Critical Care Medicine — Rotations
General Anesthesia
Teaching
Site: Jaber Hospital
EPAs mapped to this activity
For residents in TTD
| C1. Managing patients with respiratory failure | When Possible |
| C10. Managing the transport of patients who are critically ill | Required |
| C13. Debriefing routine resuscitations and critical events | Priority |
| C2. Managing patients with multisystem organ dysfunction | When Possible |
| C3. Managing the resuscitation of critically ill patients | When Possible |
| C4. Performing Procedures: Airway management | Priority |
| C5. Performing procedures: Vascular access | Priority |
| C6. Performing procedures: Chest tube, paracentesis, lumbar punctures, and temporary transvenous pacemaker insertion | When Possible |
| C7. Performing Point-of-Care ultrasound | Required |
| F2. Evaluating and managing uncomplicated and/or routine patients requiring mechanical ventilation | Required |
| TTD2. Initiating and leading resuscitation for hemodynamically unstable patients | When Possible |
| TTD4. Transferring clinical information between health care providers at handover | Priority |
| TTD5. Providing routine updates to patients or families | Required |
Competencies covered in this activity
| 1. Practise medicine within their defined scope of practice and expertise | ||||||
| 1.1. Demonstrate a commitment to high-quality care of their patients | ||||||
| 1.3. Apply knowledge of the clinical and biomedical sciences relevant to Critical Care Medicine | ||||||
| 1.3.6. Pharmacology | ||||||
| 1.3.6.1. Agents used for neuromuscular blockade | ||||||
| 1.3.6.2. Antimicrobial therapies | ||||||
| 1.3.6.3. Common intoxicants and poisons, and specific antidotes or supportive therapies | ||||||
| 1.3.6.4. Sedatives and analgesics | ||||||
| 1.3.6.5. Vasoactive agents | ||||||
| 1.3.7. Principles and practice of resuscitation | ||||||
| 1.3.8. Principles and practices of assisted mechanical ventilation and other methods of respiratory support | ||||||
| 1.3.9. Principles and methods of invasive and/or non-invasive monitoring | ||||||
| 1.3.9.1. Respiratory status | ||||||
| 1.3.9.2. Hemodynamic status | ||||||
| 1.3.9.3. Neurologic status | ||||||
| 1.3.9.4. Nutritional status | ||||||
| 1.4. Perform appropriately timed clinical assessments with recommendations that are presented in an organized manner | ||||||
| 1.5. Carry out professional duties in the face of multiple, competing demands | ||||||
| 2. Perform a patient-centred clinical assessment and establish a management plan | ||||||
| 2.1. Prioritize issues to be addressed in a patient encounter | ||||||
| 2.1.1. Recognize, resuscitate, and stabilize patients sustaining, or at risk of, cardiopulmonary arrest or other life-threatening conditions | ||||||
| 2.2. Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of diagnosis and management, disease prevention, and health promotion | ||||||
| 2.2.1. Interpret results of invasive and non-invasive monitoring | ||||||
| 2.2.1.1. Hemodynamic | ||||||
| 2.2.1.2. Neurologic | ||||||
| 2.2.1.3. Respiratory | ||||||
| 2.2.2. Interpret diagnostic imaging examinations, including general radiography, computerized tomography (CT), and point of care ultrasound | ||||||
| 2.4. Establish a patient-centred management plan, for the following | ||||||
| 2.4.1. Shock: distributive; hypovolemic; cardiogenic; obstructive | ||||||
| 2.4.2. Acute critical illness of any etiology | ||||||
| 2.4.2.1. Single or multiple organ dysfunction | ||||||
| 2.4.2.2. Oncologic emergencies | ||||||
| 2.4.2.3. Trauma and environmental injuries | ||||||
| 2.4.2.4. Sepsis | ||||||
| 2.4.2.5. Intoxication | ||||||
| 2.4.2.6. Perioperative care | ||||||
| 2.4.3. Chronic critical illness | ||||||
| 2.4.4. Pain and symptom control | ||||||
| 2.4.5. End of life, including goal-directed life-sustaining therapies | ||||||
| 2.4.6. Organ and tissue donation | ||||||
| 2.4.7. Critical illness in pregnancy | ||||||
| 2.4.8. Perioperative risk optimization | ||||||
| 3. Plan and perform procedures and therapies for the purpose of assessment and/or managemen | ||||||
| 3.1. Determine the most appropriate procedures or therapies | ||||||
| 3.1.1. Blood component therapy, and alternatives | ||||||
| 3.1.2. End of life care | ||||||
| 3.1.3. Hemodynamic support | ||||||
| 3.1.4. Invasive and non-invasive ventilation | ||||||
| 3.1.5. Medical equipment and monitoring device application | ||||||
| 3.1.6. Nutritional therapy: enteral and parenteral | ||||||
| 3.1.7. Pharmacotherapy | ||||||
| 3.1.8. Renal replacement therapy | ||||||
| 3.1.9. Supportive care | ||||||
| 3.1.10. Surgical intervention | ||||||
| 3.2. Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy | ||||||
| 3.3. Prioritize procedures or therapies, taking into account clinical urgency and available resources | ||||||
