In the Intensive care units, patient care team members include Critical Care Medicine fellows, medical students, interns, anesthesia and surgical residents, and CCM faculty. The CCM faculty members and primary service faculty members are recognized as concurrent attending physicians in the ICU. There is one collaborative team that develops a single treatment plan based on current evidence based guidelines and local consensus based protocols. All team members, including the CCM fellows, are permitted to perform any patient care activity agreed upon and intervene as indicated in emergencies or when the patient’s condition warrants deviation from the treatment plan developed in the morning. Deviations from the designated plan must be discussed with the CCM attending. Most critically ill patients will have several consulting physicians in addition to an attending physician, thus making coordination of patient care extremely important. This can be achieved by conferring with them when they arrive in the area for rounds, and rapidly notifying the attending if their patient’s condition deteriorates.
The CCM attending has ultimate responsibility for all medical decisions regarding ICU patients and is responsible for providing oversight and supervision of all care provided by fellows. Critical care attendings are to be involved in all critical decisions in medical care and must be contacted for significant changes in patient status. All procedures in the ICUs are to be supervised by an ICU attending physician except in unusual, emergency situations. Procedure logs will be maintained.
As the fellows progress through the program, they are expected to take on more of a leadership role in the ICU, leading rounds and making decisions regarding patient care. This culminates in the junior attending rotation, during which faculty allow the fellow significant autonomy and provide feedback on leadership and decision-making skills.
For more information and to apply, contact: Lori Shutter, MD, and Melissa Lukehart.