Medical Intensive Care Unit (MICU)

Overview:
Resident rotations in the medical intensive care unit (MICU) are one month in
length. Each year (PGY-1, 2, 3) a resident rotates one time through the MICU. While in
the MICU, residents work within a multidisciplinary team to provide patient care. This
team includes a MICU attending, pharmacist, respiratory therapist, nursing personnel,
and a nutritionist.

Principle Teaching/Learning Activities:

 Each patient the residents admit is discussed in detail with the MICU attending.
 The MICU attending makes patient management rounds (PMR) daily with the
resident staff. Formal teaching at the bedside occurs daily during these rounds.
 Diagnostic tests (radiographic imaging) are reviewed daily with the MICU
attending.
 Hemodynamic data (including PA catheter tracings) are reviewed with the MICU
attending.
 Directly supervised procedures- Residents have the opportunity to learn
procedures under direct supervision. Central venous lines, arterial lines,
thoracentesis, paracentesis, and lumbar puncture will be done in the presence of
the attending until the resident has demonstrated satisfactory competency in
these procedures. Residents may have the opportunity to participate in
endotracheal intubation; in all cases the MICU attending or attending
anesthesiologist will be present for the procedure. Residents may have the
opportunity to participate in the placement of pulmonary artery catheters; in all
cases the MICU attending will be present for the procedure. Residents may, in
the presence and at the discretion of the MICU attending, have the opportunity
to participate in the performance of flexible fiberoptic bronchoscopy.
 Critical Care Lecture Series (CCLS) - Weekly didactic lectures (3-4 per week, each
lasting approximately 60 minutes) focusing on management strategies of
frequently encountered conditions within the MICU population.
 Multidisciplinary Critical Care Conference Series (MCCCS) - Monthly conferences
held in conjunction with the Surgical and Trauma critical care services that
focus on recent developments in the care of critically ill patients.

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Principle Educational Goals by Relevant Competency:
In the tables below, the principle educational goals for the Medical Intensive Care Unit
are listed for each of the six ACGME competencies.

Legend for learning activities (See above for descriptions)

PMR- Patient Management Rounds CCLS- Critical Care Lecture Series
MCCCS- Multidisciplinary Critical Care Conference Series

1) Patient Care:

Principle Educational Goals Learning

Activities
Effectively define and prioritize patients’ medical problems. Direct patient care
Daily PMR
CCLS
Effectively evaluate and manage patients with severe Direct patient care
medical illnesses: sepsis, shock, respiratory failure Daily PMR
(including ARDS), congestive heart failure, gastrointestinal CCLS
hemorrhage, acute poisoning/overdose, cardiac
arrhythmias, and acute renal failure.
Effectively evaluate and manage patients receiving Direct patient care
mechanical ventilation. Daily PMR
CCLS
Learn indications, contraindications, proper insertion Direct patient care
technique, maintenance, and interpretation of data Daily PMR
obtained from the following: central venous catheter, CCLS
pulmonary artery catheter, arterial catheter, lumbar
puncture, thoracentesis, paracentesis, endotracheal
intubation, and bronchoscopy.

2) Medical Knowledge:

Principle Educational Goals Learning

Activities
Expand clinically applicable knowledge base of the basic Direct patient care
and clinical sciences underlying the care of critically ill Daily PMR
patients. CCLS
MCCCS
Understand the physiologic and pathophysiologic Direct patient care
principles of invasive hemodynamic monitoring. Daily PMR
CCLS
Understand the indications and applications of various Direct patient care
modalities of mechanical ventilation. Daily PMR
CCLS
Access and critically evaluate current medical information Daily PMR
and scientific evidence relevant to the management of CCLS
acutely ill patients. MCCCS

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3) Practice-Based Learning and Improvement:

Principle Educational Goals Learning

Activities
Identify and acknowledge gaps in personal knowledge and Direct patient
skills utilized in the care of critically ill patients. care
Daily PMR
CCLS

4) Interpersonal Skills and Communication:

Principle Educational Goals Learning

Activities
Communicate effectively with patients and families in a Direct patient
stressful critical care environment. care

Communicate effectively with physician colleagues and Direct patient

other health care professionals to assure timely, care
comprehensive patient care. Daily PMR
Communicate effectively with colleagues when signing out Direct patient
patients or turning over care to another service. care
Daily PMR

5) Professionalism:

Principle Educational Goals Learning Activities

Demonstrate acceptable professional conduct in all Direct patient care
interactions with patients, families, colleagues, and all Daily PMR
other members of the health care team. CCLS

6) System-Based Practice:

Principle Educational Goals Learning Activities

Understand and utilize the multidisciplinary resources Direct patient care
available to optimally provide care for acutely ill patients. Daily PMR
CCLS
Demonstrate appropriate and timely collaborations with Direct patient care
other members of the health care team to assure Daily PMR
comprehensive medical care. CCLS
Use evidence-based, cost-conscious strategies in the care Direct patient care
of critically ill patients. Daily PMR
CCLS
MCCCS

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Recommended Resources:

 MD Consult and UpToDate online reference materials

 Critical Care Lecture Series- articles packet

 Critical Care Medicine textbook

 ICU Textbook- Marino

Evaluation Methods:

Residents are formally evaluated by the MICU attending at the end of the rotation
using the standard ABIM evaluation forms. Additionally, modified evaluation forms are
also completed by the nursing staff for each resident. These evaluations are reviewed
by the Program Director on a monthly basis and at least semi-annually with the
resident.

Topic List for Review:

Mechanical Ventilation
Basic methods, Indications
Hemodynamic monitoring
Indications, techniques, waveform identification and basic trouble shooting
Use of sedation, analgesia and neuromuscular blockade in the critically ill patient
Acid/Base Problems
Vasopressors and Inotropic agents
Management of electrolyte emergencies – K+, Na+, Ca++, PO4, Mg++
Critical care nutrition – enteral and parenteral
Endocrine emergencies
Sepsis and Multi-system Organ Failure
Status asthmaticus and acute respiratory failure
Acute respiratory distress syndrome
DVT/Pulmonary thromboembolism – treatment and prophylaxis
Prophylaxis for stress ulceration of the GI tract
Appropriate use of antimicrobial agents
Use of anti-sepsis agents [Xigris®, etc]

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