Vanderbilt University Medical Center Division of Trauma and Surgical Critical Care

Transcription

1 Vanderbilt University Medical Center Division of Trauma and Surgical Critical Care Educational Goals and Methods MEDICAL STUDENTS Students interact with the division during their surgical intensive care unit (SICU), trauma intensive care unit (TICU), and emergency general surgery (EGS) rotations of their third and fourth years. The division provides didactic, clinical, and technical training during the rotations as follows: 1. Resident Intensive Care Unit (RICU) course provided online by The Society of Critical Care Medicine gives the framework for regular didactics given three times a week by the division attendings during their SICU/TICU rotation. The online course has PowerPoint lectures with most ICU topics including a pre test and post test. a. Tuesday, Wednesday, Thursday, 11AM 12PM, 9 th floor CCT Conference Room b. Student self registration link for the Vanderbilt University Surgical Critical Care program i. c. Downloaded PDF storage: F:\TPCC\SICU TICU Lecture PDFs d. Administrator: Addison May, MD and Barbara Gray e. Created by: Cynthia Talley, MD 2. Hands On ICU patient care & procedures are performed under supervision. INTERNS Together with the Department of Surgery, the division of trauma and surgical critical care arranges for a graded program of education and skills sessions. 1. Boot Camp : All interns in the department of surgery, anesthesia, and internal medicine are exposed to a few days of Boot Camp by the Department of Surgery during orientation. These sessions are currently arranged by the general surgery / research resident. The division teaches the vascular access portion of this Boot Camp.

2 a. Vascular Access: b. Informed Consent: i. Storage Location: F:\TPCC\Education\CVL ii. Created by: Kirby Gross, MD i. Storage Location: F:\TPCC\Education\Informed Consent ii. Created by: Cynthia Talley, MD and Arna Banerjee, MD 2. Intern Skills Stations : The surgery and anesthesia interns participate in a year long program of skills teaching given once weekly with new topics monthly. These skills are taught in the Simulation Lab (CELA) and are currently arranged by a general surgery / research resident. The division provides the coordination and education delivery for several of these sessions: a. Trauma Simulation Stations: Several mock trauma videos were created by the division to demonstrate the proper order and procedure of trauma resuscitations. i. Storage Location: F:\TPCC\Education\Trauma Simulation ii. Created by: Rick Miller, MD, Kirby Gross, MD, and Kyla Terhune, MD b. Bronchoscopy: This session includes a PowerPoint presentation created by the division of proper procedure, anatomy, and common pitfalls. The interns are then provided opportunity for hands on practice in the simulation lab. i. Requires: One critical care fellow and research resident ii. Storage location: F:\TPCC\Education\Bronch iii. Created by: Cynthia Talley, MD c. Thoracostomy Tubes: A PowerPoint presentation created by the division of proper procedure, anatomy, and common pitfalls is shown and discussed. The interns then are given practice opportunities on a realistic porcine model. i. Requires: Two critical care fellows and research resident ii. Storage location: F:\TPCC\Education\Chest Tube iii. Created by: Kirby Gross, MD d. Trauma Resuscitation Procedures: Four stations were prepared for the interns including intraosseous access with a drill, ultrasound, splinting, hemorrhage control and the pelvic

3 binder. Hands on practice was provided in all the stations. This session was two hours in duration and arranged currently by the general surgery / research resident. i. Requires: Four critical care fellows ii. Created by: Kirby Gross, MD All surgical interns rotate in the burn intensive care unit (BICU) and EGS. The designated and nondesignated preliminary interns rotate in the SICU. No interns rotate in the TICU. SICU TICU BICU EGS Rotating R1 Surgery No R1 Surgery R1 Surgery (All) R1 Surgery (All) Residents R1 Anesthesia +/ R1 OB/GYN R1 Emergency Medicine Burn Intensive Care Unit: 1. Audio files (Podcasts) of intensive care unit topics are reviewed by the interns. a Hands On procedure training: central venous lines, arterial lines, bronchoscopy, intubations, etc. 3. Patient Care training: interns take in house call approximately every third night with a backup resident / fellow by phone providing them significant autonomy with appropriate supervised direction. Surgical Intensive Care Unit: 1. Online Web Training: An is generated to interns prior to the start of their rotation providing instructions for mandatory training below: a. SICU Orientation and Pearls b. SICU Protocols and Policy Quiz c. Competency Module for Bronchoscopy PowerPoint d. Placing a Central Line e. SOP for Bedside Procedures

