Medical Knowledge

The physician fellow will demonstrate increasing, graduated expertise and competence in the following areas:

• Knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences and their application to patient care through knowledge of disease pathophysiology, diagnosis, and therapy: the physician fellow must learn to be self-motivated to acquire and share new knowledge.
• An analytical and evidence-based approach to diagnosis, therapy, etiology, and prognosis: the physician fellow must be in the habit of exploring underlying mechanisms in clinical situations and consistently and effectively applying basic science and clinical principles relevant to internal medicine to the care of patients.
• Demonstrate growing competence in diagnosing and understanding the etiology of:
  

  ABPA Acid-base balance Alveolar proteinosis ARDS Asthma Aspiration Bronchiectasis Bronchiolitis Collagen vascular diseases Congenital anomalies COPD Cor pulmonale Cough Cystic fibrosis Drug-induced lung disease Dyspnea Emphysema Epiglottitis Hemoptysis Hypersensitivity pneumonitis Interstitial lung disease Kyphoscoliosis Lung abscess Lung cancer

  Lung transplant Mechanical ventilation Mechanisms of hypoxia Mesothelioma Nosocomial pneumonia Occupational lung disease Opportunistic lung infections Pleural effusion Pneumoconiosis Pneumonia Pneumothorax Pulmonary embolism Pulmonary edema Pulmonary hemorrhage syndromes Pulmonary hypertension Respiratory failure Sarcoidosis Sinusitis Sleep disordered breathing Smoking cessation Tuberculosis/atypical mycobacteria Upper airway diseases Wegener's granulomatosis

• Understand the pathophysiology, clinical manifestations, natural history and principles of management of the following frequently encountered disorders in the critical care unit:
  • Disorders of circulatory flow including hemorrhage, sepsis, acute heart failure, and cardiac arrest.
  • Myocardial injury including early management of acute myocardial infarction and tachyarrhythmias.
  • Acute respiratory failure including hypoxia, hypercapnia, and acute respiratory distress syndrome.
  • Infections and inflammatory disorders including nosocomial pneumonia and sepsis from the abdomen and pelvis.
  • Acid-base disorders including metabolic alkalosis and acidosis.
  • Fluid and electrolyte disorders including acute oliguria, hypertonic and hypotonic syndromes, potassium, calcium, and phosphorus abnormalities.
  • Blood component therapy including erythrocyte transfusions and platelet disorders and replacement.
  • Complications arising from hematologic and oncologic malignancies
  • Conditions commonly following solid and hematologic transplants.
  • Neurological disorders including alterations in mentation, movement, and ischemic insults.
• Acute management of toxins and their corresponding treatment. Understand the principles of hemodynamic monitoring and treatment in the critical care unit, including:
  • Invasive arterial blood pressure
  • Pulmonary artery catheter
  • Central venous pressure and wedge pressure
  • Thermodilution
  • Vasoactive drugs
• Understand the principles and management of mechanical ventilation in both the critical care unit and in chronic ventilator facilities:
  • Principles of mechanical ventilation
  • Patterns of assisted ventilation
  • The ventilator-dependent patient
  • Discontinuing mechanical ventilation
• Understand the principles and management of standard critical care practices in patient care including:
  • Vascular access
  • The indwelling vascular catheter
  • Gastrointestinal prophylaxis
  • Venous thromboembolism prophylaxis
  • Analgesia and sedation
• Understand and apply the principles of end-of-life care common to the critical care unit including:
  • Assessment of the comatose patient
  • Withdrawal of support
  • Effective communication with family members