Surgical Critical Care

Surgical Critical Care Fellowship Educational Experience

The mission of the Surgical Critical Care Fellowship Program is to provide an educational environment to develop the skills for state-of-the-art support of human physiology under the stress of extreme illness, injury or surgery; provide compassionate and humanistic care to those individuals with critical surgical illness; provide an environment for the development of a program optimized for clinical basic scientists who will become leaders in the arena of multidisciplinary critical care medicine.

The goals of the Surgical Critical Care Program are:

  • The fellow will become proficient in the recognition and comprehensive management of problems commonly encountered in the surgical critical care arena;
  • The fellow will satisfy the requirements and successfully obtain certification in Surgical Critical Care by the American Board of Surgery;
Competencies and Curriculum Expectations: This SCC Fellowship focuses on the six core ACGME competencies approved by the ACGME Board, February 13, 2007. 

ACGME Competencies

  1. Patient Care (PC): Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
  2. Medical Knowledge (MK): Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
  3. Practice-based Learning and Improvement (PBL): Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
  4. Interpersonal and Communication Skills (ICS): Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
  5. Professionalism (P): Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
  6. Systems-based Practice (SBP): Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Objectives

  • Objectives for this fellowship have been aligned to ACGME competencies, as listed above [For example: (PR)].  Through the tenure of this academic training experience, the fellow will:
  • Demonstrate effective communication with staff, patients, and families (ICS)
  • Demonstrate respect, compassion, and integrity (PR)
  • Demonstrate appropriate and thorough history and physical examination of the critically ill/injured patient (PC)
  • Demonstrate the ability to develop appropriate differential diagnosis and treatment plan for the critically ill/injured patient (MK)
  • Learn the basic resources available for the care of the critically ill/injured patient (SBP)
  • Learn the appropriate information needed for care of the critically ill/injured patient (PBL)
  • Develop a process improvement project, including an education and implementation plan.
  • Monitor compliance with the process and track outcomes. (PBL)


Medical Knowledge and Skills

Upon completion of this fellowship, the fellow should be able to demonstrate proficiency in critical careknowledge in the following areas:

  • Cardiopulmonary Resuscitation (CPR)
  • Physiology, pathophysiology, diagnosis, and therapy of disorders of the cardiovascular, respiratory, gastrointestinal, genitourinary, neurologic, endocrine, musculoskeletal, and immunologic systems, as well as of infectious diseases.
  • Metabolic, nutritional, and endocrine effects of critical illness
  • Hematologic and coagulation disorders
  • Critical obstetric and gynecologic disorders
  • Trauma; thermal, electrical, and radiation injuries; inhalation and immersion injuries
  • Monitoring and medical instrumentation
  • Critical pediatric surgical conditions
  • Pharmacokinetics and dynamics of drug metabolism and excretion in critical illness
  • Ethical and legal aspects of surgical critical care
  • Principles and techniques of administration and management
  • Biostatistics and experimental design 

Upon completion of this fellowship, the fellow should be able to demonstrate proficiency in critical careskills in the following areas (collect data on experience):

  • Respiratory airway management, including endoscopy, tracheostomy (both open and percutaneous), and ventilator management;
  • Endocrine: diagnose and manage acute endocrine disorders, including the pancreas, thyroid, adrenals, and pituitary;
  • Circulatory: invasive and noninvasive monitoring techniques, including transesophageal and transthoracic cardiac ultrasound, computation of cardiac output and of systemic and pulmonary vascular resistance, monitoring electrocardiograms, use of vasoactive agents and the treatment of the various forms of shock, and management of cardiac assist devices;
  • Neurological: use of intracranial pressure monitoring systems; interpretation of transcranial Doppler ultrasound; management of acute neurologic emergencies; electroencephalography
  • Renal: evaluation of renal function; appropriate use and complications of various forms of hemodialysis; management of electrolyte and acid-base disorders;
  • Gastrointestinal: utilization of gastrointestinal intubation and endoscopic techniques in the management of the critically ill patient; application of enteral feeds, management of stomas, fistulas, and percutaneous catheter devices;
  • Hematologic: application of autotransfusion, assessment of coagulation status with thromboelastography, appropriate use of component therapy;
  • Infectious disease: classification of infections and application of isolation techniques, pharmacokinetics, drug interactions, and management of antibiotic therapy during organ failure, nosocomial infections, indications for applications of hyperbaric oxygen therapy;
  • Nutritional: application of enteral and parenteral nutrition, monitoring and assessment of metabolism and nutrition; interpretation of indirect calorimetry
  • Monitoring/bioengineering: calibration of transducers and other medical devices
  • Miscellaneous: use of special beds for specific injuries, and employment of skeletal traction and fixation devices.

Clinical Learning Environment

The SCC fellow is expected to work towards the objectives for each of the ACGME competencies. However, because the teaching and learning that happen within the clinical setting are vital to continued medical training, the following objectives have been aligned to the ACGME’s Clinical Learning Environment (CLER) six focus areas. 

It is expected that a fellow (with the faculty mentor and Program Director) will be intentional in making sure these objectives are consistent throughout the academic experience. The CLER focus areas are:

Patient Safety: including opportunities for residents to report errors, unsafe conditions, and near misses, and to participate in inter-professional teams to promote and enhance safe care. 