4 f Resident Intensive Care Unit (RICU) course provided online by The Society of Critical Care Medicine gives the framework for regular didactics given three times a week by the division attendings during their SICU/TICU rotation. The online course has PowerPoint presentations with most ICU topics including a pre test and post test. a. Tuesday, Wednesday, Thursday, 11AM 12PM, 9 th floor CCT Conference Room b. Student self registration link for the Vanderbilt University Surgical Critical Care program i. c. Downloaded PDF storage: F:\TPCC\SICU TICU Lecture PDFs d. Administrator: Addison May, MD and Barbara Gray e. Created by: Cynthia Talley, MD 3. Hands On ICU procedure training: central venous lines, arterial lines, bronchoscopy, intubations, thoracentesis, etc. 4. Patient Care training: interns take in house call approximately every third night with an in house second year resident and fellow. Emergency General Surgery: 1. Acute Care Surgery Conference weekly. This conference discusses operative options and pitfalls for trauma and emergency general surgery patients. The conference is delivered by senior residents, fellows, and attendings. a. Tuesdays, 12pm 1pm, MAB 404 b. Administrator: Matt Eckert, MD and Missi Rowe c. Storage Location: F:\TPCC\Acute Care Surgery Conference RESIDENTS Together with the Department of Surgery, the division of trauma and surgical critical care arranges for a graded program of education and skills sessions.

5 1. Summer School : All second year surgical residents participate in intensive skills training for three months from June of the first year until August of the second year. This training is organized by the general surgery / research resident. The division organizes and delivers three of the sections. Each session is two hours in duration. a. Percutaneous tracheostomy: This session includes a PowerPoint presentation created by the division of proper procedure, anatomy, and common pitfalls. The residents are then provided opportunity for hands on practice through simulation. i. Storage Location: F:\TPCC\Education\Perc Trach ii. Created by: Addison May, MD b. Thoracostomy Tubes: A PowerPoint presentation created by the division of proper procedure, anatomy, and common pitfalls is shown and discussed. The residents then are given practice opportunities on a realistic porcine model. i. Storage location: F:\TPCC\Education\Chest Tube iii. Created by: Kirby Gross, MD c. Ultrasound: A didactic PowerPoint presentation created by the division addressing the ultrasound physics, procedure, anatomy, and common pitfalls with the FAST, central venous access, and thoracic models is shown. The residents are then given practice opportunities with simulation models. i. Storage Location: F:\TPCC\Education\Ultrasound ii. Created by: Oliver Gunter, MD and Kirby Gross, MD 2. Advanced Trauma Life Support: The division provides the organization, delivery of educational modules, and certification of all second year residents. All second year surgical and anesthesia residents rotate in the SICU. All second year surgical and emergency medicine residents rotate in the TICU. All second year residents rotate on BICU and EGS. All fourth year residents rotate in the TICU and EGS. All chief residents rotate on EGS. SICU TICU BICU EGS Rotating R2 Surgery R2 Surgery x 2 R2 Emergency R2 Surgery R2 Surgery

6 Residents R2 Anesthesia Medicine R4 Surgery x 2 R4 Surgery R5 Surgery Burn Intensive Care Unit: Surgical Intensive Care Unit: 1. Audio files (Podcasts) of intensive care unit topics are reviewed by the residents. a Hands On procedure training: central venous lines, arterial lines, bronchoscopy, intubations, etc. 3. Hands On operative training: burn débridements, skin grafting 4. Patient Care training: residents take in house call approximately one night a week with home call backup for the interns on most of the other evenings. 1. Online Web Training: An is generated to residents prior to the start of their rotation providing instructions for mandatory training below: a. SICU Orientation and Pearls b. SICU Protocols and Policy Quiz c. Competency Module for Bronchoscopy PowerPoint d. Placing a Central Line e. SOP for Bedside Procedures f Resident Intensive Care Unit (RICU) course provided online by The Society of Critical Care Medicine gives the framework for regular didactics given three times a week by the division attendings during their SICU/TICU rotation. The online course has PowerPoint presentations with most ICU topics including a pre test and post test. a. Tuesday, Wednesday, Thursday, 11AM 12PM, 9 th floor CCT Conference Room

