Critical Care Medicine — Rotations
Interventional Radiology (IR)
Teaching
Site: MKH
EPAs mapped to this activity
For residents in C
| C10. Managing the transport of patients who are critically ill | When Possible |
| C12. Supervising, assessing, and coaching junior colleagues | Optional |
| C5. Performing procedures: Vascular access | Priority |
| C6. Performing procedures: Chest tube, paracentesis, lumbar punctures, and temporary transvenous pacemaker insertion | Priority |
| C7. Performing Point-of-Care ultrasound | Priority |
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 | ||||||
| 1.3.1. Normal and abnormal anatomy, including the appearance with diagnostic imaging | ||||||
| 1.3.4. Developmental physiology and pharmacology in adolescents | ||||||
| 1.3.5. Psychosocial needs of adolescent patients and their families | ||||||
| 1.3.11. Principles of medical transport | ||||||
| 1.3.11.1. Physiology during transport, including air transport | ||||||
| 1.3.11.2. Modes of transportation, patient care equipment, and monitoring methods | ||||||
| 1.3.11.3. Role of paramedical personnel | ||||||
| 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 | ||||||
| 2.2. 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 | ||||||
| 3. Plan and perform procedures and therapies for the purpose of assessment and/or managemen | ||||||
| 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 | ||||||
| 4. Establish plans for ongoing care and, when appropriate, timely consultation | ||||||
| 4.1. Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation | ||||||
| 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 | ||||||
| 2.2. Provide a clear structure for and manage the flow of an entire patient encounter | ||||||
| 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 | ||||||
| 4.1. Facilitate discussions with patients and their families in a way that is respectful, non-judgmental, and culturally safe | ||||||
| 4.1.1. Explain life-sustaining therapies, in clear language, and describe the expected outcome of such therapies | ||||||
| 4.2. Assist patients and their families to identify, access, and make use of information and communication technologies to support their care and manage their health | ||||||
| 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. Contribute to the improvement of health care delivery in teams, organizations, and systems | ||||||
| 1.1. Apply the science of quality improvement to contribute to improving systems of patient care | ||||||
| 1.1.1. Identify environmental hazards and promote safety for patients and staff | ||||||
| 1.1.2. Identify, analyze, and minizime risk of critical icidents, adverse events, complications of critical illness | ||||||
| 1.1.3. Implement quality improvement activities, including evidence-based practice, best practice guidelines and benchmarking, and change management | ||||||
| 1.1.4. Participate in the processes of clinical audit and peer review | ||||||
| 1.2. Contribute to a culture that promotes patient safety | ||||||
| 1.3. Analyze patient safety incidents to enhance systems of care | ||||||
| 1.4. Use health informatics to improve the quality of patient care and optimize patient safety | ||||||
| 2. Engage in the stewardship of health care resources | ||||||
| 2.1. Allocate health care resources for optimal patient care | ||||||
| 2.2. Apply evidence and management processes to achieve cost-appropriate care | ||||||
| 3. Demonstrate leadership in health care systems | ||||||
| 3.1. Demonstrate leadership skills to enhance health care | ||||||
| 3.1.1. Apply knowledge of the function and operation of a critical care unit | ||||||
| 3.1.1.1. Physical requirements of ICU design | ||||||
| 3.1.1.2. Administrative organization required to operate an ICU | ||||||
| 3.1.1.3. Unit staffing requirements, skills, education, and organization | ||||||
| 3.1.1.4. Critical care unit equipment requirements | ||||||
| 3.1.2. Manage the clinical, academic, and administrative affairs of an intensive care unit | ||||||
| 3.1.2.1. Facilitate the clinical care of critically ill patients | ||||||
| 3.1.2.1.1. Triage and prioritize patients for admission | ||||||
| 3.1.2.1.2. Manage safe and timely admission to and discharge from ICU | ||||||
| 3.1.2.1.3. Supervise and delegate to other health care professionals according to competence and role | ||||||
| 3.1.2.1.4. Facilitate effective multidisciplinary and interprofessional team cooperation | ||||||
| 3.1.2.2. Manage unit resources by applying knowledge of the following: | ||||||
| 3.1.2.2.1. Criteria for admission to, and discharge from ICU | ||||||
| 3.1.2.2.2. Common risk factors for post-ICU mortality or re- admission | ||||||
| 3.1.2.2.3. Commonly used scoring systems for assessment of severity of illness, case mix, and workload | ||||||
| 3.1.2.2.4. Published standards of care at local, national and international level including consensus statements and care bundles | ||||||
| 3.1.2.2.5. Principles of national/local health care legislation applicable to Critical Care Medicine | ||||||
| 3.1.2.3. Facilitate the unit’s participation in scholarly work | ||||||
| 3.2. Facilitate change in health care to enhance services and outcomes | ||||||
| 4. Manage career planning, finances, and health human resources in personal practice(s) | ||||||
| 4.1. Set priorities and manage time to integrate practice and personal life | ||||||
| 4.2. Manage personal professional practice(s) and career | ||||||
| 4.3. Implement processes to ensure personal practice improvement | ||||||
