By its nature, critical care medicine encompasses many disciplines and pathophysiologic derangement of multiple organ systems. Fellows are expected to gain experience in the diagnosis and management of the following: cardiac diseases, endocrine disorders, environmental exposures, ethical issues, gastrointestinal diseases, hematologic disorders, infectious diseases, neurologic disorders, enteral and parenteral nutrition, pulmonary diseases, renal diseases, rheumatologic disorders, and substance abuse including drug withdrawal and overdose syndromes, geriatric critical care issues and delivering unwelcome news in the ICU. Trainees will also become competent in the diagnosis and management of common presentations of many critical illnesses. In addition, subspecialty trainees are expected to develop competence in procedures essential to the diagnosis and management of ICU patients including indications, contraindications, complications, performance, and interpretation of results. Fundamental procedural competence should include: advanced cardiac life support; arterial blood gas sampling and interpretation; bronchoscopy; chest tube thoracostomy; endotracheal intubation and airway management; oximetry monitoring; pulmonary artery catheterization; radiology including plain films, computed tomography, nuclear medicine, magnetic resonance, and interventional radiographic techniques; vascular (arterial and venous) access placement, and ventilator management.
Fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices in an environment that allows for innovative solutions without placing patients in harm’s way. The application of clinical knowledge and the development of skills to diagnose successfully and treat patients effectively require deliberate and meaningful practice in a controlled environment.
Effective clinical education which focuses on patient safety, the reduction of medical error, and enhanced healthcare quality have become major public policy issues and so the “see one, do one, teach one” practice of medicine is out of favor. Simulation is a proven and effective tool for training, performance evaluation and research. It also enhances complex communication skills and the ability to work in high-performing teams to enhance patient care and patient safety.
The Critical Care program has access to state-of-the-art simulation opportunities through the Center for Experiential Learning and Assessment (CELA), whose mission is to support the education mission of the Vanderbilt University School of Medicine. Critical Care Faculty members working with the Center are committed to developing standardized Critical Care Crisis Resource Management (CRM) scenarios to evaluate the fellow’s knowledge base, communication skills and practice. Simulation curricula can be specified and scheduled in advance when it makes the most sense in the continuum of training, rather than leaving it to the chance occurrence of learning during routine patient care.
CRMs will span many common critical care scenarios from ethics to sepsis and will include team-building exercises. The CRMs will be supervised by the critical care faculty and the fellow’s performance will be evaluated by the supervising faculty. After the debriefing, the scenario will be evaluated by the fellow and program improvements will be ongoing as the process matures.
Additional teaching occurs through the didactic series of lectures associated with the CRM scenario under evaluation. Finally, fellows are expected to augment the above curricula by independent reading. In addition to complementing the more organized components of the program, this commitment to self-study and acquisition of new knowledge is considered integral to achievement and maintenance of expertise in Critical Care Medicine.
A standardized electronic grading tool will be used to evaluate the fellows and for the fellows to evaluate the program.
Examples of Core Competencies in Simulation Training