7 Trauma Intensive Care Unit: b. Student self registration link for the Vanderbilt University Surgical Critical Care program i. c. Downloaded PDF storage: F:\TPCC\SICU TICU Lecture PDFs d. Administrator: Addison May, MD and Barbara Gray e. Created by: Cynthia Talley, MD 3. Hands On ICU procedure training: central venous lines, arterial lines, bronchoscopy, intubations, thoracentesis, pulmonary artery catheters, etc. 4. Patient Care training: residents take in house shift call during the day or evening alternating each week. Immediate supervision is provided by the in house SICU fellow. 1. Resident Intensive Care Unit (RICU) course provided online by The Society of Critical Care Medicine gives the framework for regular didactics given three times a week by the division attendings during their SICU/TICU rotation. The online course has PowerPoint presentations with most ICU topics including a pre test and post test. a. Tuesday, Wednesday, Thursday, 11AM 12PM, 9 th floor CCT Conference Room b. Student self registration link for the Vanderbilt University Surgical Critical Care program i. c. Downloaded PDF storage: F:\TPCC\SICU TICU Lecture PDFs d. Administrator: Addison May, MD and Barbara Gray e. Created by: Cynthia Talley, MD 2. Hands On ICU/Trauma Bay Training: a. R2 Intubation, Percutaneous Tracheostomy, Thoracostomy Tube, Central Venous Lines, Arterial Lines, Pulmonary Artery Catheters, Thoracentesis/Paracentesis. b. R4 Trauma Laparotomy/Thoracotomy, Decompressive Laparotomy, Extremity Fasciotomy, Neck Exploration

8 Emergency General Surgery: 3. Patient Care training: residents take in house shift call during the day or evening alternating each week. Immediate supervision is provided by the in house TICU fellow and attending. 1. Acute Care Surgery Conference weekly. This conference discusses operative options and pitfalls for trauma and emergency general surgery patients. The conference is delivered by senior residents, fellows, and attendings. a. Tuesdays, 12pm 1pm, MAB 404 b. Administrator: Chadi Abouassaly, MD and Missi Rowe c. Storage Location: F:\TPCC\Acute Care Surgery Conference Hands On operative training: All levels of residents are exposed to a full breadth of both emergency and elective general surgery cases. 3. Patient Care training: senior residents take home call during the evenings and the junior residents alternate in house night shifts during the week. Immediate supervision is provided by the in house EGS attending. FELLOWS The educational program for surgical critical care fellows involves structured didactics delivered in a weekly format, administrative responsibilities, monthly rotation of clinical duties, research assistance, and many course certifications. Fellows manual: pdf Didactics 1. Trauma / Resuscitation Conference: This is a multidisciplinary conference that offers CME credit to faculty. Every Monday the Departments of Trauma, Emergency Medicine, Pharmacy, LifeFlight, and Nashville Fire Department review cases of trauma patients during the previous week for both quality control and education of residents / faculty. a. Mondays, 11am 12pm, Oxford House Room702 b. Administrator: Kevin High and Valerie McSterling c. Website:

9 Administration 2. Acute Care Surgery Conference: This conference offers CME credit to faculty and focuses on operative options and pitfalls for trauma and emergency general surgery patients. The conference is delivered by senior residents, fellows, and attendings. Attendance includes the residents of the EGS and TICU services. a. Tuesdays, 12pm 1pm, MAB 404 b. Administrator: Matt Eckert, MD and Missi Rowe c. Storage Location: F:\TPCC\Acute Care Surgery Conference Department of Surgery Morbidity and Mortality Conference: This conference addresses all of the morbidities and mortalities of each clinical service. The chief residents of each service present the cases to the department faculty and residents with educational discussion and points for quality improvement. The SICU fellow presents their cases once during the month. a. Wednesdays, 6:30am 7:30am, Light Hall, 5 th floor b. Administrator: Kenneth Sharp, MD and Allison Watts 4. Fellows Conference: This conference offers CME credit to faculty and focuses on educational pieces to improve ICU patient care but also to prepare for the critical care boards. Each fellow presents a one hour topic 2 3 times during the year with many presenters from both inside and outside the division. a. Thursdays, 12pm 1pm, MAB 404 b. Administrator: Matt Eckert, MD c. Storage Location: F:\TPCC\FELLOWSHARED\Fellow's conference schedule 5. Department of Surgery Grand Rounds: This conference also offers CME credit to faculty and provides one hour of didactics with updates regarding new research findings. There are frequently visiting professors discussing their specialty and innovative research. a. Fridays, 7am 8am, Light Hall, 2 nd floor b. Administrator: Jeff Dattilo, MD and Allison Watts 1. SICU Process Improvement Meeting: This meeting is held once monthly with collaboration from SICU attendings, nurses, staff, and fellows. The fellows are frequently involved in improvement projects. a. Fourth Tuesday of the month, 3pm 4pm, 9 th floor CCT Conference Room