| 3.4. Perform diagnostic and therapeutic procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstance | ||||||
| 3.4.1. Diagnostic and monitoring procedures | ||||||
| 3.4.1.1. Use, zero, and calibrate transducers | ||||||
| 3.4.1.2. Use monitoring equipment | ||||||
| 3.4.1.2.1. Cardiac output | ||||||
| 3.4.1.2.2. Intra-abdominal pressure | ||||||
| 3.4.1.2.3. Intracranial pressure (ICP) | ||||||
| 3.4.1.2.4. Peripheral nerve stimulation for neuromuscular blockade | ||||||
| 3.4.2. Use point-of-care ultrasound (POCUS) assessment for | ||||||
| 3.4.2.1. Ascites | ||||||
| 3.4.2.2. Cardiac ventricular size and function | ||||||
| 3.4.2.3. Identification of a pneumothorax | ||||||
| 3.4.2.4. Pericardial effusion | ||||||
| 3.4.2.5. Pleural effusion | ||||||
| 3.4.2.6. Vascular access, including central venous access | ||||||
| 3.4.2.7. Intravascular volume status | ||||||
| 3.4.3. Techniques to treat hypothermia and hyperthermia and induce hypothermia | ||||||
| 3.4.4. Airway | ||||||
| 3.4.4.1. Airway maintenance | ||||||
| 3.4.4.2. Endotracheal intubation | ||||||
| 3.4.4.3. Management of the difficult and failed airway | ||||||
| 3.4.4.4. Replacement of an existing tracheostomy tube | ||||||
| 3.4.5. Breathing | ||||||
| 3.4.5.1. Ventilation by bag and mask | ||||||
| 3.4.5.2. Initiation of and weaning from assisted ventilation | ||||||
| 3.4.5.3. Maintenance of long term assisted ventilation | ||||||
| 3.4.5.4. Thoracostomy tube insertion | ||||||
| 3.4.5.5. Thoracentesis | ||||||
| 3.4.5.6. Fiberoptic bronchoscopy in the intubated patient | ||||||
| 3.4.6. Circulation | ||||||
| 3.4.6.1. Cardiopulmonary resuscitation | ||||||
| 3.4.6.2. Insertion of arterial catheters | ||||||
| 3.4.6.3. Insertion of central venous catheters | ||||||
| 3.4.6.4. Intraosseous vascular access if available | ||||||
| 3.4.6.5. Insertion of a pulmonary artery catheter | ||||||
| 3.4.6.6. Defibrillation | ||||||
| 3.4.6.7. Elective cardioversion | ||||||
| 3.4.6.8. Transcutaneous pacing | ||||||
| 3.4.6.9. Insertion and management of a transvenous pacemaker | ||||||
| 3.4.7. Renal | ||||||
| 3.4.7.1. Insertion of a temporary hemodialysis catheter | ||||||
| 3.4.8. Gastrointestinal | ||||||
| 3.4.8.1. Paracentesis | ||||||
| 3.4.9. Nervous system | ||||||
| 3.4.9.1. Lumbar puncture | ||||||
| 5. Actively contribute, as an individual and as a member of a team providing care, to the continuous improvement of health care quality and patient safety | ||||||
| 5.1. Recognize and respond to harm from health care delivery, including patient safety incidents | ||||||
| 5.2. Adopt strategies that promote patient safety and address human and system factors | ||||||
| 5.2.1. Apply the principles and techniques of infection prevention and control, including those for the protection of health care workers | ||||||
| 1. Establish professional therapeutic relationships with patients and their families | ||||||
| 1.1. Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion | ||||||
| 1.1.1. Address the impact of the unique and stressful environment of the critical care unit for patients and their families | ||||||
| 1.2. Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety | ||||||
| 1.3. Recognize when the perspectives, values, or biases of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly | ||||||
| 1.4. Respond to a patient’s non-verbal behaviours to enhance communication | ||||||
| 1.5. Manage disagreements and emotionally charged conversations | ||||||
| 1.6. Adapt to the unique needs and preferences of each patient and to his or her clinical condition and circumstances | ||||||
| 2. Elicit and synthesize accurate and relevant information, incorporating the perspectives of patients and their families | ||||||
| 2.1. Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information | ||||||
| 2.1.1. Gather information about the patient’s and family’s perspectives and values for end-of-life care | ||||||
| 2.3. Seek and synthesize relevant information from other sources, including the patient's family, with the patient's consent | ||||||
| 3. Share health care information and plans with patients and their families | ||||||
| 3.1. Share information and explanations that are clear, accurate, and timely, while assessing for patient and family understanding | ||||||
| 3.1.1. Use language and terminology that facilitates understanding and decision making | ||||||
| 3.2. Disclose harmful patient safety incidents to patients and their families accurately and appropriately | ||||||
| 4. Engage patients and their families in developing plans that reflect the patient’s health care needs and goals | ||||||
| 4.3. Use communication skills and strategies that help patients and their families make informed decisions regarding their health | ||||||
