ME538M.23

Medical Intensive Care Unit Experience - BWH

Director(s): Erik Alexander, Anthony Massaro, Nora Osman, Rebecca Sternschein
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month, except July.
Location: BWH - Brigham and Women's Hospital (23)
Open to Exclerks: No (HMS only)
Description: In this clerkship students will be introduced to the evaluation and management of patients in a tertiary care center Medical Intensive Care Unit. The student will be part of a team comprised of 3 interns, 3 residents, a critical care fellow and an attending Pulmonary and Critical Care physician. Students will be responsible for evaluation of patients on admission and follow these critically ill patients throughout their ICU stay. With assistance from the intern and resident, the student will formulate and present a daily plan of care. The student will take call every fourth night with an intern and resident. During the rotation, the student will gain an understanding of the pathophysiology and management of patients with a variety of critical illneses including respiratory failure, hypotension, sepsis, gastrointestinal bleeding and renal failure. As an integral member of the team, the student will also interact with varied consultative services and participate in regular family meetings. The student will gain exposure to a variety of procedures performed in the intensive care unit including placement of central venous access, arterial access, thoracentesis, paracentesis and bronchoscopy. Activities will also include participation in daily morning didactic teaching session as well as regularly scheduled MICU conferences (Ethics Rounds, Journal Club, Morbidity and Mortality Conference and a shared MICU/SICU conference). During the last week of the rotation, the student will be expected to lead a teaching session on a critical care topic of their choice.
Incorporation of Basic Science Content and Evidence-Based Medicine:
An understanding of basic pathophysiology and evidence based medicine will be emphasized on daily rounds and in the daily morning teaching conference. Teaching focused on the patient-ventilator interaction is an ideal format to reinforce principles of pulmonary physiology and pathophysiology. Similarly, discussions related to shock require a return to cardiac physiology and pathophysiology. Students will learn about evidence-based approaches to the management many critical care topics incluidng ARDS (low-tidal volume ventilation, ideal volume status, use of steroids), sepsis (early goal-directed therapy) and transfusion practices in the ICU. This teaching will be a part of daily rounds as well as the daily didactic teaching session.
Grade Criteria:
Honors with Distinction: Ability of the student to consistently perform on a level exceeding expectations for someone at their degree of training. This includes history taking which misses very few details, comprehensive physical diagnosis with particular skill in obtaining pulmonary findings, concise and complete oral presentations and notes as well as an exemplary knowledge base. Students receiving honors with distinction will demonstrate the ability to communicate clearly with families and consulting teams. Additionally, this grade requires a student presentation which is outstanding in the estimation of the attending. Honors: Ability of the student to consistently perform at or above the level of someone at their degree of training. This includes an outstanding performance on at least three aspects of their evaluation include history taking, physical diagnosis, fund of knowledge, communication skills, oral presentations and note writing. Satisfactory: Ability of the student to perform at or near the expected level of someone at their degree of training with respect to history taking, physical diagnosis, fund of knowledge, communication skills, oral presentations and note writing. Unsatisfactory: Inability to perform at the expected level of someone at their degree of training with respect to more than one of the following: history taking, physical diagnosis, fund of knowledge, oral presentations and note writing.