Quality Improvement: including how sponsoring institutions engage residents in the use of data to improve systems of care, reduce health care disparities and improve patient outcomes. 

Supervision: including how sponsoring institutions maintain and oversee policies of supervision concordant with ACGME requirements in an environment at both the institutional and program level that assures the absence of retribution.

Professionalism: with regard to how sponsoring institutions educate for professionalism, monitor behavior on the part of residents and faculty and respond to issues concerning: (i) accurate reporting of program information; (ii) integrity in fulfilling educational and professional responsibilities; and (iii) veracity in scholarly pursuits.

Transitions In Care: including how sponsoring institutions demonstrate effective standardization and oversight of transitions of care. 

Duty Hours/Fatigue Management & Mitigation--including how sponsoring institutions: (i) demonstrate effective and meaningful oversight of duty hours across all residency programs institution-wide; (ii) design systems and provide settings that facilitate fatigue management and mitigation; and (iii) provide effective education of faculty members and residents in sleep, fatigue recognition, and fatigue mitigation. 

Professionalism

Clinical
  • Supervise/direct the patient care delivery for those patients within the ICU to which you are assigned for the month to the attending satisfaction.  (CLER Focus Area: Patient Care, Supervision)
  • Remain in compliance with ACGME duty hour guidelines and record them in the University of South Carolina “New Innovations” system on a daily to weekly basis.  (CLER Focus Areas: Duty Hours/FM, Professionalism)
  • Be present within the unit or available by phone within 5 minutes which you are assigned beginning at the time specified by the director of that service and remain in the unit to the degree required to enable your direction of the resuscitation and management of critically ill or injured patients.  (CLER Focus Areas: Patient Care, Professionalism)
  • Respond to pages and/or phone calls from the ICU within a 5 minute timeframe while on duty. (CLER Focus Area: Professionalism)
  • Participate in the daily ICU rounding process and, in collaboration with the faculty, direct ICU rounds.  (CLER Focus Areas: Patient Care, Professionalism)
  • Maintain a current and accurate case log via the American College of Surgeons case log system or similar database.  (CLER Focus Area: Professionalism)
  • Attain the skills and judgment to supervise invasive procedures according to institutional and service specific performance standards and guidelines. (CLER Focus Area: Supervision)
  • Perform duties in a healthy physical state, including appropriate rest prior to work (CLER Focus Area: Duty Hours/FM)

Educational  (CLER Focus Area: Professionalism)

Practice-based Learning and Improvement

Through the tenure of this academic training experience, the fellow will develop progressive skills and habits in order to meet the following goals:

  • Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement  (CLER Focus Area: Quality Improvement)
  • Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems  (CLER Focus Area: Quality Improvement)

Interpersonal and Communication Skills (CLER Focus Area: Professionalism)

Through the tenure of this academic training experience, the fellow will: 
  • Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals
  • Demonstrate effective skills in teaching the specialty of surgical critical care 

Professionalism  (CLER Focus Area: Professionalism)

Through the tenure of this academic training experience, the fellow will demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles

Systems-based Practice

Through the tenure of this academic training experience, the fellow will: 

  • Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.   (CLER Focus Area: Quality Improvement)
  • Administer a surgical critical care unit to include: appointment, education, and supervision of specialized personnel; establish policy and procedures for the unit; and coordinate unit activities with other administrative units in the hospital  (CLER Focus Area: Patient Care, Supervision, Professionalism)

The Lean Green Belt Course at Palmetto Health

The Lean Green Belt course will provide participants with the methodology, tools and understanding to continuously improve the processes in their work areas. Participants will learn the skills which will allow them to lead teams charged with redesigning processes to solve specific operational problems and create ‘value’. Value is defined by the Value Equation:

 
Value is improved by improving quality and/or decreasing cost.
Prisma Health–Midlands is one of the first healthcare systems to partner with the Institute of Industrial Engineers (IIE) to offer the Lean Green Belt for Healthcare certification. Candidates will be certified after completion of the course (5 days), exam (1-2 hours) and project (3-6 months).

We offer the course 4 times a year. The class is designed for Prisma Health–Midlands Leaders and process owners – generally 12-15 per session. The participant makeup in each class is diverse, various levels of leadership from a variety of clinical and operation departments to insure quality, in-class discussion.
 
Prisma Health–Midlands partners with IISE (Institute of Industrial and Systems Engineers) as a Qualified Training provider (www.iise.org). The course is accredited through them on behalf on IACET (https://www.iacet.org/).
The Institute of Industrial & Systems Engineers has been accredited as an Authorized Provider by the International Association for Continuing Education and Training (IACET). In obtaining this accreditation, IISE has demonstrated that it complies with the ANSI/IACET standard, which is recognized internationally as a standard of good practice. As a result of their Authorized Provider status, IISE is authorized to offer IACET CEUs for its programs that qualify under the ANSI/IACET standard. As an IACET Authorized Provider, IISE offers CEUs for its programs that qualify under the ANSI/IACET standard.