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Critical Care Rotation
The critical care rotation is designed to provide fellows with a well rounded education in the management of critically ill patients. While focused on medical patients, trainees completing the program will have sufficient experience to competently provide critical care for surgical and trauma patients as well. A modern intensive care unit does not exist in isolation, but functions as an integral part of the hospital setting, coexisting and coordinating with other services, including medical, ancillary, quality management, and administrative. Fellows will be trained in the necessary skill sufficient to permit competent administration of an intensive care unit.
Clinical training in critical care medicine takes place at all three teaching hospitals, Jackson Memorial Hospital, Veterans Affairs Medical Center and the University Of Miami Hospital and Clinics. Fellows will spend a minimum of nine months and not more than fifteen months in a critical care unit. The program incorporates three months of training in a non-medical intensive care unit, i.e. Surgical Intensive Care Unit, Trauma Intensive Care Unit, Neurosurgical Intensive Care Unit, or Chest Surgical (Transplant) Intensive Care Unit. Fellows will gain an understanding of the pathophysiology of a broad range of critical illnesses including respiratory failure of various causes, sepsis and septic shock, hemorrhage and hemorrhagic shock, renal failure, hepatic failure, status epileptics, acute stroke, acute cardiac events including myocardial infarction and cardiogenic shock and many other conditions. Fellows will learn and master therapeutic techniques including invasive and noninvasive ventilatory support, resuscitation, invasive monitoring and bedside diagnostic techniques, intubation, pacemaker insertion, tube thoracostomy, use of vasoactive agents conscious sedation and therapeutic sedation, and nutrition support in the critically ill. These rotations are also designed to instruct the fellows in aspects of intensive care unit administration. Fellows will be intimately involved in evaluating patients for appropriateness of intensive care. They will become familiar with anticipated staff loads based on patient acuity, thus learning how to utilize an intermediate care setting. Fellows will participate in quality management activities of the intensive care unit under the direct supervision of the attending. They will become familiar with the intricacies of explaining critical illness to families of patient, with associated issues such as advance directives. Autopsy and Morbidity/mortality conferences will be attended when relevant.