Medical Intensive Care Unit (MICU) Inpatient Service Curriculum
Educational Purpose and Goals
The MICU Inpatient service is a clinical rotation that provides house officers exposure to the diagnosis and treatment of critical illness. This rotation is intended to provide the exposure, clinical knowledge, skills, and professional attitudes needed to care for critically ill patients with a wide variety of disease states. The medical team consists of supervising attending physicians, critical care fellows, residents (from Internal Medicine and Emergency Medicine training programs), interns (from Internal Medicine, Emergency Medicine, and Anesthesiology training programs), and senior medical students. The rotation lasts for approximately two-four weeks.
Educational Purpose and Goals
PGY 1: Introduce the MICU Inpatient service while achieving the following goals:
- Demonstrate baseline competency in medical interviewing and physical examination, with a focus on elements specific to critical illness.
- Formulation of a differential diagnosis and outline a plan for the evaluation and management of a diverse patient problem list.
- Demonstrate organization that enables longitudinal evaluation, management and treatment of the critically ill patient, often with multi-organ system failure.
- Document patient encounters and medical plans in the medical chart.
- Educate patients about their disease, medications, and therapies.
- Anticipate obstacles to and orchestrate successful transition to home.
- Demonstrate professionalism by providing leadership, effective communication, and teaching during interactions with the patients, the medical team, and students.
- Understand the differential diagnosis and management of major physiologic derangements of critical illness, including but not limited to shock and respiratory failure.
- Understand and manage basic mechanical ventilator settings in intubated patients.
- Observe and perform common procedures, including but not limited to central venous line placement, arterial blood draws, arterial line placement, and insertion of naso- and oro-gastric devices.
- Observe and participate in discussions regarding goals of patient care, palliation, and end-of-life issues.
PGY 2: Revisit the MICU Inpatient service while achieving the following goals:
- Manage the MICU Inpatient service, providing leadership and teaching.
- Demonstrate advanced skills in medical interview and physical exam, with a focus on elements specific to critical illness.
- Develop an integrated, efficient, and focused plan for evaluation and management of a patient with complex disease that effects multiple organ systems.
- Work effectively as a member of a comprehensive medical care team looking to provide competent and compassionate medical care.
- Understand long term management of patients, with regards to preventative care, risk factor modification, adverse medication effects, and follow-up.
- Demonstrate professionalism by providing leadership, effective communication, and teaching during interactions with the patients, the medical team, and students
- Utilize the differential diagnosis of major physiologic derangements of critical illness to develop a diagnostic and therapeutic plan.
- Manage mechanical ventilator settings and liberation of intubated patients.
- Perform and teach common procedures, including but not limited to central venous line placement, arterial blood draws, arterial line placement, and insertion of naso- and oro-gastric devices.
- Lead discussions regarding goals of patient care, palliation, and end-of-life issues.
- Provide mentorship and serve as a role-model for interns and medical students on the team.
- Provide constructive feedback to the interns and medical students on the team.
PGY 3: Revisit the MICU Inpatient service while achieving the following ADDITIONAL goals:
- Reinforce evidence based style of practice
- Solidify habits of practice based learning
Patient Care Rounds – The MICU Inpatient Service rounds daily to discuss issues pertaining to care of the patients on the service. These interactive rounds focus on integrating pertinent patient history, physical exam findings, and information from consultation services to formulate a diagnostic evaluation and management strategy. Additionally, the service meets regularly with social work and case management colleagues to construct a plan which ensure the social and medical well-being of the patients on the service.
Radiology Rounds – In addition to patient care rounds, the MICU Inpatient Service holds daily rounds to review the radiology studies on all MICU patients. Interns and residents interpret the films with the supervision and teaching of an attending physician.
Teaching Rounds – In addition to patient care rounds, the MICU Inpatient Service holds daily rounds to review pertinent topics in critical care medicine. These presentations, given by attending physicians, review the physiology, pathophysiology, and management of critically ill patients.
