourage participation without reservation, we pledge that all information regarding the performance of specific individuals and scenarios will be kept confidential, and ask that you do the same.

Link to: Simulation Based Critical Care Curriculum and LCME Accreditation Standards

Surgery Critical Care Selectives

Orientation:

Students on the Surgical Critical Care Selectives are required to attend Orientation held by Dr. Matthew Sharpe on the first day of the rotation.

Simulations:

Students are required to attend the simulations offered by Dr. Emily Diederich.

Change of Rotation:

In the rare case that a student wishes to make a change to a different Critical Care Selective once the rotation has begun (for example, changing from Burn Unit to MICU because of low patient census), approval must be obtained from Dr. Sharpe, the rotation faculty from which the student departs, and the Registrar so that credit can be given to the student for completion of the proper course number. Courtesy notice to the Surgery Education Coordinator, Debra DeConink, is requested in the case of making such a change.

DISCLAIMER:

All course material will be covered as time and circumstance permit. Learning assistance, academic performance enhancement, and psychological services at KUMC are free,
confidential, and available at Student Counseling & Educational Support Services by calling 913-588-6580 or visiting G116 Student Center.

Any student in this course who needs an accommodation because of a disability in order to complete the course requirements should contact the instructor or the Equal Opportunity/Disability Specialist (913-588-7813, TDD 913-588-7963) as soon as possible.

The four-week critical care selective offers the M4 student the opportunity to develop the knowledge, skills, attitudes and behaviors required to care for very ill hospitalized patients. The several intensive care units (pediatrics, neonatal, medical, surgical, coronary, etc.) allow the student to focus on an interest in a particular specialty. This selective helps ensure that all students have basic knowledge and skills in critical care.

Surgical Critical Care Rotations:

SURG 927 Critical Care: Burn Center

Burnett Burn Center, KU Medical Center, Kansas City, KS

This rotation emphasizes the care of burn patients ranging from outpatient treatment to ICU level care. The experience includes the floor and ICU level burn patients along with extensive operative experiences. Plastic surgeons, general surgeons, and trauma/critical care staff are KU School of Medicine faculty members. The team includes a PGY-2 resident and a nurse practitioner. The OR experience includes a combination of acute burn surgery, burn re-construction, and surgery for complex wounds including flaps.

Clinic days are Tuesday, Wednesday, and Thursday. Conferences, including burn rounds, are held on Wednesday. The strengths of this rotation include extensive hands on experience and an opportunity for one on one experience with the resident, nurse practitioner, and the attending staff. Research opportunities are available that extend beyond the rotation.

The objective of this clerkship is to provide students with experience in the management of critically ill patients. Students participate in the diagnosis and treatment of patients in the KUMC Burn Center. Clinical work is supplemented by conferences and simulations.

• There is a limit of 1 student per rotation
• This rotation fulfills the Critical Care Selective requirement

SURG 928 Critical Care: Neurosurgical Intensive Care Unit

Neurosurgical Intensive Care Unit, KU Medical Center, Kansas City, KS

This rotation places special emphasis on cerebrovascular pathophysiology. The experience includes the learning of basic skills and principles underlying the recognition and management of neurologic emergencies, cerebrovascular emergencies, and vascular neurologic disorders. Additionally, the student becomes familiar with the pathophysiologic processes of increased intracranial pressure, cerebral edema, mass effect and cerebral perfusion failure. Attending faculty are KU School of Medicine faculty members from the Departments of Anesthesia and Neurology. Residents from the KU School of Medicine form a two-resident team, ranging from PGY-2 to PGY-4. Students have the optional opportunity of supervised participation in invasive procedures in the intensive care unit and operating room.

Clinic days are held on Thursdays. Lecture series are held on Monday, Tuesday, Wednesday, and Thursday mornings. Neurology, Neurosurgery, Neuropathology, and Neuroradiology case presentations and Grand Rounds are held on Friday mornings. This neuro-critical care rotation allows the student to develop a foundation in emergency and critical care neurology.

The objective of this Critical Care Selective is to provide students with experience in the management of critically ill Neurosurgery patients. Students participate in the diagnosis and treatment of patients in the Neurosurgical Intensive Care Unit. Clinical work is supplemented by conferences and simulations.

• There is a limit of two students per rotation
• This rotation fulfills the Critical Care Selective requirement

SURG 929 Critical Care: Surgical Intensive Care Unit

Surgical Intensive Care Unit, KU Medial Center, Kansas City, KS

The fourth-year surgical critical care elective is designed for the student to gain an appreciation and familiarity with the thought processes/procedures utilized in the care of the critically ill patient. Each student’s experience will be unique, based upon the patients for whom they care for during this rotation. Students will gain experience in obtaining a history/physical exam and developing a treatment plan for the assigned patients in the ICU, as well as to integrate acquired patient data and medical knowledge and propose changes in patient care. Additionally, students will gain experience in insertion of invasive pressure monitors such as arterial lines, central lines, and interpretation of data obtained from these monitors.