| 4.3.1. Implement a clinical audit including mortality reviews and complication rates | ||||||
| 1. Respond to an individual patient’s health needs by advocating with the patient within and beyond the clinical environment | ||||||
| 1.1. Work with patients to address determinants of health that affect them and their access to needed health services or resources | ||||||
| 1.1.1. Identify religious, cultural, and socioeconomic issues related to the care of the patient | ||||||
| 1.1.2. Advocate for critically ill patients from vulnerable populations | ||||||
| 1.2. Work with patients and their families to increase opportunities to adopt healthy behaviours | ||||||
| 1.3. Incorporate disease prevention, health promotion, and health surveillance into interactions with individual patients | ||||||
| 2. Respond to the needs of the communities or populations they serve by advocating with them for system-level change in a socially accountable manner | ||||||
| 2.1. Work with a community or population to identify the determinants of health that affect them | ||||||
| 2.2. Improve clinical practice by applying a process of continuous quality improvement to disease prevention, health promotion, and health surveillance activities | ||||||
| 2.3. Contribute to a process to improve health in the community or population they serve | ||||||
| 2.3.1. Promote activities that impact upon the maintenance and improvement of health in the general population, such as injury prevention | ||||||
| 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 | ||||||
| 3.2. Identify, select, and navigate pre-appraised resources | ||||||
| 3.3. Critically evaluate the integrity, reliability, and applicability of health-related research and literature | ||||||
| 3.3.1. Apply the principles of levels of evidence | ||||||
| 3.3.2. Apply evidence for and against specific therapeutic interventions or treatments | ||||||
| 3.3.3. Apply integrative literature, including meta-analyses, practice guidelines, decision analyses, and economic analyses | ||||||
| 3.4. Integrate evidence into decision-making in their practice | ||||||
| 4. Contribute to the creation and dissemination of knowledge and practices applicable to health | ||||||
| 4.1. Demonstrate an understanding of the scientific principles of research and scholarly inquiry and the role of research evidence in health care | ||||||
| 4.2. Identify ethical principles for research and incorporate them into obtaining informed consent, considering potential harms and benefits, and vulnerable populations | ||||||
| 4.3. Contribute to the work of a research program | ||||||
| 4.5. Summarize and communicate to professional and lay audiences, including patients and their families, the findings of relevant research and scholarly inquiry | ||||||
| 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 | ||||||
| 1.5. Exhibit professional behaviours in the use of technology-enabled communication | ||||||
| 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 | ||||||
| 3. Demonstrate a commitment to the profession by adhering to standards and participating in profession-led regulation | ||||||
| 3.1. Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing practice | ||||||
| 3.1.1. Utilize the medical, legal, and ethical frameworks for organ donation and transplantation | ||||||
| 3.1.2. Incorporate medico-legal considerations in the care of critically ill patients | ||||||
| 3.1.3. Utilize legal and ethical frameworks to determine the capacity of patients to give informed consent | ||||||
| 3.1.3.1. Substitute decision-maker identification | ||||||
| 3.2. Recognize and respond to unprofessional and unethical behaviours in physicians and other colleagues in the health care professions | ||||||
| 4. Demonstrate a commitment to physician health and well-being to foster optimal patient care | ||||||
| 4.1. Exhibit self-awareness and manage influences on personal well-being and professional performance | ||||||
| 4.1.1. Develop effective strategies to monitor fatigue, burnout, and psychological distress, and mitigate effects on clinical performance | ||||||
| 4.1.2. Maintain capacity for professional clinical performance in challenging situations | ||||||
| 4.1.3. Apply strategies to mitigate the personal impact of patient safety incidents and adverse outcomes | ||||||
| 4.2. Manage personal and professional demands for a sustainable practice throughout the physician life cycle | ||||||
| 4.3. Promote a culture that recognizes, supports, and responds effectively to colleagues in need | ||||||
| 4.3.1. Recognize and respond appropriately to impaired performance in self and colleagues | ||||||
Training experiences included in this activity
Core of Discipline
Required2.2. Simulation-based education, including procedural skills, communication, and team training (i.e., crisis resource management)
2.3. Continued participation in scholarly activity
Recommended
3.1. Clinical services related to defined learning needs based on primary specialty training and individual competencies
4.1.1. Focused assessment with sonography for trauma (FAST)
4.1.3. Ultrasound assessment for deep vein thrombosis
4.4. Participation in scholarly rounds
Optional
5.1. Provision of teaching for the general public on topics relevant to critical illness (e.g., participation in health advocacy presentation for the general public)
5.2. Participation in leadership training
5.3. Formal instruction in communication
Transition to Practice
Required2.1. Formal instruction in practice management. Topics include
2.3. Presentation of a completed scholarly or CQI project