Surgery and Anesthesiology Critical Care Medicine Subinternship

Course Number: MD455.01

The UCLA Department of Anesthesiology and Perioperative Medicine offers a three week Surgery and Critical Care Medicine Subinternship to fourth year UCLA and visiting medical students. The rotation is offered throughout the year (July through June) for up to a maximum of two medical students per rotation. During this rotation, medical students work in the Cardiothoracic Intensive Care Unit (CTICU) and the Surgical Intensive Care Unit (SICU) in the Ronald Reagan UCLA Medical Center alongside attending, resident and fellow physicians.

The Surgery and Anesthesiology Critical Care Medicine Subinternship is designed not only to teach complex physiology and pharmacology, but also to expose students to the specialties of surgery, anesthesiology, and critical care medicine. Medical students are on a team of physicians, advanced practice nurses, and other healthcare professionals, caring for critically ill patients in the CTICU. Our 24 bed CTICU is staffed 24 hours a day with in-house attending coverage. A rigorous didactic and bedside education program is in place for medical student education. The CTICU focuses on caring for patients before and after complex cardiothoracic operations including single or multiple cardiac valve replacement/repair, coronary artery bypass surgery, heart and lung transplantation, as well as mechanical cardiac support. In addition to cardiac, aortic, and general thoracic cases, medical students will manage a wide variety of patients following complex trauma and major surgical operations. Medical students also will be exposed to the care of patients transferred from outside hospitals. Under the supervision of ICU attendings, fellows, and residents, medical students participate in day-to-day patient care in our CTICU.

Learning Objectives

Our Surgery and Anesthesiology Critical Care Medicine Subinternship emphasizes care of critically ill cardiothoracic surgical patients in the Intensive Care Unit. Specific learning objectives include:

• Demonstrate knowledge of mechanical ventilator techniques, including basic ventilator techniques (synchronized intermittent mandatory ventilation, assist/control ventilation, pressure-support ventilation, continuous positive airway ventilation [CPAP]), advanced ventilator techniques (high-frequency/oscillation, prone, airway pressure-released, Bi-Level), non-invasive ventilator support and assessment patients for initiation and discontinuation of mechanical ventilation.
• Assist in the management of cardiopulmonary resuscitation; assist in the management hypovolemic, vasodilatory, cardiogenic, neurogenic/spinal and anaphylactic shock; assist in the diagnosis and management of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS), including fluid and transfusion therapy
• Treat infections, including patients with systemic infections (wound infections, pneumonia, peritonitis, sepsis, and septic shock)
• Assist in the management patients with hemodynamic instability and cardiac dysfunction, including mechanical cardiac support tools, such as intra-aortic balloon pump (IABP), venovenous and venoaterial extracorporeal membrane oxygenation, and ventricular assist devices (VADs); assist in the management of pacemakers (Implanted, transthoracic, transvenous, percutaneous), defibrillators (external, AICD), and inhaled nitric oxide and prostacyclin
• Identify and manage malnutrition and assist in the institution of enteral and parental nutrition
• Manage disorders in fluid, electrolyte and acid-base balance
• Manage patients with liver and kidney dysfunction
• Assist in the management patients both pre-and post lung and heart transplantation
• Promote patient safety in the ICU including prophylaxis against gastrointestinal hemorrhage
• Exhibit good judgment in stressful situations

Schedule

Typical CTICU Weekly Schedule

Typical SICU Weekly Schedule

If the medical student is involved in an interesting learning case, he or she is encouraged to stay longer. Medical students are also required to take two evening calls until 11:00 P.M. or one overnight call per week to take advantage of education opportunities available in the evening that typically vary throughout the day. As our multidisciplinary Critical Care Medicine Subinternship in Anesthesiology is an excellent opportunity to gain knowledge and clinical training in the Intensive Care Unit, it is very important to be in attendance every day as scheduled. Medical students are encouraged to plan their rotation around this expectation. Any anticipated absences must be approved by the Medical Student Education Coordinator and Clerkship Director prior to the start of the rotation.

Visiting medical students who are interested in pursuing a rotation in the UCLA Department of Anesthesiology and Perioperative Medicine may apply through VSAS, the Visiting Student Application Service. To obtain information about the David Geffen School of Medicine at UCLA’s supplemental document requirements, application deadlines, and fees, or to view detailed elective course descriptions, please visit http://medschool.ucla.edu/current-visiting-students.

If you have any questions, please contact the Medical Student Coordinator, Jessyka Delgado, either by phone at (310) 267-8667 or via email at [email protected].