The CA -1 Critical Care Rotation is meant to provide all residents by the end of the CA -1 year with an initial exposure and understanding of:
• the critical care aspects of trauma management and care from ATLS acute care to chronic ICU care and end of life management
• gain introductory familiarity with critical care consultation evaluation and management of other surgical services
• gain exposure and experience in the performance of technical invasive critical care procedures and the cognitive evaluation of their indications, risks and complications

The resident will demonstrate skill in the following six competencies:
1. Patient Care
• the resident shall become familiar with Acute Trauma Life Support (ATLS) algorithms for emergency trauma evaluation and learn the emergency critical care evaluative and therapeutic procedures leading to emergency transfer to operative surgery and anesthetic management
• become familiar with emergency airway management in non operating room emergency and elective circumstances and technical equipment and pharmacologic options
• become proficient in assessing the clinical facts, risks and benefits surrounding another physician’s request to perform an invasive critical care procedure (arterial canula, central venous and/or pulmonary artery cannulation, tube thorascostomy and fiberoptic bronchoscopy)
• become informed about the evidence based policies and procedures of the trauma ICU provided upon entry to the rotation
• be able to review and present the standardized ICU progress data sheet to the attending intensivist and the cognitive relevance of it’s content
• use appropriate communication skills with patients and other physicians so as to respond to patient/family concerns and to make general patient status changes known across the trauma and critical care professionals involved
• gain experience in performing invasive critical care procedures
2. Medical Knowledge
The CA- 1 resident shall demonstrate basic knowledge of:
• the pathophysiology of respiratory failure and mechanical ventilation
• circulatory shock and how it is approached in patients with trauma and post surgical states
• the types and indication of the basic mechanical ventilatory modes
• pharmacology of drugs commonly used in critical care and their relation to the prior pharmacology and medical history of the patient
• understand the approach to bacterial infection, hospital hygiene procedures, antibiotic usage and parsimony, nosocomial pneumonia and central line infection policies and procedures
• understand the purpose of informed consent to perform critical care procedures at ICU admission and appreciate patient’s rights to refuse procedures and/or limit life saving care under ethical standards of medical practice and hospital policies including the use of ethics consultation
3. Practice-based Learning Improvement
It is expected that the resident will demonstrate proficiency with:
• use information technology to manage information, access on-line medical information, and support their own education
• locate, appraise, and assimilate evidence from scientific studies related to critical care and utilize this information to improve patient care
• apply knowledge of study designs and statistical methods to critically analyze clinical studies and trials in the literature
4. Interpersonal and Communication Skills
Residents shall demonstrate interpersonal and communication skills that result in effective information exchanged with patients, families and the ICU care teams and specialty consultants involved in the care of critically ill patients.
5. Professionalism
Residents will demonstrate the ability to:
• maintain sensitivity and responsiveness to patients’ culture and religion and care for all patients in a nonjudgmental fashion
• demonstrate a commitment to ethical practices, including patient confidentiality, informed consent, and equal treatment of all patients
• respond in a timely manner to requests by surgeons and nurses of the ICU
6. Systems-based Practice
Residents are expected to:
• be familiar with the daily trauma surgical assessment and be prepared to discuss same with the critical care attending on bedside rounds
• understand where critical care consideration and actions relate to the surgical care of the patient and where additional diagnostic approaches apply
• understand drug usage protocols as they relate to cost/benefit approaches in the critical care setting

RESIDENT ASSESSMENT
The final evaluation for the rotation is performed by Dr. Rie, director of the trauma anesthesia and surgical critical care consultation service with input from trauma surgical attending physicians who have worked with residents during the rotation. The evaluation for CA 1 residents is based on direct observation and feedback from anesthesiology and surgical critical care attendings who have worked with the resident