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Curriculum

Our comprehensive educational program in surgical critical care begins with an initial twelve-week lecture series by the critical care faculty addressing the "basics" of critical care management. The concepts introduced are reinforced at the patient bedside during daily patient teaching rounds.

Following the initial lecture series, we begin to focus on developing the resident's advanced clinical skills as well as administrative skills and scholarly pursuits. Bimonthly evidence-based medicine guideline development working conferences are alternated with monthly research conferences and monthly "Professional Development" lectures. These advanced skills conferences are in addition to a weekly critical care lecture series, which addresses a variety of critical care topics throughout the year.

Each fellow, upon completing the residency, is expected to be able to demonstrate the following skills:

  • Demonstrate ability to organize and lead a comprehensive, multi-disciplinary approach to patients with multi-system critical illness.
  • List the indications, complications, and various techniques for monitoring the following:
    • Arterial, central venous, and pulmonary arterial pressure
    • Invasive and non-invasive cardiac output
    • Continuous right heart volumetric measurements
    • Intracranial pressure (ICP)
    • Intra-abdominal pressure (IAP)
    • Abdominal perfusion pressure (APP)
    • Continuous pulse oximetry (SaO2)
    • Continuous end-tidal capnography (PetCO2)
    • Ventilator waveforms (flow-volume and pressure-volume loops)
  • Define in physiologic terms the adequacy of cardiac output and its implications for cellular oxygenation, end-organ perfusion, and multiple-system organ failure.
  • List and prioritize means for increasing cardiac output and oxygen transport through use of resuscitative fluid and vasoactive medication interventions.
  • Reproduce and effectively utilize the formula for:
    • Mean arterial pressure (MAP)
    • Mean pulmonary artery pressure (MPAP)
    • Systemic vascular resistance index (SVRI)
    • Pulmonary vascular resistance index (PVRI)
    • Left ventricular stroke work index (LVSWI)
    • Right ventricular stroke work index (RVSWI)
    • Cardiac index (CI)
    • Stroke volume index (SVI)
    • Right ventricular end-diastolic volume index (RVEDVI)
    • Coronary perfusion pressure (coronary PP)
    • Cerebral perfusion pressure (cerebral PP)
    • Abdominal perfusion pressure (APP)
  • List the major risk factors for and definitions of acute respiratory failure, acute lung injury, and acute respiratory distress syndrome (ARDS).
  • Discriminate between oxygenation, ventilation, and airway support.
  • Demonstrate proficiency in the various techniques for airway support.
  • List the physiologic mechanisms responsible for arterial hypoxemia and arterial hypercarbia including intrapulmonary shunt and deadspace ventilation.
  • Discuss indications, contraindications and complications of various modes of mechanical ventilation including:
    • Controlled Mechanical Ventilation (CMV)
    • Intermittent Mandatory Ventilation (IMV)
    • Assist Control Ventilation (ACV)
    • Pressure Support Ventilation (PSV)
    • Continuous Positive Airway Pressure (CPAP)
    • Bi-Level Positive Airway Pressure (BiPAP)
    • Positive End-Expiratory Pressure (PEEP)
    • Pressure Controlled Ventilation (PCV)
    • Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
    • Independent Lung Ventilation (ILV)
    • High Frequency Ventilation (HFV)
    • Airway Pressure Release Ventilation (APRV)
  • Discuss various methods for supporting oxygenation in patients with arterial hypoxemia.
  • Reproduce and effectively utilize the formulae for:
    • Arterial O2 content (CaO2)
    • Venous O2 content (CvO2)
    • Alveolar O2 content (CAO2)
    • Alveolar O2 tension (PAO2)
    • Intrapulmonary shunt (Qsp/Qt)
    • Arteriovenous oxygen content difference (C(a-v)O2)
    • Oxygen utilization or extraction ratio (VO2 / DO2)
    • Oxygen delivery (DO2)
    • Oxygen consumption (VO2)
  • Define and list the major categories of shock and recognize the hemodynamic patterns of each.
  • Select and administer appropriate resuscitation fluids for critically ill patients.
  • Appropriately define, recognize, and treat sepsis, septic shock, and systemic inflammatory response syndrome.
  • Interpret arterial blood gas measurements in terms of acid-base disorders, adequacy of oxygenation, and adequacy of ventilation.
  • List the differential diagnosis of oliguria and its appropriate management.
  • Identify laboratory tests that discriminate between intrinsic renal and pre-renal causes of oliguria and apply this information in the prevention of acute renal failure.
  • Demonstrate understanding of the importance of adequate nutrition in the critically ill and the various methods by which nutrition can be supported.
  • Discuss methods for prophylaxis against acute upper GI bleeding in acutely stressed patients.
  • Discuss non-pancreatic organ system dysfunction associated with acute pancreatitis.
  • Discuss the changes in biochemical markers associated with acute hepatobiliary dysfunction.
  • Identify and use screening tests available for the evaluation and treatment of coagulation disorders.
  • Identify and manage the presence of adrenal insufficiency of critical illness.
  • Demonstrate understanding of the unique physiology and complications of pregnancy.
  • Identify the differences between adult and pediatric resuscitation and critical care management.
  • Demonstrate proficiency in the assessment and treatment of thermal and electrical burns.
  • Discuss ethical considerations created by the use of modern technology and demonstrate ability to effectively and compassionately discuss end-of-life issues with patients and their family.
  • Demonstrate ability to develop educational programs and effectively teach the principles of critical care to other physicians and allied health personnel.
  • Demonstrate proficiency in research design, biostatistical analysis, and quality assurance programs that contribute to optimal patient care.