Anesthesiology residents will spend one month on the NSICU rotation during their CA-1 or CA-2 year of training. This will serve as one of the two (trauma ICU being the other) months of required critical care anesthesiology rotation months. Upon completion of the NSICU rotation, the anesthesiology resident will be able to:
• evaluate and adequately prepare a treatment plan for those patients requiring NSICU care
• develop a rational approach to diagnostic testing in the ICU that will maximize patient benefit while controlling costs
• to rationally utilize consultants in a timely manner and use the information appropriately
The resident will demonstrate skill in the following six competencies:
1. Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective in caring for an ICU patient. Residents are expected to:
• perform an appropriate initial evaluation and treatment for problems commonly experienced by patients in NSICU
• verify that appropriate diagnostic tests have been ordered or reviewed given the patients findings on initial evaluation, scientific evidence and clinical necessity
• develop an initial treatment care plan
• respond to ongoing charges in the patient status and develop a plan for therapy including diagnostic options, evaluation of date with appropriate interpretation
• learn appropriate neurologic evaluation of the ICU patient
2. Medical Knowledge
Residents must demonstrate knowledge about the application of various ICU monitoring, therapies, and patient management. Residents are expected to:
• apply knowledge of various neurological critical care physiologies including but limited to intracranial pressure monitoring and treatment, cerebral perfusion pressure, spinal cord perfusion
• apply knowledge of invasive monitoring techniques including indications, contraindications, sterile technique, and potential complications
• attain knowledge of electroencephalography and indications for usage in ICU
• attain knowledge of principles of mechanical ventilation and appropriate ventilator management
• demonstrate an understanding of common ICU test sensitivity and specificity and how this effects ordering tests and interpreting test results
3. Practice-based Learning Improvement
Residents must be able to investigate and evaluate their ICU patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:
• locate, appraise, and assimilate evidence from scientific studies related to their patient(s) ICU problems
• use information technology to manage information, access on-line medical information, and support their own education
• facilitate the learning of students, nurses, respiratory therapists, and other health care professionals they come in contact with in the ICU
4. Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange with patients (if appropriate), their patients' families, and professional associates. Residents are expected to:
• work effectively with others as a member of the ICU team
• skillfully perform an initial ICU evaluation
• act as a consultant in anesthesiology by discussing preoperative concerns with the patients' from the ICU scheduled to go to the OR
• write legible and organized ICU notes
5. Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
• demonstrate sensitivity and responsiveness to patients' and their families' culture, age, gender, and disabilities and respect and compassion when talking with patients and their family members
• demonstrate a commitment to ethical practices including confidentiality of patient information, informed consent, and equal treatment
• wear appropriate attire
• demonstrate sensitivity to end of life issues
6. Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:
• demonstrate a rational process of deciding when consultation is indicated and arrange consultations in a timely manner as appropriate for ICU patient
• formulate appropriate question(s) to be posed to consultants
• determine appropriate preoperative laboratory tests to reduce costs of over-ordering batteries of unnecessary tests

RESIDENT ASSESSMENT
Competencies will be assessed by the following methods:
1. Attending discussions with residents of ICU patients will be used to assess patient care, medical knowledge, and interpersonal and communication skills.
2. The attendings of record will review ICU charts for legibility, organization, and completeness (communication skills).
3. A global rating form will be used at the end of the month to evaluate the resident on the six competencies based on direct observation and feedback from the ICU staff, other physicians who interact with the resident, and anesthesiology critical care attendings.
4. An oral examination will be administered during the monthly rotation. The resident examinee will be provided immediately with feedback after this examination.

PREREQUISITES
Anesthesiology residents will be assigned to the NSICU after successful completion of his/her PGY-1 year.