Teaching Schedule April 8 - May 5 2009

Teaching Schedule Rotation 11 April 8 - May 5, 2009

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What to teach during a critical care rotation...

Critical Care Medicine encompasses a vast knowledge base, and this can seem overwhelming when you start. It can be just as overwhelming to those who are trying to teach and help you learn during your rotation. Selecting those areas of theory and practice to concentrate on is a daunting task, and oversimplification and topic bias are real risks. In an effort to reach some form of meeting of minds between trainers and residents, a team at the University of Calgary set out to develop an objective tool for curriculum development. The abstract of the published result is shown below. You can access the full-text article by clicking here. 

So much to teach, so little time: a prospective cohort study evaluating a tool to select content for a critical care curriculum

Adam D Peets , Kevin McLaughlin , Jocelyn Lockyer  and Tyrone Donnon 

 author email corresponding author email Critical Care 2008, 12:R127doi:10.1186/cc7087

Published:	15 October 2008 See related commentary by Buchman, http://ccforum.com/content/12/6/188

Abstract

Introduction

Curricular content is often based on the personal opinions of a small number of individuals. Although convenient, such curricula may not meet the needs of the target learner, the program or the institution. Using an objective method to ensure content validity of a curriculum can alleviate this issue.

Methods

A form was created that listed clinical presentations relevant to residents completing intensive care unit (ICU) rotations. Twenty residents and 20 intensivists in tertiary academic multisystem ICUs ranked each presentation on three separate scales: how life-threatening each is, how commonly each is seen in critical care, and how reversible each is. Mean scores for the individual scales were calculated, and these three values were subsequently multiplied together to achieve a composite score for each presentation. The correlation between the two groups' scores for the presentations was calculated to assess reliability of the process.

Results

There was excellent agreement between the two groups for rating each presentation (correlation coefficient r = 0.94). The 10 clinical presentations with the highest composite scores formed the basis of our new curriculum.

Conclusions

We describe a method that can be used to select the content of a curriculum for learners in an ICU. Although the content that we selected to include in our curriculum may not be applicable to other ICUs, we believe that the process we used is easily applied elsewhere, and that it provides an efficient method to improve content validity of a curriculum.

Their "top-ten" included...

1. Acute respiratory failure
2. Cardiac dysrhythmia
3. Shock
4. Derangements of electrolytes and osmolality
5. Acid-base derangements
6. Seizure
7. Cardiac arrest
8. Drug overdose and withdrawal
9. Multisystem trauma
10. Sepsis

Antifungal Therapy in the ICU

Invasive fungal infections, especially invasive candidiasis, are a significant problem in the ICU. Candida represents the fourth most common cause of bloodstream infection in the US, and the third most common in ICU. The mortality from candida bloodstream infection is higher than that of gram negative bacteraemia.

There has been increasing interest in prophylactic and pre-emptive antifungal therapy, as well as concern over the potential for increased resistance to antifungal drugs. Update yourself on this important topic with a focus on antifungal agents and especially the role for echinocandins such as Caspofungin in the ICU by viewing our presentation. You can find it by clicking here.

Presentation Mini-Viewer

You can now view our presentations using the new mini-viewer. You can select and scan the presentations in miniature then choose to review them in full-screen when you find what you are looking for.

The mini-viewer can be found here. 

Delirium in the ICU

Delirium is a common epiphenomenon in the critically ill and is associated with an increased risk of morbidity and mortality, as well as prolonged hospital stay. You need to be able to make an early diagnosis of delirium as well as taking steps to minimise the risk and treat it effectively. In the "Other Presentations" section of the site you will find an overview of delirium covering pathophysiology, diagnosis and scoring, and treatment options.  You should all take the opportunity to review this important topic. You can view the presentation by clicking here.