Rotation Objectives for Residents
Residents rotating through the ICU come from a broad range of base training programs and previous ICU experience. Please refer to the rotation-specific objectives for your program for the individualized core competencies.
Our hospital has several programs of excellence, including high-risk obstetrics, complex oncological surgery, and high-risk hematology/oncology. We are also responsible for providing Critical Care Response Team services to Princess Margaret Hospital.
Our ICU has a mix of medical and surgical patients. We are particularly interested in providing critical care services to high-risk, obstetrical and immunocompromised patients. In support of the surgical department, we also provide post-operative care to HIPEC patients in conjunction with General Surgery and complex sarcoma patients in conjunction with Orthopedic Surgery.
GENERAL LEARNING OBJECTIVES
Medical Knowledge and Management
Understand and discuss the differential diagnosis and initial approach to management for common ICU problems:
- Shock, sepsis, and circulatory collapse
- Respiratory failure/ARDS
- Altered LOC
- Multi-organ failure
Develop an approach to various technical skills, depending on your base training program:
- Central lines, arterial lines, EZ-IO
- Airway management
- Chest tubes, bronchoscopy
You will have the opportunity to gain experience as the Code Blue Team Leader with support from an ICU attending and/or fellow.
RESPONSIBILITIES AND SUPERVISION
During the day:
You are expected to take on the primary responsibility for the patients you are following (with support from the fellow and attending), including the following:
- Examining the patient and reviewing overnight events before interdisciplinary rounds
- Following up on outstanding investigations and consults
- Updating the patient and their family
- Attending family meetings
- Performing procedures (when appropriate)
As residents, you will be doing 24 hours of in-house call coverage for the duration of your ICU rotation. Overnight you will be responsible for taking the first call from nursing staff for any issues that arise for patients who are admitted to the ICU. You will also be paged directly for new consults from the ED. It is important to let the fellow on-call with you know when you are going to see a new consult.
You are not expected to be able to manage all of these issues on your own. Especially if it is one of your first rotations in the ICU, have a very low threshold to call the fellow or attending if there is anything you are concerned about or uncertain how to manage. You are never alone, and people expect to be called.
Contact the fellow or attending early in the following situations:
- A patient is deteriorating or is sicker than anticipated
- There are major changes to treatment recommendations from a consulting service
- A patient needs a new imaging test or procedure
- There are concerns re: family communication or goals of care
- There are issues with disposition