Electives - Goals and Objectives

Goals and Objectives: General Electives

Knowledge of general critical care is an increasingly complex, essential component of patient care in the neurocritical care unit. The skillset needed to manage patients with acute brain injury and concurrent illness is highly specialized and in demand.

Fellows receive 8 weeks of general elective in year 1 and 12 weeks in year 2.  Fellows may choose to complete their electives at either NYPH-Columbia campus or NYPH-Cornell campus. Each elective must be approved by submission of an elective request form and identification of a supervising attending for the elective. Upon completion, fellows are proficient in the aspect of their elective as it relates to the complex management of a wide range of critical care issues that may arise in patients with severe acute brain injury. The following set of core educational objectives is designed to clearly communicate the expectations of neurocritical care fellows in terms of knowledge, skills and attitudes in critical care during their electives.

These educational goals are met through a series of clinical experiences, regularly scheduled seminars and conferences in general critical care subjects, multidisciplinary conferences, and individual projects.

INDEX OF COMPETENCIES: PC=Patient Care; MK=Medical Knowledge; PBLI=Practice-Based Learning & Improvement; ICS=Interpersonal & Communication Skills; Prof=Professionalism; SBP=Systems-Based Practice

Fellows receive 8 weeks of elective in year 1 and 12 weeks of elective in year 2.  Each elective block is one week long. At the end of the rotation, the fellows are expected to demonstrate the following:

Objective 1 (PC, ICS, PBLI, MK): Demonstrate proficiency in all medical and diagnostic procedures considered to be essential for the area of chosen elective by:

• Demonstrating competence in the following procedural critical care skills, applications of advanced technology and instrumentation for monitoring the physiologic status of patients based on their chosen elective and how it relates to management of patients with critical neurologic illness.
• Developing and executing a therapeutic management plan for patients with common diagnoses in critical illness
• Participating in a multi-specialty team of physicians, medical students and allied health professionals in patient management.

Objective 2 (MK): Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social behavioral sciences, as well as the application of this knowledge to patient care by:

Basic knowledge and application of knowledge of the following general critical care issues as they pertain to the fellow’s chosen elective:

• Cardiorespiratory resuscitation
• Invasive and noninvasive neurologic monitoring
• Hematologic and coagulation disorders
• Effects of critical illness on endocrine, metabolic, and nutritional aspects of patient health
• Ethical and legal aspects of neurosurgical critical care
• Cardiopulmonary monitoring, hemodynamic monitoring, and medical instrumentation including central venous access and arterial line placement
• Trauma as it relates to neurologic disease
• Physiology, pathophysiology, diagnosis and treatment of cardiovascular, gastrointestinal, neurologic, endocrine, musculoskeletal, infectious, and respiratory system disorders in patients with critical illness

Objective 3 (ICS, MK, PBLI):  Acquire and demonstrate the ability to synthesize and apply knowledge and understanding gained from basic science, clinical research, and information technology to provide accessible information to patients and support one’s own education by:

• Leveraging information technology to gather the most up-to-date scientific evidence to make informed decisions regarding diagnostic and therapeutic interventions.
• Proficiently using information technology to manage information, access on-line medical information, support their own education, and apply this information in the clinical care of patients.
• Finding, assessing, and assimilating the best evidence for clinical decision-making and continuously evaluating and improving patient care practices.

Objective 4  (SBP, PROF, ICS): Leverage knowledge of medical systems and regulatory requirements of medical training and practice by:

• Participating in analysis of safety event(s)
• Disclosing patient safety events to patients and their families (simulated/actual) with guidance from mentor as needed
• Performing patient safety and/or quality improvement project(s)
• Delivering patient-centered care with focus on individual needs of patient and family
• Leading interdisciplinary patient-centered care
• Advocating for safe and effective transitions of care
• Adjusting individual practice to address needs of specific patient populations
• Modifying individual practice to optimize care within a broader health care system

Objective 5 (SBP, ICS, PROF):  Demonstrate professionalism and expertise in using the system of care in a way that is beneficial and essential for patients, by:

• Effectively communicating with other members of the health care team (i.e., other physicians, nurses, social workers, etc.) to coordinate and optimize patient care.
• Advocating for quality patient care and assisting patients in dealing with system complexities.
• Functioning as a team member to facilitate and optimize patient care.

• Demonstrating effective listening skills and providing patients the opportunity to explain their problem and concerns.
• Actively participating in the education of patients, families, medical students, residents and other health care professionals.
• Demonstrating superior interpersonal and communications skills with professional associates and other health care providers.

Objective 6 (ICS, PROF, PC):  Demonstrate the ability to interact and communicate with patients in a manner that is culturally sensitive and patient-centered, by:

• Demonstrating respect, compassion, integrity, and responsiveness to the needs of patients, their families and society that supersede self-interest.
• Providing care that is sensitive to each person’s age; gender; and cultural, economic, and social circumstances.
• Demonstrating clear, understandable, and effective interpersonal and communication skills to counsel and educate patients and their families.
• Demonstrating a commitment to ethical practices pertaining to patient privacy and autonomy, the provision or withholding of clinical care, confidentiality of patient information, informed consent, and conflict of interest and business practices.
• Creating and sustaining a therapeutic and ethically sound patient-physician relationship.
• Creating and sustaining an environment where patients and their families feel comfortable asking questions about the patients’ diseases and treatments.
• Promoting an environment that supports shared decision making by including patients and families in decisions and choices about treatment.
• Effectively and empathetically delivering bad news to patients and their families.

Objective 7 (ICS, PROF, SBP): Demonstrate the ability to interact, communicate and work effectively with clinical and ancillary staff in the chosen elective’s main field of service, by:

• Obtaining and providing appropriate consultation.
• Carrying out respectful and effective communication with: colleagues, nurses, and ancillary staff in a way that encourages cooperation and patient-based care.

Objective 8 (PROF): Demonstrate the ability to conduct oneself in a professional manner by:

• Consistently exhibiting a professional appearance; neat, well-groomed, conservative attire in compliance with the hospital dress code
• Consistently demonstrating professional attitudes consistent with being a physician, with an emphasis on responsibility, compassion, sensitivity to diverse patient populations and cultures.
• Continuously adhering to ethical principles, confidentiality, informed consent and a commitment to excellence and on-going professional development.
• Exhibiting dependability, responsibility and self-respect.
• Arriving for clinical duties and completing work in a timely manner and with appropriate attention to detail
• Consistently demonstrating personal integrity and altruism.
  • Serving as a role model for residents and medical students.