The student will follow and actively participate in the care of 1-2 patients daily. Participation includes pre-rounding to gather overnight events and data, presentation of patients during rounds using a systems-based approach, participation in the daily plan formulation, and subsequent management throughout the day. Students are expected to know their patients past medical, social, and surgical histories as well as any pre-hospital medications and allergies. After rounds, students are expected to work with the residents/fellows in evaluation and management of critically ill patients and implementation of the daily plan, including all bedside procedures.

The student will participate in various educational offerings each week. Wednesday: Journal Club. This is for all house staff and students and covers both classic and contemporary critical care literature. Friday: Didactic Lecture. All house staff and students are expected to attend.

• There is a limit of 2 students per rotation
• This rotation fulfills the Critical Care Selective requirement

Non-Surgical Critical Care Rotations:

ANES 911 Critical Care: Anesthesia - The objective of this clerkship is to provide students with experience in the management of critically ill patients. Students will participate in the diagnosis and treatment of patients in the Post-Anesthesia Unit. Clinical work will be supplemented by conferences and other educational activities.

MED 905 Critical Care: Coronary Care Unit - The objective of this clerkship is to provide students with experience in the management of critically ill patients. Students will participate in the diagnosis and treatment of patients in the health system or Kansas City VAMC Coronary Care Unit. Clinical work will be supplemented by conferences and other educational activities.

MED 912 Critical Care: Medical Intensive Care Unit - The objective of this clerkship is to provide students with experience in the management of critically ill patients. Students will participate in the diagnosis and treatment of patients in the health system or Kansas City VAMC Medical Intensive Care Unit. Clinical work will be supplemented by conferences and other educational activities.

PED 926 Critical Care: Neonatology - The student will be actively involved in the care and management of the high-risk and acutely ill neonate. Through a clinical participation, tutorial sessions and assigned reading emphasis will be placed on modern neonatal intensive care techniques and developmental physiology and biochemistry. Students may elect additional consecutive four-week periods to pursue aspects of neonatology in more detail, engage in investigative projects or acquire first-hand experience in the operation of a regionalized program for care of high-risk or acutely ill neonates in the state. Students must contact the Pediatric Department (Benito Berado) to finalize enrollment.

PED 930 Critical Care: Pediatric Intensive Care Unit - Principles of ongoing assessment and management of critically ill children with single and multiple organ failure will be presented. The teaching format will be formal and informal rounds at the bedside in the KU Pediatric ICU by faculty members of the Pediatric Critical Care Division. Integration of history-taking, physical examination skills, and laboratory and radiological assessment with pathophysiology will be emphasized. Students must contact the Pediatric Department (Benito Berado) to finalize enrollment.

Course/Rotation Number: 927
Burn (Burnett Burn Center), KU Medical Center, Kansas City, KS

This rotation emphasizes the care of burn patients ranging from outpatient treatment to ICU level care. The experience includes the floor and ICU level burn patients along with extensive operative experience. Plastic surgeons, general surgeons and trauma/critical care, are all KU faculty members. The team also includes a PGY-2 resident and a nurse practioner. The OR experience includes a combination of acute burn surgery, burn reconstruction, and surgery for complex wounds including flaps. Clinic days are Tuesday, Wednesday and Thursday. Conferences including burn rounds are held on Wednesday. The strength of this rotation includes extensive hands on experience with the opportunity for one on one experience with the resident, nurse practioner and the attending staff. Research opportunities are available that extend beyond the rotation.

• There is a limit of one student per rotation.
• This clerkship fulfills the Critical Care Selective requirement.

Course/Rotation Number: 929
Critical Care Surgical Intensive Care Unit, KU Medical Center, Kansas City, Ks

The objective of this clerkship is to provide students with experience in the management of critically ill patients. Students will participate in the diagnosis and treatment of patients in the Surgical Intensive Care Unit. Clinical work will be supplemented by conferences and other educational activities.

• There is a limit of 2 students per rotation
• This clerkship fulfills the Critical Care Selective requirement.

Course/Rotation Number: 928
Neurosurgical Intensive Care Unit, KU Medical Center, Kansas City, KS

This rotation places special emphasis on cerebrovascular pathophysiology. The experience includes the teaching basic skills and principles underlying the recognition and management of neurologic emergencies, vascular emergencies, and vascular neurologic disorders and to become familiar with the pathophysiologic processes of increased pressure, cerebral edema, mass effect and cerebral perfusion failure. All attending faculty are KU School of Medicine faculty members. Residents from the KU School of Medicine form a two-resident team, ranging from PGY-2 to PGY-4. Students have the optional opportunity of supervised participation in invasive procedures in the intensive care unit.

Clinic days are held on Thursdays. Lecture series are held on Monday, Tuesday, Wednesday and Thursday mornings. Friday mornings is Neurology, Neurosurgery, Neuropathology and Neuroradiology Case presentations and Grand Rounds. The strengths of this rotation are fourth year students may elect to rotate on Neuro-ICU as a pre-residency exposure. This neurocritical care rotation provides a foundation in emergency and critical care neurology.

• There is a limit of two students per rotation.
• This clerkship fulfills the Critical Care Selective requirement.