ICU/Critical Care Medicine Service - Wishard Hospital
Two interns and two upper level residents are assigned to manage the critically ill patients at Wishard hospital. With an average daily census of 12-15 patients, this is an opportunity to learn ventilator management, perform central venous catheters, and build confidence in taking care of the sickest patients in the hospital. Call is every fourth night. Interns are supervised by a night float resident since the ICU residents take call on alternate days. The critical care faculty provide a specific set of didactic conferences for the ICU team during the month to round out this educational experience.
ICU/Critical Care Medicine Service - Methodist Hospital
This is a very busy critical care service, in which resident’s care for ICU and/or pulmonary floor inpatients under the supervision of internal medicine faculty trained in multidisciplinary critical care. Residents see patients in the Adult, Neuro, and Comprehensive Cardiovascular Critical Care Units, as well as other patient units throughout the hospital. This ICU experience is unique in that there is extensive exposure to patients with neurologic and surgical diagnoses as well as patients with primary medical problems. Commonly encountered problems include intracranial hemorrhage, increased intracranial pressure, multisystem trauma, multiorgan failure, sepsis, etc. There are many opportunities to manage ventilators and perform procedures including pulmonary artery catheterization. The usual census is 5-10 patients per resident. ICU lectures are given several times a week. ICU call occurs every 4-6 days with an in-house ICU attending.
ICU/Critical Care Medicine Service - VAMC
Four second year residents care for all medicine patients admitted to the intensive care unit. Three residents specifically admit and care for the medical ICU (MICU) patients while one resident is a priori assigned to the cardiac care unit (CCU). On call, the single resident admits to both services. In addition to patient-centered bedside teaching, there are pulmonary/critical care and cardiology didactic teaching sessions. A pulmonary/critical fellow is dedicated to this ICU and directs the ICU admissions, coordinates care with the housestaff, and is available to assist with procedures. Housestaff are encouraged to attend the weekly divisional teaching conferences with the pulmonary fellows. Call is every fourth night.
ICU/Critical Care Medicine Service - University Hospital
Four third year (senior) residents care for a daily census of 10 to 14 ICU patients. Common problems include respiratory failure due to COPD and ARDS, septic and cardiogenic shock, hypertensive crisis and renal failure, GI-liver emergencies, as well as care for complicated neurology, obstetrics, ENT, and general surgical patients. Residents have access to a senior critical care medicine fellow who is assigned to the ICU and available for assistance with procedures or difficult management issues. A pulmonary/critical care medicine fellow and staff provide bedside teaching and directly supervise patient care. Subspecialist attending physicians (pulmonology, cardiology, nephrology, gastroenterology, hepatology, and others) cover a core curriculum of ICU topics. The dedicated ICU nutritionists, respiratory therapists, nurses, and pharmacists also give informative didactic lectures. Patient care in this environment is optimized by a multidisciplinary team approach so that any questions regarding medical ethics, evidence-based medicine, medication dosages, etc. can occur efficiently. It is expected that residents will gain expertise in ventilator management, ICU monitoring, and be able to get "signed off" on the majority of required procedures. Fourth year students may elect to do this rotation as a subinternship. Call is every fifth night on average.