Lectureship – The following lectures augment the MICU Inpatient Service educational program:
- Resident Morning Report cases specific to critical illness
- Twice monthly ICU lecture series
- Housestaff Topics Lectures
- Housestaff Advanced Topics Lectures
- Resident Journal Club
- Resident Harrison’s Club
- Housestaff Morbidity and Mortality Conference
- Resident Board Review
- Teaching Rounds as described above
Independent Study – A syllabus for self-directed learning is distributed to housestaff at the beginning of their time on the MICU Inpatient Service. This syllabus was developed and is updated regularly by the Pulmonary and Critical Care faculty. It is designed to ensure breadth in the educational experience of the service. Additionally, the housestaff are routinely asked to engage in literature searches to ask focused clinical questions that arise in the care of their patients.
Disease and Patient Characteristics
Major Disease Categories:
Pathophysiology of Circulation in Critical Illness
Pulmonary Embolic Disorders
Pathophysiology and Differential Diagnosis of Acute Respiratory Failure
Management of Ventilated Patient
Acute Hypoxemic Respiratory Failure
Acute-On-Chronic Resp Failure
Liberation for Mechanical Ventilation
Principles of Antimicrobial Therapy and the Clinical Pharmacology of Drugs Septic Shock
Bacterial Infections of CNS
Infectious Complications of Intravascular Devices
Coma, Persistent Vegetative State, and Brain Death
Blood Products and Plasmaphoresis
Acute Renal Failure
Rhabdomyolysis and Myoglobinuria
Dialysis in in the Critical Care Patient
DKA, Hyperglycemic Coma
Adrenalcortical Insufficiency/Thyroid Disease
Acute and Chronic Hepatitis
Pain Control, Sedation, and Use of Muscle Relaxants
Ventilator-Induced Lung Injury
Monitoring Respiratory System
Pulmonary Artery Catheter
Prevention and Early Detection of Complications of Critical Care
Multiple Organ System Failure: Clinical Expression, Pathogenesis, and Therapy
Withholding and Withdrawal of Life-Sustaining Therapy
Central Line placement
Arterial Blood Gas Sampling
Critical Care Pharmacology (Xigris/Thrombolytics/etc)
Critical Illness and Pregnancy
- The acute indications for hospitalization vary greatly, as indicated by the disease characteristics as described above
- The majority of the patients admitted to the MICU Service have acute medical issues in the setting of chronic illnesses.
Clinical Encounters and Procedures
Initial Patient Encounter
- Patients are admitted to the MICU Service with acute illness from the emergency room, other inpatient ward and intensive care units, and as transfers from other hospital facilities.
- Patient care is transferred from the MICU Service to one of several University of Chicago Hospital ward services, a chronic care facility, or occasionally an inpatient or home hospice program
- Principles of Critical Care, Third Edition Hall, Schmidt, and Wood
- Internet Resources
- General Medicine Reference Links: http://medicine.uchicago.edu/section_pages/gmed/Intranet/Reference.htm
- Chief Resident’s Literature Search Link:
- Program’s Gen Med “Guideline/Landmark Article” Links:
Patient-Focused Literature – The housestaff are routinely asked to engage in literature searches to ask focused clinical questions that arise in the care of their patients.
Lectureship – Presentation slides and handouts from the lectures outlined above are made available to housestaff after the lectures have occurred.
The attending physician is responsible for ensuring the highest level of care to patients admitted to their resident team. This is accomplished through regular supervision of the work completed by the resident, intern and students on the team. The attending should see and evaluate all patients at admission. They should see and evaluate all patients on a daily basis throughout the entire admission. In both cases, the plan of care should be reviewed with the housestaff team delivering appropriate feedback where necessary. The attending should be available 24 hours a day to the housestaff team for question or concerns arising in the course of patient care.
- Communication of Expectations
- Ongoing Verbal Feedback
- Mid-rotation Feedback
- End of Rotation Feedback
- End of Rotation Evaluation
- Written / New Innovations
- Patient Driven Evaluation
- Throughout rotation
- Focus on Interpersonal Communication and Professionalism
- Team Members Evaluated