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Site Specific Goals & Objectives

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Medicine Residency Program

Goals and Objectives of Training

 

The educational objectives for the University of Toronto Critical Care Medicine training program are based on the CanMEDS 2005 Physician Competency Framework for subspecialty training. The objectives of the program are met during the course of training through the academic half-day lecture series, simulation sessions, journal club, ethics sessions, and clinical rotations. By the end of the training period, the resident will acquire the core competencies required to function as an independent critical care consultant.

Medical Expert


1.1. General Requirements
The adult critical care medicine resident must demonstrate:

  • diagnostic and therapeutic skills for ethical and effective care of the critically ill patient;
  • the ability to access and apply relevant information to the practice of critical care;
  • effective consultation services with respect to patient care, education and legal issues.

1.2 Specific Requirements
The adult critical care medicine resident will:

  • demonstrate detailed knowledge of the generalist and specialist aspects of critical illness;
  • demonstrate competencies in the safe application of equipment, careful monitoring, judicious use of drugs, and the coordinated provision of multidisciplinary care for effective organ system support;
  • demonstrate ability to recognize, resuscitate, and stabilize patients sustaining, or at risk of, cardiopulmonary arrest or other life-threatening disturbances;
  • demonstrate working knowledge of applied clinical physiology and homeostasis and the ability to recognize, prevent, and treat single or multiple organ failure;
  • demonstrate basic understanding of physiology, pathophysiology, and pharmacology as they pertain to the critically ill patient;
  • demonstrate both basic and applied knowledge of the following:

Respiratory Dysfunction
Cardiovascular Dysfunction
Neurological Dysfunction
Neuromuscular Dysfunction
Renal Dysfunction
Gastrointestinal Dysfunction
Hepatic Dysfunction
Hematological/OncologicDisorders
Metabolic-Endocrine Disorders
Trauma
Septic Illness
Intoxication
Burns and/or Electrical Injury
Nutritional Support
Pharmacotherapy
Transportation
Transplantation
End of LifeIssues
Critical Illness in Pregnancy

Technical Skills
Demonstrate proficiency in the following technical skills:
A core skill requires mastery of the technique.
An advanced skill requires an appreciation and understanding of the technique, not the actual performance.

Airway
Breathing
Circulation
CentralNervousSystemCNS
Renal
Gastrointestinal
Nutrition
Transport
Miscellaneous

Communicator
2.1. General Requirements
The adult critical care medicine resident must be able to:

  • establish relationships with patients/families;
  • listen effectively;
  • obtain and synthesize relevant history from patients/families/communities; and
  • discuss appropriate information with patients/families and the health care team

2.2. Specific Requirements

  • Assess, communicate with, and support patients and families confronted with critical illness.
  • Explain life-sustaining therapies, in clear language, and describe the expected outcome of such therapies in view of the patient's goals and wishes.
  • Know and understand the consequences of the language used to impart information.
  • Be acquainted with the unique, stressful milieu of the critical care for patients and their families.
  • Demonstrate respect and understanding for the role of other team members in communicating and facilitating decision-making with critically ill patients and their families.
  • Communicate effectively with families who may be dysfunctional, angry, confused, or litigious.
  • Explain the concept of brain death and organ donation, in clear language.

Collaborator
3.1. General Requirements
The adult critical care medicine resident must be able to:

  • consult effectively with other physicians and health care professionals; and
  • contribute effectively to interdisciplinary team activities.

3.2. Specific Requirements

  • Contribute to productive communication and cooperation among colleagues in all aspects of education, service, and research, as they impact on the critical care environment, recognizing the multi-disciplinary nature of the specialty.
  • Demonstrate knowledge and skill in preventing and resolving conflict.
  • Demonstrate leadership in the continuing education of members of the multi-disciplinary health care team.

Manager
4.1. General Requirements
The adult critical care medicine resident should be able to:

  • allocate finite health care resources wisely;
  • work effectively and efficiently in a health care organization;
  • utilize information technology to optimize patient care, life-long learning, and other activities; and
  • utilize personal resources effectively to balance patient care, learning needs, and outside activities.

4.2. Specific Requirements

  • Be familiar with the administrative organization required to operate an Intensive Care Unit within an acute urban or rural hospital.
  • Be knowledgeable regarding unit staffing requirements, skills, education, and organization.
  • Be able to evaluate and cooperatively determine unit equipment requirements.
  • Be able to manage the clinical, academic, and administrative affairs of an Intensive Care Unit.
  • Demonstrate the ability to acquire, interpret, synthesize, record, and communicate (written and verbal) clinical information in managing health problems in the critical care setting.

Health Advocate
5.1. General Requirements
The adult critical care medicine resident should be able to:

  • identify the important determinants of health affecting patients; and
  • contribute effectively to the improved health of patients and communities.

5.2. Specific Requirements

  • Understand, in general, the diverse determinants of health, disease, and illness, and relate occupational and environmental exposures, socio-economic factors, and life style factors to critical illness.
  • Understand, in general, the health care system and more specifically the structure, function, and financing of critical care units.
  • Understand the importance of medico-legal considerations for the critically ill.
  • Be able to communicate to the general population critical care issues and their impact on the maintenance and improvement of health care.

Scholar
6.1. General Requirements
The adult critical care medicine resident should be able to:

  • facilitate the learning of patients/families, house staff/students and other health professionals;
  • contribute to the development of new knowledge; and
  • develop, implement, and monitor a personal continuing education strategy.

6.2. Specific Requirements

  • Demonstrate the expertise necessary for rational use of the principles of "evidence based medicine" in both clinical and research settings.
  • Demonstrate the expertise to competently appraise:
    • levels of evidence;
    • interventions;
    • diagnostic tests;
    • prognosis; and
    • integrative literature (meta-analyses, practice guidelines, decision and economic analyses).
    • Demonstrate a basic understanding of biostatistics, study design, protocol writing, and manuscript preparation.
    • Demonstrate the ability to efficiently access information from the medical literature using current information retrieval tools.
    • Practice the principles of adult learning and help others learn by providing guidance constructive feedback.
    • Be familiar with the concepts of basic applied research and epidemiology in order to capably evaluate newer forms of therapy.

Professional
7.1. General Requirements
The adult critical care medicine resident should be able to:

  • deliver the highest quality care with integrity, honesty, and compassion;
  • exhibit appropriate personal and interpersonal professional behaviours; and
  • practice medicine ethically consistent with the obligations of a physician.

7.2. Specific Requirements

  • Be aware of, and understand, moral and ethical issues as they impact on patients, their families, and critical care providers.
  • Understand the role and responsibilities of the critical care physician at the local, regional, and national levels.
  • Develop and demonstrate use of a framework for recognizing and dealing with ethical issues in clinical and/or research practice including truth-telling, consent, conflict of interest, resource allocation, and end-of-life care.
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