The document provides an orientation for medical students on their critical care rotation in the intensive care unit (ICU). It outlines the daily schedule and responsibilities, including morning and afternoon rounds, teaching sessions, procedures students will be expected to learn and perform, evaluations, journal club, grand rounds, and tips for survival. The rotation will be demanding but rewarding, with students gaining experience managing life and death situations and being exposed to a variety of procedures and educational activities under supervision. Support is available from attending physicians and the critical care program for any concerns.

1. Orientation to the ICU Critical Care Lecture Series

2. Welcome ICU is one of the most demanding rotations you will do Also is very rewarding educationally Expect to be tired You will deal with life and death everyday You will be on the steep side of the learning curve You will survive…..

3. The nuts and bolts Morning rounds Teaching sessions Afternoon rounds Call Procedures Evaluations Journal club Grand rounds www.dalccm.com

4. Morning Rounds Start at 9 a.m. You will subdivide patients, review them and have a plan ready by that time. If you are post call you will inform your colleagues of major changes in patient status and new admissions You will present your assessment and plan to the team Xrays will be reviewed at completion of rounds A “to do” list will be generated and delegated at completion of rounds

5. Morning Rounds If you have academic half day do not round on patient We cannot just read your note If you review a patient you must be present to present them . You may be asked to not simply read your note, but to present your patient without notes. Report should start with a general overview on the patient’s diagnosis and status. Assessments and therapeutic plans should be system by system, head to toe. A summary statement should conclude your presentation.

6. Teaching Sessions If the unit isn’t crazy goal is to teach at least 1 hour/day. Usually will occur sometime between 11 and 1. It is strongly encouraged that you attend the teaching session if you are post call. The teaching schedule is circulated prior to your rotation. It is expected that you have done some reading to prepare for the session. If a session cannot be done, it will be rescheduled.

7. Teaching Sessions Simulator sessions every Tuesday afternoon. You will have the opportunity to learn crisis management skills You will have the opportunity to deal with uncommon, life threatening conditions

8. Discharges Prior to leaving the ICU a patient must have: Transfer orders Written, signed and dated the day of discharge ICU summary note Dictated note (priority dictation)

9. Afternoon Rounds At 4 pm the night shift attending will do rounds with the team and the day time attending You will present the major issues that need ongoing management over the night and indicate possible pit falls The team then leaves except for the on call resident

10. Call You will manage the unit independently (except for PGY1) Do not hesitate to call your staff You will see consults on the floor and the emerg but….. Your responsibility is to the patients in the unit. You are not responsible for prolonged resuscitations on the floor or the emergency department. You are not the code team at the HI but you are at the VG

11. Procedures You will be exposed to: Central line insertion Arterial line insertion Intubation Chest tube insertion LP Thoracentesis Paracentesis Tracheostomy US guidance Feeding tube insertion

12. Procedures You must learn during your rotation: Central line insertion Arterial line insertion Emergency airway management Residents who have proficiency in these skills may teach other residents If you are not expert in a skill ask for assistance from your staff. Remember do no harm . All procedures are to be recorded in your log book. Indicate failed attempts and complications The log book is a formative record of your experience Failed attempts/complications will not be held against you.

13. Evaluations Every Friday afternoon you receive formal feedback on the week’s performance. This evaluation is forwarded to the education office which creates a final evaluation for your rotation based on each of the evaluations. The night time staff also submit evaluations

14. Evaluations At the completion of the rotation you will have the opportunity to provide feedback to the staff and evaluate the rotation in general.

15. Journal Club Held on a monthly basis Discuss articles chosen by the attending staff You may be chosen (lucky you!) to present an article and evaluate it’s quality based on the JAMA guidelines Attendance is mandatory

16. Grand Rounds First Tuesday of every month 378 Bethune building 12 pm Attendance is mandatory Often comes with food….mmmm foooood!

17. www.dalccm.com Website for the critical care program at Dalhousie Excellent resource of talks and seminars You get access by paying the price of performing a formative MCQ test.

18. Tips for Survival Ask for guidance/tips from the old guard already here Listen to the nurses Call your attending Devil is in the details Think before you speak Assume everyone else is an idiot: Do not take information at face value Make sure that errors are not propogated

19. Summary This will be a rotation you will never forget. Hard work pays off in developing skills you need to save lives. It will be scary but you have lots of backup. Any concerns call Karen Berry on 3608