Critical Care Medicine — Rotations
Research
Teaching
Competencies covered in this activity
| 1. Practise medicine within their defined scope of practice and expertise | ||||||
| 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 | ||||||
| 1.3.2. Pathophysiology of: | ||||||
| 1.3.2.1. Organ dysfunction | ||||||
| 1.3.2.2. Sepsis | ||||||
| 1.3.2.3. Blunt and penetrating trauma | ||||||
| 1.3.2.4. Environmental injuries | ||||||
| 1.3.3. Physiology in critically ill women who are pregnant | ||||||
| 1.3.4. Developmental physiology and pharmacology in adolescents | ||||||
| 1.3.5. Psychosocial needs of adolescent patients and their families | ||||||
| 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 | ||||||
| 1.3.10. Principles of the determination of neurological death | ||||||
| 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 | ||||||
| 1.3.12. Principles for the coordination and triage of services for mass casualty management | ||||||
| 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 | ||||||
| 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 | ||||||
| 2.2. 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 | ||||||
| 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 | ||||||
| 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 | ||||||
| 4. Manage career planning, finances, and health human resources in personal practice(s) | ||||||
| 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 | ||||||
| 4.4. Pose questions amenable to scholarly investigation and select appropriate methods to address them | ||||||
| 4.4.1. Conduct scholarly work | ||||||
| 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 | ||||||
| 1.2. 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 | ||||||
| 1.3. Recognize and respond to ethical issues encountered in practice | ||||||
| 1.3.1. Demonstrate an awareness and understanding of moral and ethical issues as they impact on patients and their families, and critical care providers | ||||||
| 1.3.2. Develop and demonstrate use of a framework for recognizing and dealing with ethical issues in clinical and/or research practice including truth- telling, consent, conflict of interest, resource allocation, and end-of-life- care | ||||||
| 1.4. Recognize and manage conflicts of interest | ||||||
| 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 | ||||||
| 3.3. Participate in peer assessment and standard-setting | ||||||
| 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
Required2.3. Continued participation in scholarly activity
2.4. Teaching, supervision, and assessment of other learners
2.5. Formal instruction in equity, diversity, and inclusion, including
Recommended
3.1. Clinical services related to defined learning needs based on primary specialty training and individual competencies
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
5.4. Attendance at a specialty-specific conference
Transition to Practice
Required2.1. Formal instruction in practice management. Topics include
2.2. Participation in ICU administration and management, e.g., allocation of limited resources, participation in resource allocation committees, and ICU policy development
2.3. Presentation of a completed scholarly or CQI project