Intensive care experiences occur in Bellevue Hospital, Tisch Hospital, and the VA Medical Center. Each unit has its own curriculum of lectures that include hands-on demonstrations and practice with the latest technological tools and devices.
With the exception of the intensive care unit at Bellevue, all units are staffed by a team of three second- or third-year residents and four interns. The Bellevue Hospital ICU is staffed by three third-year residents and four interns - an example of graduated responsibility. This approach enhances the exposure of each intern to the management style of different residents and maintains the team atmosphere. At the supervisory level, fellows and attendings are available around the clock.
The Medical Intensive Care Unit at the VA Medical Center
The newly renovated MICU is a state-of-the-art
18-bed facility. The MICU team, composed of one pulmonary fellow, three residents (one
third-year and two second-year residents) and four interns, is directly
supervised by a critical care attending, who rounds with the team
each morning and is available for consultations at all times.
The medical residents have primary management responsibility for their patients, whose pathologies and acute illnesses cover a broad range of diagnoses. As the tertiary referral center for cardiac and neurosurgical interventions for the all regional VA hospitals, residents have the opportunity to receive training in and to perform various procedures, such as central venous and arterial line placement, invasive cardiac monitoring, diagnostic/therapeutic paracenteses and thoracenteses, and endotracheal intubation.
Emphasis is placed on the educational experience of intensive care
medicine, with ample time dedicated to teaching rounds. The teams
generally conduct work rounds early in the morning and then round
with the attendings to discuss both management and academic issues.
The pulmonary fellow is present throughout the day for supervision
and teaching purposes and is on-call after hours for assistance.
Residents have overnight call every third night, and interns are
on overnight call every fourth night.
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The Medical Intensive Care Unit at Bellevue Hospital
This new, state-of-the-art, 12-bed ward is contiguous with the Critical Care Unit, Surgical Intensive Care Unit,
and Neonatal Intensive Care Unit. Few rotations entrust as much responsibility to senior
residents and interns and the team concept of patient care is tightly embraced. The team is led
by an attending physician and a fellow from the Pulmonary/Critical
Care Division, who are both available on a 24-hour basis.
The heart of the team is compromised of three senior residents and four interns who together manage all aspects of patient care. Senior residents have overnight call every third night while interns are scheduled every fourth night. A typical day begins with teaching rounds and a discussion of all new admissions from the previous day. The variety of pathologies seen can at times be astonishing.
Bedside multidisciplinary team rounds, which include
nursing, nutrition, respiratory therapy and radiology, follow teaching
rounds. Bedside teaching is provided by the attending
and consultants from other services. "Hands on"
ventilator management, as well as the placement and interpretation
of data from invasive monitoring equipment, is encouraged under the
watchful eye of an attending or fellow. Successful
completion of the rotation transforms the uncertainties associated with intensive care into
deliberate, rational actions that benefit critically ill patients.
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The Intensive Care Unit/Critical Care Unit at Tisch Hospital
The patient population in the combined 14-bed ICU/CCU is primarily medical, with invaluable exposure to acute care
cardiology. The team is comprised of four interns, one third
year resident, two second year residents, one pulmonary/critical care
fellow, and several intensivists. Hands-on teaching makes this rotation among the most valued and includes ICU morning academic work rounds consisting of formal case-by-case presentations, as well as discussion of management
and academic issues. Formalized care plans are coordinated with the managing intensivist for each
case and a wide variety of formal conferences further supplement the
education experience.
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The Critical Care Unit at Bellevue Hospital
This highlight of the residency program is led by Dr. Timothy Vittorio and gives house staff
the opportunity to participate in the care of critically-ill patients with a variety of disorders,
including: coronary artery disease, congestive heart failure,
atrial and ventricular arrhythmias, pericardial disorders, hypertension,
endocarditis, and valvular disease. Working directly
with a cardiology attending and fellow, house staff play a crucial role
in formulating initial therapeutic and diagnostic plans in this modern
12-bed acute care unit with attached 6-bed step-down
unit that serves as a tertiary referral center for the New York City hospital
system.
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