One (1) month of didactic curriculum is designed to provide a comprehensive overview of critical care topics. This time will consist of lectures, seminars, and simulation lab activities. Ongoing didactics include Surgery/Anesthesia Grand Rounds, Critical Care Grand Rounds, Death & Complications conference, weekly resident lectures.
Eleven (11) months of rotations throughout various ICU within the health system along with subspecialties related to critical care. The fellows will work closely with existing ICU Physician Assistants and Nurse Practitioners. The rotations are organized and designed to provide a supportive environment to foster learning, skills and critical thinking.
The ICU rotations include:
Surgical ICU (SICU)
During the SICU rotation, CC APP fellows are expected to expand their knowledge of general post -operative care, surgical complications, acute post operatively pain management, transplantation. You will be exposed to various patient populations including, trauma, transplant, vascular, oncology, craniofacial, orthopedic, pancreatic, endocrine, plastic and urologic patients. Fellows will further their understanding of ventilator, vasopressor support, resuscitation and fluid management.
Medical ICU (MICU)
While in the MICU the goal of the fellow is to gain knowledge and experience with acute medical illness, including diagnosing and treatments of illnesses. Fellows will expand their knowledge base of invasive and non invasive ventilation, advanced ventilator modalities, pulmonary disease processes and VV ECMO.
During their time in the NICU – the fellows will focus on various neurological processes- including management of seizures, intracerebral hemorrhages as well as post- operative care of the neurosurgical patient. Critical care APP fellows will gain exposure to and knowledge of management of- lumbar drains, intracerebral pressure monitors, ventricular drains, target temperature management and brain death testing.
During the rotation in the CTICU fellows will gain further understanding of acute cardiac care and management of cardiothoracic patients. They will have exposure to intra-aortic balloon pumps, ventricular assist devices, pulmonary artery catheters, and VA ECMO. Fellows will gain the knowledge and skills of taking care of post- operative cardiothoracic patients, as well as be able to diagnose and manage post- operative complications. They will be able to diagnose and treat dysrhythmias, as well as use inotropes and afterload reducing agents.
General Surgery or Internal Medicine Intern Rotation
Each fellow will begin their year as a general surgery or internal medicine intern. The purpose of this rotation is to develop the skills of management of step-down and floor surgery/internal medicine patients. During this month they will develop the skills of navigating Duke’s health system, learn to call consults, familiarize themselves with Maestro care, as well as learn now to admit and discharge patients. Fellows will learn when patients need a higher level of care and when to transfer to ICU.
Two weeks will be spent with the palliative care consulting team. During these two weeks the goal of the fellow is to learn the skills of running a family meeting and interacting with families and patients during end of life. The fellow will be exposed to palliative care medicine and focus on treating patient’s symptoms.
Two weeks will be spent rotating through the operating room with an anesthesiologist, anesthesia resident or CRNA. The purpose of this rotation is to get hands on experience intubating, learning medications used to intubate, place IVs, central lines and arterial lines.
Each fellow will have the opportunity to have 6 weeks of elective time. One month is designed for the fellow to spend an additional 4 weeks in an ICU of their choice. The goal of the other month of elective is to give the resident exposure to other services- including but not limited to- infectious disease, renal consults, cardiology, neurology, gastroenterology, emergency medicine. This month can be broken down into 1-2 week blocks.
Each fellow will be given a two week vacation. This block of time is to be taken opposite the palliative care or elective rotation.
- Each fellow is responsible for making the most out of this 12 month experience, provide the best care to each patient, and learn from every opportunity and mentor each day, as well as partake in independent learning both during and outside of the hospital
- Procedure logs must be kept up to date; logs will be reviewed by the fellowship faculty throughout the year
- Evaluation of rotations: Each fellow must fill out an evaluation of the rotation at the end of each rotation. The information gathered from these evaluations will be used to improve the rotation for future residents as well as determine appropriateness of the rotation for future residents.
(Further detailed responsibilities will be provided in the Critical Care Resident Handbook which will be distributed during orientation)
Successful completed of the Critical Care NP/PA Residency Program will be based on performance evaluations, passing of end of rotation examinations, demonstration of competencies in simulation labs, as well as two academic projects.
- A minimum of 2 evaluations from each rotation from attending physicians or APPs.
- Must complete all evaluations of rotations after completion of each rotation in a timely manor
- On time and consistent attendance to all scheduled shifts, didactic labs and lectures
- Attendance to >60% of critical care grand rounds
- Upholds and demonstrates Duke’s core values