Inpatient US Clinical Experience in Critical Care/Pulmonology in New Orleans

Information about this clinical experience:

You will be under the supervision of a physician board-certified in internal medicine and pulmonary / critical care. This physician holds a hospital appointment at Christus Health. The preceptor is an experienced educator and is Clinical Assistant Professor of Medicine at Edward via Virginia College of Osteopathic Medicine.

You will rotate through a 26-bed intensive care unit in a hospital that is a major referral center for a large surrounding area. A team of intensivists trained in pulmonary and critical care medicine are responsible for the care of all patients in this ICU. A wide range of patients with life-threatening conditions will be seen during this clinical experience. The emphasis will be on learning how to stabilize, evaluate, and treat these critically ill patients while working within a multidisciplinary team.

To prepare for the learning opportunities in this clinical experience, rotators are encouraged to read the following resources prior to the rotation:

Medical Student’s Guide to the Intensive Care Unit

The ICU Survival Book

A typical day will be as follows:

9 AM to 10 AM

Upon arrival, your preceptor will receive report/sign-out from an intensivist colleague. The report will provide a summary of new patients admitted to the ICU as well as status updates on established patients.

During this first hour, you will be assigned to follow 1-2 patients. Over the first hour of the shift, you will be expected to gather patient data to present to the team during rounds. Although you will collect this data from multiple sources, an important source of information will be the bedside nurse. As the typical ICU nurse follows 1-2 patients, he or she can provide detailed perspectives on the patient’s status, response to treatments, and preferences of the patient and his or her family.

10 AM to 12:30 PM

During this part of the day, you will round with the attending and the nursing staff. You will be expected to present your case(s) to the team, including differentials, assessment, and plan.

1 PM to 1:30 PM

You will take part in multidisciplinary rounds with ICU charge nurse, respiratory therapy, physical therapy, nutritionist, pharmacist, infection control, and case manager. The purpose of this meeting is to gather all parties involved in the patient’s care together to understand everyone’s concerns and perspectives and finalize care plans for critically ill patients. Studies have shown that interprofessional rounding in the ICU improves communication and collaboration and leads to higher-quality and safer care.

2 PM to 8 PM

You will have the opportunity to observe how new patients are assessed for ICU admission from different parts of the hospital, including the emergency department, operating room, and hospital ward.

In the afternoons, there may be time for teaching on important topics in critical care. Since the preceptor is well versed in point-of-care ultrasonography (POCUS), you may have the opportunity to observe how it is done and how the findings impact diagnosis and treatment. This is a particularly important aspect of the clinical experience as POCUS has been shown to reduce diagnostic uncertainty in the care of hospitalized patients both inside and outside the ICU. As an increasing number of internal medicine residency programs are incorporating POCUS into their curricula, this will be an excellent opportunity to gain experience in this important area.

Some part of the afternoon will be devoted to writing notes. These are not notes that will enter the official record, but rather notes that you will turn into your preceptor for review and feedback.

8 to 9 PM

The final hour of the shift will be focused on reassessing patients in the ICU so that proper handoff in care can be executed with the oncoming intensivist.