Critical Care Medicine  

Resident Training

Clinical Training

The Stanford Intensive Care Units consist of a 36-bed Medical Surgical Intensive Care Unit and a 25-bed Cardiovascular Surgical Intensive Care Unit. The Medical-Surgical ICU Service on which residents work is responsible for the primary management of 15 - 40 patients in these units. Residents are exposed to a broad scope of pathology in both medicine and surgery patients. All medical patients requiring intensive care are admitted to our service for primary management. (The only other adult ICU in the hospital is a coronary care unit). Depending on the surgical service, we either consult (neurosurgery) or fully manage (OB/Gyn, ENT, Orthopedics, Plastic/reconstructive, Ophthalmology) these interesting patients. We occasionally are consulted by other services (Cardiac, Thoracic, General, Vascular).

Our service also receives a regular intake of patients transferred from outside hospital intensive care units (Critical Care Transport).

The service is composed of a faculty of fourteen attendings trained in Anesthesia and/or Internal Medicine. All the attendings have completed specialized training in Critical Care Medicine. Each 2 week block, the service is split into the 'Green' and 'Blue' teams, each under the direction of an attending, who daily directs the patient care delivered by 4 residents (on each team) from Anesthesia, Medicine and Emergency Medicine. The 4 residents are on call every fourth night.

Residents are heavily supervised in order to optimize patient care and the resident’s education, in both the science and art of Critical Care Medicine. An apprenticeship relationship best describes the way residents work with fellows and attendings on this ICU service.

Typical Stanford daily schedule:

Anesthesia residents may also receive Critical Care training at the Palo Alto Veteran’s Adminstration Hospital , located 2 miles from Stanford Medical Center .

The VA Medical/Surgical ICU offers a variety of patients to care for with 40% medical and 60% surgical. Of our surgical patients, about 50% of these being patients post cardiac surgery. The PAVAH is a National Center of Excellence for cardiac surgery in the VA system. The VA ICU team is composed of 2 clinical fellows, 2 research fellows to aid with call, 3 residents (one each from medicine, surgery and anesthesia), and 3 medicine interns. There is one attending physician to run the clinical service and an additional attending available to manage all triage issues related to all monitored beds in the hospital. In addition, valued members of our team include our excellent nursing staff, critical care pharmacy specialists, nutritionists and social workers, as well as our critical care respiratory therapists.

The ICU team is responsible for the care of ALL patients admitted to the ICU. The medicine patients are managed solely by the ICU team as at Stanford hospital. The surgical patients are admitted under the name of the surgery attending physician and are co-managed with the surgical team.

Typical PAVAH daily schedule:

The American Board of Anesthesiology requires that residents in Anesthesiology will receive ‘…at least 2 months of training in Critical Care Medicine.’ Stanford Anesthesia residents receive 2-4 months of Critical Care training.

Didactics

A resident lecture series is provided each day during the resident’s 1 month experience and is designed to encompass the basic concepts in Critical Care Medicine (monitoring, shock, sepsis, vasoactive drugs, mechanical ventilation, ARDS, ethical issues, ACLS, nutrition, etc). Most lectures are delivered by the ICU faculty.

Stanford Medicine Resources:

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