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University of Washington Medical Center
Andrew M. Luks, MD
Fourth year medical students will function at the sub-intern level on the Medical Intensive Care Unit (MICU) service at the University of Washington Medical Center. During the rotation, they will have direct patient care responsibilities through which they will learn about various forms of critical illness and how to apply different therapeutic and diagnostic modalities commonly used in critical care medicine.
The primary goals of this rotation are as follows:
At the end of this rotation, students should be able to:
The sub-internship will be open to 4th year medical students by departmental permission.
The rotation will be offered from September until May of each year.
The MICU service at the University of Washington Medical Center will consist of an attending physician, a pulmonary and critical care fellow, 2 second-year residents and 3 first-year residents. A senior level physician, the nocturnalist, provides additional attending level in-house coverage of the ICU at night. The sub-intern will take call on this service every 4th night along with one of the second year residents.
Working under the supervision of the pulmonary and critical care fellow and a senior resident, the sub-intern will be responsible for all aspects of care for their patients. They will be expected to write all admission and daily progress on their patients and to communicate with consultants and other providers that are part of the multidisciplinary MICU team.
At the start of the rotation, the sub-intern will admit one patient per night but as the rotation progresses this total may be increased to 2 patients per call night at the discretion of the supervising resident, fellow or attending physician based on the sub-intern’s demonstrated skills and current patient load. Sub-interns may be responsible for up to 4 patients at any one time.
During the course of their work on the service, sub-interns may also gain experience in certain procedures including central venous catheter or arterial line placement. However, priority for all therapeutic and diagnostic procedures goes to the interns and residents on the service and the sub-intern may have to defer to these individuals in certain situations, even when such procedures are being performed on their patients. In the era of work-hour requirements and caps on admissions, it has become increasingly difficult to ensure that the resident staff get adequate procedural experience. It is for this reason that priority for all procedures goes to the resident staff. If they have done an adequate number of the procedure in question or are too busy with other work to complete the procedure, then the sub-intern will have an opportunity to do the procedures.
Your workweek will run from Monday through Saturday morning. On Monday through Thursday, you will arrive early enough to pre-round on your patients and remain in the hospital until your work and other important team activities are done, with the goal being that you leave by 6PM (this is not written in stone). On Friday, you will arrive at the same time as on other days but stay through the evening shadowing the nocturnist and intern, and then leave by 9:30AM on Saturday. This will provide an opportunity to experience nighttime work in the ICU when a lot of interesting things can happen. You will then have off the remainder of Saturday and all of Sunday and return on Monday morning. You will take admissions Monday through Friday as needed to try and maintain a steady personal census of patients. On Fridays, you will stop admitting by around 6PM in order that all of your work on any new patients is done by the time the R2 leaves and the nocturnist starts their shift.
Several different teaching modalities are employed on this service:
The weekly schedule for the rotation is as follows:
* X-ray rounds take place at the PACS machine in the 5East ICU
There is no required reading for the clerkship. Sub-interns are, however, expected to read materials relevant to the care of their patients and other patients on the service as time permits during their rotation. Available sources of reading materials include:
At the end of the rotation, the student’s performance will be evaluated by the attending physician, pulmonary and critical care fellow and senior resident using the current Evaluation of Student Performance in the Clinical Curriculum form. This evaluation is completed on-line but the sub-intern will also receive feedback in person from each of their evaluators.
Students will be graded on an Honors / High Pass / Pass / Fail Basis. There are no examinations or required assignments for this rotation. In order to pass the rotation, students must be present for all assigned workdays and must demonstrate the ability to adequately execute patient care responsibilities.
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