MED3-3031/F: Junior Internship Any - Critical Care Medicine

Course Coordinator:  Dr. John Boldt

Maximum Size:  2


Educational Purpose:

The critical care rotation is a one-month elective rotation for fourth year medical students in which the principles of critical care medicine and evaluation and treatment of critically ill patients are emphasized. Critical illness does not respect socioeconomic boundaries, however, many critically ill patients do present with additional complications of substance abuse or lack of timely medical care. Ethical issues concerning the intensity of care are often encountered. The appropriate environmental precautions and hazards are frequently discussed when isolation of patients is required. Aspects of care unique to the intensive care unit are also emphasized.


Teaching Methods:

The critical care team generally consists of one or two upper level residents, one or two interns, and the medical students allowing the team to structure different tasks according to individual team member skills. The upper level residents teach the interns and students; the attending intensivist teaches the entire team during didactic sessions as well as during daily rounds. Reading assignments are distributed based on rotation goals as well as particular disease entities encountered. During these rounds and conferences, the pathogenesis of conditions is reviewed and the particular skills needed for evaluation and management of critically ill patients are reviewed. The importance of including family members in these discussions and compassionate care for individuals is emphasized.


Disease Mix:

All aspects of critical illness may be evaluated and managed by the team on this rotation. Particular emphases include:

A. Consultation and management of critically ill patients.

B. Ventilator and airway management.

C. Management of acute respiratory failure, including adult respiratory distress syndrome.

D. Systemic inflammatory response states, including sepsis.

E. Nutrition in the critically ill patient.

F. Interventions to decrease the risk of secondary complications in the critically ill patient.


Patient Characteristics and Types of Clinical Encounters:

In this rotation, students evaluate patients for whom consultation is requested in intensive care units. These patients generally manifest high illness acuity in a wide range of pulmonary, cardiac, neurologic and infectious problems. Resident supervision is constantly present in the hospital for students; attending supervision likewise is constantly present within the hospital and through daily team rounds.


Procedures and Services:

The critical care team often performs procedures in the intensive care unit which include central line placement, thoracentesis, chest tube placement, bronchoscopy, and tracheotomy management. Students will be invited to observe and possibly assist in these procedures.


Reading List:


1. MKSAP 14. Pulmonary and Critical Care.

2. Snow V, et al. Evidence base for management of acute exacerbations of COPD. Ann Intern Med 2001;134:595-9.

3. Rivers E, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM 2001;345:1368-77.

4. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. NEJM 2001;345:351-8.

5. Jacobi J, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30:119-41.

6. Recommended Text: The ICU Book by Paul Marino

7. Current literature as assigned by the faculty supervisor


Pathological Material and Educational Resources:

Students are encouraged to review the results of diagnostic biopsies and therapeutic procedures. If an autopsy is performed on a patient for whom they have been providing consultation, they are encouraged to view the autopsy.


Method of Evaluation of Student Performance:

A. Attending and resident evaluation of clinical performance at the end of the month.

B. Required completion of reading assignments.

C. Completion of assigned learning topics by attending. 

UT College of Medicine Chattanooga     960 East Third Street, Suite 100     Chattanooga, TN 37403     (800)947-7823, ext 6956

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