Among the strongest features of the surgical residency program at NYHQ is its teaching in Surgical Critical Care. Each resident will spend 8 months in the SICU, these months being divided among the first three years of training. Surgical Intensive Care Units at both hospitals are under the direction of surgeons with special qualification in Critical Care, and many of the core attending staff have similar qualification.
Surgical Critical Care
ICU residents participate fully in all aspects of care for the critically ill patient. At twice daily rounds, residents are provided teaching and supervision by more senior residents, and daily Director rounds provide further instruction in the subtleties of critical care. In order to keep the assigned resident at the center of patient care process, nurses may only take orders written or co-signed by that resident.
Technical procedures required for patient care are all performed by the residents, including:
- Endotracheal intubation
- Respiratory Care
- Flexible and rigid sigmoidoscopy
Credentialing procedures have been established to ensure that procedures are properly learned. Thus, no resident can insert a central line or Swan-Ganz catheter without direct supervision of a more senior resident or attending, until he/she has proven competent with the given procedure. Once “signed off” on a technique, the resident may thereafter perform said procedure without supervision.
Under attending supervision, residents become facile in making decisions regarding:
- Respirator settings and weaning
- Pulmonary care
- Nutritional management of the critically ill
- Management of cardiac medications
- Antimicrobial treatment in the critically ill