10 Research b. Administrator: Bryan Collier, DO and Barbara Gray 2. SICU Morbidity and Mortality Conference: This meeting is held once monthly prior to the departmental morbidity and mortality conference listed above. The SICU attendings and fellows review the month s cases and determine whether any of the cases need further review and referral to the process improvement meeting. The SICU fellow of the month leads this conference with a presentation of the cases with an educational point for quality improvement. a. Third Tuesday of the month, 3pm 4pm, 9 th floor CCT Conference Room b. Administrator: Bryan Collier, DO and Barbara Gray 3. Multidisciplinary Surgical Critical Care Meeting: This meeting is held once monthly to address the administrative needs of the SICU with attendance by the nursing administration and physicians. This meeting gives the fellows an opportunity to witness the hurdles with directing an ICU. a. Second Tuesday of the month, 6am 7am, 9 th floor CCT Conference Room b. Administrator: Addison May, MD and Barbara Gray 4. Division of Trauma and Surgical Critical Care Faculty Meeting: This meeting gives the fellows an inside observation of the challenges with directing a practice. a. First and Third Wednesday of the month, 3pm 4pm, MAB 404 b. Administrator: John Morris, MD and Dee Mewbourne 5. Individual Fellow Administrative Duties: To encourage awareness of the duties of an academic appointment, the fellows are each given administrative responsibilities for the year. a. Fitzgerald Casimir: Coordinates the Trauma Emergency Resuscitation Conference b. Mayur Patel: Coordinates the SICU resident call schedule and resident evaluations c. Hart Tyson: Coordinates the Fellows Conference d. Cynthia Talley: Coordinates the fellows vacation and leave schedule Division of Trauma and Surgical Critical Care Research Meeting: These meetings are held at least once a week with direction from the division chair, Dr. John Morris. o Saturdays, 8am, MAB 404

11 Courses ATLS Instructorship: Each fellow becomes an ATLS instructor by taking a short course with supervision of education during the next student course. The ATLS Instructor Course Directors are Drs. Richard Miller and Oscar Guillamondegui ATLS Student Course Directorship: Each fellow is given the opportunity to become a course director for the student course. The fellow is supervised during their coordination of an ATLS student course by Dr. Richard Miller. The ATLS Student Course Directors are Drs. Richard Miller, Oscar Guillamondegui, and Cynthia Talley. ATLS Instructor Course Directorship: Each fellow is given the opportunity to become a course director for the instructor course. The fellow is supervised during the coordination of an ATLS instructor course by the regional ATLS representative, Dr. Julie Dunn. Advanced Trauma Operative Management (ATOM) Course: Each fellow attends the ATOM course given at least once a year, usually in the spring. Fundamentals of Critical Care Support (FCCS) Course: While most fellows have received training in this course prior to their fellowship, it is offered for certification through the department of anesthesia critical care. FCCS Instructorship: The department of anesthesia critical care also offers training as an FCCS instructor by supervision of delivery of FCCS lectures during a student course. Ultrasound for Critical Care. This has been coordinated both within our division as well as with emergency medicine. The last one was with Dr. Jim Fiechtl from the emergency medicine department. This involved FAST, central venous access, peripheral venous access, transthoracic echocardiogram (TTE). Transesophageal Echocardiogram (TEE) : This course is upcoming and in development by Dr. Oliver Gunter. Inferior Vena Cava (IVC) Filter Course: This course is offered to all fellows and developed by Dr. Oliver Gunter. The course guest lecturer was Dr. Ron Sing from Carolinas Medical Center including both a didactic introduction as well as hands on training with a training model, fluoroscopy and donated equipment.