Acute Care Surgery / Surgical Critical Care
Surgical Critical Care
Program Goals and Objectives
- We provide a rich and diverse educational environment. The foundation of this environment consists of the eight trauma surgeons with added qualifications in SCC working in a large tertiary care TICU/SICU producing a wealth of diverse and complex critical illness. The SCC fellow receives one-on-one didactic and hands-on instruction from both the SCC attending of the week during daily rounds and duties, and the on-call faculty. Multiple conferences, including daily multidisciplinary Trauma and Surgical ICU rounds, weekly multidisciplinary critical care grand rounds, monthly critical care journal club, general surgery grand rounds, and SCC/Acute Care Surgery research meeting supplement the curriculum. In addition, a weekly critical care conference is held to discuss topics in the curriculum specific to critical care and to ensure that the curriculum outline is covered. In summary, we have a dedicated and enthusiastic teaching force working who have a wealth of experience in evidence-based care, technology, research, and administrative development.
- The SCC program ensures excellent training in key physiologic areas of SCC. As a foundation, each fellow becomes ATLS certified and an ATLS instructor. Each fellow becomes competent in managing all organ systems in critical illness including neurologic, cardiovascular, pulmonary, gastrointestinal, musculoskeletal, metabolic, nutritional, endocrine, and hematologic systems. The foundation of education lies in teaching by the SCC faculty, from morning report through overnight call. The focus of organ system-based education is daily multidisciplinary rounds, where active, hands-on learning predominates. Each fellow is expected to augment this approach through autonomous learning with the wealth of resources provided. SCC Fellows are responsible for the management of critically ill trauma, burn, general surgical, neurosurgical, and orthopaedic populations.
- Neurologic expertise is achieved through close interaction with faculty in SCC, neurology, and neurosurgery. Cardiovascular physiology is mastered through didactic, bedside, and autonomous learning as described, with a focus on bedside resuscitation. SCC fellows participate in shock resuscitation secondary to all etiologies, incorporating technology such as right heart ejection fraction pulmonary artery catheters directed at endpoints of resuscitation. Fellows become adept at managing end-stage pulmonary disease, including severe acute respiratory distress syndrome. Management of respiratory failure includes using varied ventilation strategies depending on patient and pathology, and fellows also are exposed to patients managed via extracorporeal membrane oxygenation. In addition, all airways in the surgical ICUs are managed primarily by the SCC service, providing ample experience in the management of the difficult airway. The multidisciplinary team includes nutritional support and a dedicated ICU pharmacist, serving as additional resources for SCC resident learning. Fellows become facile with parenteral and enteral nutrition, including selection and placement of access, formulations, calorimetry, and bedside nutritional assessment. SCC fellows participate in the selection and application of all novel critical care technologies utilized within the SICU.
- The WFUSOM SCC program prepares fellows to become leaders in critical care regionally and nationally. In addition to intellectual preparation, this goal is achieved through development of administrative and research expertise. SCC fellows work closely with the Director of SCC within the scope of all administrative duties. Critical skills in ICU directorship are acquired, including ICU design, evidence-based protocol development, database development and management, and ICU performance improvement. Regarding research, the program provides resources commensurate with the resident’s level of need. All SCC faculty are involved in research, with fellows encouraged to associate with projects of interest. In addition, fellows are expected to design, carry out, and publish, a novel SCC-based research project, under the guidance of faculty, trauma data coordinators, and statisticians. Fellows have the opportunity to submit his or her work to be presented at national conferences.