Internal Medicine: ICU

Rotation Goals and Objectives

  1. General Description
    1. Family Physicians actual practices vary considerably in the extent to which they provide inpatient care for critically ill patients. This portion of the curriculum is designed to provide residents with the skills and expertise expected of family physicians with active practices involving this area. Additionally, this rotation emphasizes the care of adult patients with a variety of medical disorders commonly cared for by family physicians as well as general internists and intensivists.
    2. Residents will work with a team of physicians specializing in internal medicine and its subspecialties. The resident will be supervised at all times by a faculty member specializing in internal medicine or a senior resident from the internal medicine residency program. With the support of the senior resident and faculty physician, the resident will be responsible for the comprehensive care of all hospitalized patients assigned to them. Didactic material will be presented to the resident on a daily basis from the attending physician and senior resident during hospital rounds. Formal didactic material will also be presented during the daily internal medicine morning report sessions. The resident will be required to present some of the topics at these morning report sessions.
    3. Residents are expected to follow their patients in the Family Medicine Center during this rotation.
    4. Level - PG 1 year
    5. Location - VAMC
    6. Duration - One month rotation, two times during the PG 1 year
    7. Internal Medicine - ICU is a full time rotation.
    8. One half day per week will be spent in the family medicine center.
    9. Participation in the Family Medicine call pool is NOT required during this rotation.
    10. Work hour form submission is required at the completion of this rotation during work hour submission months.
    11. Evaluation of Rotation
      1. The evaluation of the resident on this rotation will be done by the completion of an evaluation form by the attending physicians and senior resident at the end of the rotation.
      2. The resident will fill out a rotation evaluation for at the end of the rotation.
      3. The knowledge, skills and competencies acquired during this rotation will be evaluated by a Family Medicine attending as the resident provides care to patients in the Family Medicine Center.
      4. The resident's performance on the American Board of Family Medicine In-Training examination will also be used to assess knowledge in this area.
  2. Patient Care skills to be mastered
    1. Performance of complete history taking
    2. Performance of complete physical examination
    3. The evaluation and treatment of common problems for which adults are admitted to the hospital and the ICU
    4. The coordination of comprehensive care for hospitalized patients
    5. Recognition of the role of the family and other psychosocial factors in the care of hospitalized patients.
    6. Develop an understanding of what consultative services are useful to a hospitalized patient
    7. Develop an understanding of the multidisciplinary services that are useful to hospitalized patients
    8. The arrangement of discharge and follow up care for patients who have been hospitalized.
  3. Medical Knowledge skills to be mastered
    1. An increasing knowledge base to care for the breadth of patients that internists and family physicians care for who require hospitalization.
      1. Specific medical topics should be reviewed and learned on a daily basis based on the diagnoses and disorders of patients currently admitted to the resident's service.
  4. Practice Based Learning and Improvement
    1. This competency is addressed longitudinally throughout the rotation.
      1. Scientific evidence will be reviewed by the resident and attending physician in the context of their patients.
      2. The practical implementation of evidence-based medicine will be discussed as the medical decision making is reviewed.
      3. Medical evidence will be reviewed and presented during the daily morning report sessions.
      4. Information technology will be utilized by the resident as he or she is required to research topics as directed by the attending physician.
      5. Information technology will be utilized as the hospital implements its electronic health record.
      6. The resident will also be evaluated on the steps they took during the rotation to improve their shortcomings.
  5. Interpersonal and Communication Skills
    1. This competency is addressed longitudinally throughout the rotation.
      1. The resident will observe and be observed, taught and evaluated in the performance of obtaining patient histories, documenting histories, writing prescriptions, educating patients about treatment plans and prognosis, teaching medical students and other learners, and interactions with patients, families, office staff and physicians.
  6. Professionalism
    1. This competency is addressed longitudinally throughout the rotation.
      1. The attending physician will observe and assess the resident's sense of personal responsibility including attendance, promptness, motivation, completion of duties, and appropriate dress.
      2. Ethical and legal practice skills will be taught
      3. Respect for cultural, age, and gender differences will be taught, observed and evaluated.
      4. The resident is expected to treat patients, families and colleagues with respect, understanding, sympathy and honesty
  7. Systems Based Practice
    1. This competency is addressed longitudinally throughout the rotation.
      1. The resident will learn to become aware of available resources and the cost effectiveness of testing and therapeutic options
      2. The resident will gain an increasing understanding of the role of the patient, physician, support staff, and insurer in the health care environment
      3. The resident will gain an increasing understanding in the role of the hospital in the health care environment.
      4. Through the coordination of care for the hospitalized patients, the resident will become aware of the breadth of available resources in our community as well as to the limitations of the resources in our community. In this regard, the resident will be expected to work very closely with social workers and hospital case coordinators to assist in providing the best care available to our patients.