MEDICAL KNOWLEDGE

Fellows must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

The fellow should demonstrate increasing, graduated expertise and competence in the following areas:

A. Knowledge about established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences and their application to patient care through knowledge of disease pathophysiology, diagnosis and therapy. The Fellow must learn to be self-motivated to acquire and share new knowledge.

B. An analytical and evidence-based approach to diagnosis, therapy, etiology, and prognosis. The Fellow must be in the habit of exploring underlying mechanisms in clinical situations and consistently and effectively applying basic science and clinical principles relevant to internal medicine to the care of patients.

C. Understanding the pathophysiology, clinical manifestations, natural history and principles of management of the following frequently encountered disorders in the critical care unit:

a. Disorders of the circulation, including hypotension, hemorrhage and hypovolemia, acute heart failure, hypertensive emergencies, and cardiac arrest

b. Myocardial injury, including early management of acute coronary syndrome and tachyarrhythmias

c. Acute and chronic respiratory failure, including hypoxia, hypercapnia, and acute respiratory distress syndrome

d. Infections and inflammatory disorders, including sepsis from the lungs, abdomen, pelvis, skin, or elsewhere, and the appropriate use of anti-microbials, including antibiotics, anti-fungal and anti-viral agents

e. Prevention and treatment of nosocomial infection, including ventilator-associated pneumonia and catheter-related sepsis

f. Acid-base disorders

g. Fluid and electrolyte disorders, including hypertonic and hypotonic syndromes; potassium, magnesium, calcium and phosphorus abnormalities

h. Evaluation and management of acute renal failure; assessment and management of oliguria.

i. Hematologic and coagulation disorders, such as thrombocytopenia and DIC

j. Blood component therapy, including the approach to the massively transfused patient

k. Acute neurological disorders, including coma, delirium, spinal cord injury, CNS hemorrhage, status epilepticus, and stroke, as well as the determination of brain death

l. Assessment and management of the patient with major trauma

m. Post-operative management after major surgery

n. Assessment and management of the patient with major GI bleeding

o. Assessment and management of the patient with critical illness during pregnancy or the patient with an obstetrical emergencies

p. Analgesia, sedation, and use of muscle relaxants in the ICU

q. Acute management of toxins and their corresponding treatment

r. Understand the principles of hemodynamic monitoring and treatment including:

• Calibration of hemodynamic monitoring system
• Invasive blood pressure monitoring
• Pulmonary artery catheter
• Central venous, pulmonary artery, and “wedge” pressu
• Measurement of cardiac output
• Vasoactive drugs
• Central and mixed venous oxygen saturation

s. Understand the principles and management of mechanical ventilation:

• General principles of mechanical ventilation
• Patterns of assisted ventilation
• Respiratory mechanics and ventilator waveforms
• The ventilator-dependent patient
• Discontinuing mechanical ventilation
• Complications of mechanical ventilation

t. Understand the principles of nutritional support, including both enteral and parenteral nutrition

u. Understand the principles and management of standard critical care practices in patient care, including:

• Vascular access
• The indwelling vascular catheter
• Gastrointestinal prophylaxis
• Analgesia and sedation

v. Understand and apply the principles of end-of-life care common to the critical care unit including:

• Assessment of the comatose patient
• Advanced directives
• Withdrawal of support
• Effective communication with family members