PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Completion of the surgery core clerkship is required.
PURPOSE: The purpose of the rotation is to learn basic treatment strategies in treating critically ill patients in the intensive care unit and to become familiar with the evaluation and management of trauma patients. This rotation will sharpen the use of the basic medical principles learned during the first three years of medical school, especially those from the core surgery clerkship as well as those from human anatomy, physiology, and pathophysiology.
COMPETENCIES: The student will have two core subject competencies which are intimately related: surgical critical care and trauma surgery.
The student will become comfortable with the management of critically ill surgical patients. This will include learning ventilator management strategies in the treatment of acute lung injury, the use of vasopressor and inotropic drugs in supporting cardiovascular function, the management of acute intracranial hypertension and the recognition and treatment of various forms of shock. Included in this is the acquisition of technical skills to treat the critically ill patient including, but not limited to, central line insertion, arterial line insertion, intracranial pressure monitor insertion, tube thoracostomy, and critical care ultrasonography.
Additionally, the student will participate in the acute assessment, resuscitation, operative management, and post-operative management of trauma patients. Our trauma service is unique in that the trauma surgeons provide the primary surgical management of all cardiac, thoracic, vascular, and intra-abdominal injuries encountered. Furthermore, our trauma center at Mount Sinai is a high volume penetrating trauma center with over 40% penetrating trauma encountered. As such, our trauma experience will provide the student an uncompromised exposure to the surgical care of the trauma patient.
Education will be accomplished by several means. First, lectures from faculty are held several times a week on the topics mentioned above. Furthermore, the student will participate in patient case discussions as part of daily rounds, the trauma morning report, and the trauma quality improvement meetings.
This rotation contributes to the core competencies in the following areas:
– Patient Care: The student will have ample opportunity to assess patients and learn diagnostic skills especially in the acute setting.
– Medical Knowledge: The formal didactic program will aid the students in the application of basic principles already learned and increase the depth of knowledge as it relates to the endocrine/metabolic response to surgery and injury.
– Practice Based Learning: This rotation will allow the student to identify knowledge gaps in their approach to emergency situations and also technical skills that need to be acquired to be effective in intervening in such circumstances.
– Interpersonal and Communication Skills: The patient population at Mt. Sinai is a diverse population including many cultures that are not commonly familiar to the medical student. In addition to learning how to accommodate cultural differences, learning how to interact in the extremely stressful circumstances of an acutely ill/injured patient will provide invaluable experience for the student as they approach residency training.
– Systems Based Practice: The unique nature of trauma patients requires an organized and integrated multi-disciplinary approach. This provides an opportunity for the student to learn the role of many practitioners in health care and the collaboration needed to be successful in managing these types of complex patients.
INSTRUCTIONAL METHOD: The course will be 2 or 4 weeks in length, but 4 weeks is preferable to obtain the full exposure to the continuum of care of critically ill trauma patients.
Learning activities include teaching rounds with the faculty on a daily basis, didactic lectures on Monday, Wednesday and Thursday morning and patient case discussions on Thursday morning as well. The student will participate in pre-operative assessment of critically ill trauma patients, the operative interventions, and post-operative patient care in the SICU as well as on the general care floors.
Call responsibility will be 1 in 4 nights. Call rooms are provided in the hospital for the medical students on the trauma service.
Recommended readings include:
- ATLS Student Course Handbook
- The ICU Book by Paul Marino
- Practice Management Guidelines from the Eastern Association for the Surgery of Trauma (https://www.east.org/education/practice-management-guidelines)
- Other primary literature and textbook reading that relates to specific patient conditions encountered on a daily basis.
ASSESSMENT: Students will be evaluated by the faculty as to their performance and progress in providing critical care services. This will be performed at the midpoint for those students electing to do a 4 week rotation and will be done by the rotation coordinator in a face-to-face fashion with the core competencies forming the outline of the evaluation.
NOTE: Mid-rotation evaluations will be performed.
Program Number: ELEC 682
Location: Mt. Sinai Medical Center, Level 1 Trauma Center, 1501 S. California, Suite F1046, Chicago, IL 60608
Program Director: Jonathan Bean, MD (Clinical Assistant Professor of Surgery UIC) Telephone: 773-257-5051 Extension: 4752
Coordinator: Eraina Downing
Faculty: Jonathan Bean, MD, Grace Chang, MD, Amir Vafa, MD
Duration of Elective: 2 or 4 weeks
Night Call: 1 in 4 nights, flexible
# of Students Accepted: Min: 1 Max: 2
Housestaff Used as Faculty: Yes
Number of hours per week: 40
Outpatient: 4 hrs/week
Inpatient: 8 hours/day x 5 days