| 5. Document and share written and electronic information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy | ||||||
| 5.1. Document clinical encounters in an accurate, complete, timely, and accessible manner, in compliance with regulatory and legal requirements | ||||||
| 5.2. Communicate effectively using a written health record, electronic medical record, or other digital technology | ||||||
| 5.3. Share information with patients and others in a manner that enhances understanding and that respects patient privacy and confidentiality | ||||||
| 1. Work effectively with physicians and other colleagues in the health care professions | ||||||
| 1.1. Establish and maintain positive relationships with physicians and other colleagues in the health care professions to support relationship-centred collaborative care | ||||||
| 1.1.1. Contribute to productive communication and cooperation among colleagues recognizing the multidisciplinary nature of the specialty | ||||||
| 1.2. Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care | ||||||
| 1.2.1. Demonstrate respect and understanding for the roles of other team members in communicating and facilitating decision-making with critically ill patients and their families | ||||||
| 1.3. Engage in respectful shared decision-making with physicians and other colleagues in the health care professions | ||||||
| 1.3.1. Share expertise when acting in the consultant role, using referral as an opportunity to improve quality of care | ||||||
| 2. Work with physicians and other colleagues in the health care professions to promote understanding, manage differences, and resolve conflicts | ||||||
| 2.1. Show respect toward collaborators | ||||||
| 2.2. Implement strategies to promot understanding, manage differences, and resolve conflict in a manner that supports a collaborative culture | ||||||
| 3. Hand over the care of a patient to another health care professional to facilitate continuity of safe patient care | ||||||
| 3.1. Determine when care should be transferred to another physician or health care professional | ||||||
| 3.2. Demonstrate safe handover of care, using both oral and written communication, during a patient transition to a different health care professional, setting, or stage of care | ||||||
| 1. Engage in the continuous enhancement of their professional activities through ongoing learning | ||||||
| 1.1. Develop, implement, monitor, and revise a personal learning plan to enhance professional practice | ||||||
| 1.2. Identify opportunities for learning and improvement by regularly reflecting on and assessing their performance using various internal and external data sources | ||||||
| 1.3. Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice | ||||||
| 3. Integrate best available evidence into practice | ||||||
| 3.1. Recognize practice uncertainty and knowledge gaps in clinical and other professional encounters and generate focused questions | ||||||
| 1. Demonstrate a commitment to patients by applying best practices and adhering to high ethical standard | ||||||
| 1.1. Exhibit appropriate professional behaviours and relationships in all aspects of practice, demonstrating honesty, integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality | ||||||
| 1.1.1. Recognize circumstances where personal prejudices or biases may affect behaviour, including cultural, financial and academic aspects, and respond appropriately | ||||||
| 1.2. Demonstrate a commitment to excellence in all aspects of practice | ||||||
| 1.2.1. Develop and demonstrate use of a framework for implementing published standards of care | ||||||
| 1.2.2. Demonstrate responsibility for safe patient care, including effective transfer and continuity of care | ||||||
| 1.2.3. Demonstrate an understanding of the role and responsibilities of the critical care physician at the local, regional, and national levels | ||||||
| 2. Demonstrate a commitment to society by recognizing and responding to societal expectations in health care | ||||||
| 2.1. Demonstrate accountability to patients, society, and the profession by responding to societal expectations of physicians | ||||||
| 2.2. Demonstrate a commitment to patient safety and quality improvement | ||||||
Training experiences included in this activity
Transition to Discipline
Required2.1. Advanced Cardiovascular Life Support (ACLS) or equivalent
2.3. Orientation to the program, including policies, resident resources, program portfolios, learning resources, and assessment systems
Recommended
4.1. Simulation-based education, including procedural skills, communication, and team training (i.e., crisis resource management)
Optional
5.1. Membership in a specialty-specific professional organization