The critical care selective will expose the student to a broad experience in the care of critically ill patients. The clinical site will be a licensed critical care unit (e.g., a medical ICU, surgical ICU, cardiac care unit, neonatal ICU, pediatric ICU, or similar unit). Students will be able to identify preferences for sites from a list of approved critical care rotations and will be assigned to sites based on their preferences and pedagogical and organizational needs. It will be a four-week rotation, and students will be expected to attend clinical duties full time (minimum 36 hours per week). Overnight and/or call duties may vary depending on the clinical site.
Students will be required to attend weekly four-hour Thursday afternoon group learning sessions at the UC Riverside School of Medicine main campus. There will also be a group session on the first day of the rotation at the school for an introduction to the rotation. These can be attended virtually or in person.
Students are required to complete a Critical Care Procedure and Diagnosis Log during the rotation (see below for details), and log duty hours.
Access to a series of online learning modules will be provided to each student, and completion of all modules is required by the end of the rotation. Certain modules will be required to be completed by a certain date as preparation for the on campus didactic sessions (e.g., completion of the online shock module prior to the teaching session on shock). Other adjunctive materials will be provided for various didactic sessions as well (such as slide decks, articles, etc.) and students will be expected to have reviewed these materials prior to specific sessions.
In addition, one session will focus on debriefing regarding difficult patient experiences, and students will be required to complete a reflective writing assignment prior to the session.
Finally, each student will be required to research and present a 20-30 minute presentation on a relevant critical care topic during the final academic session of the rotation. The presentation will be expected to be focused, evidence-based, and to draw and synthesize information from the primary literature. The presentation should cover core physiological and background information, current best practices, current research directions, and future directions for clinical care and research. It is strongly suggested that you have your presentation reviewed by one of your clinical faculty and/or the selective director prior to presentation for feedback.
As approved by the general faculty, the Medical Education Committee has established educational program objectives for the program leading to the M.D. degree. The Educational Program Objectives are comprised of competencies and the measurable objectives by which attainment of each competency can be assessed. The full text of the University of California, Riverside School of Medicine Educational Program Objectives (EPO) can be accessed here.
EPO competency areas referenced:
All objectives are followed by the EPOs to which they pertain.
Director
Brigham C. Willis, M.D.
Attendance
Students are directed to the UCR SOM attendance policy in the Student Handbook.
Students are expected to attend a minimum of at least 20 “shifts” at their clinical site during their four week rotation. A student may not miss more than three days of a rotation due to illness, emergency, or an approved absence. A longer absence must be remediated in consultation with the selective director and medical education or the rotation must be repeated.
Interactive Learning Sessions
UCR SOM or Virtual
Academic Half-day – Thursday afternoons (See session list and specific requirements below.) All sessions are mandatory. There is also an orientation on the first day of the rotation. Dismissal to sites by 10 a.m.
Clinical Site Requirements
Call Schedule:
All students are expected to participate in some type of after-hours experience. While students are not required to take overnight call, such call may be a part of the schedule at a given site, within the limits set by duty hour rules. The schedule will vary according to the site. Specific expectations and schedules will be determined by the site director.
Dress Code:
Professional attire is expected when you are interacting with patients in the inpatient and outpatient clinical setting. Examples of appropriate dress include trousers and a button-down shirt for men and slacks/skirt and a blouse for women. White coats and name badges are expected in both the inpatient and outpatient setting. Scrubs are acceptable based on site director preference. Closed toe shoes are necessary for your protection.
Professionalism and Privacy Practices Issues:
Cell phones and other electronic devices should be used appropriately. Photographs of patients are not permitted without express, written permission. When in lectures, rounds and other learning environments, please pay attention and limit the use of these devices.
You are responsible for learning the privacy practices for each site at which you work. The attending and/or site coordinator will be familiar with these and can provide guidance. Always keep HIPPA in mind and observe all policies and practices.
Suggested Texts
Some readings from the suggested texts will be required prior to designated academic sessions
Required Online Modules
Virtual Critical Care Rounds
Provided through the Society for Critical Care Medicine (SCCM) website. Students will be expected to complete all modules in either the VCCR Adult I or VCCR Pediatric II series. Each student will be provided with a login and password for both series, and progress and completion dates will be monitored by the selective director. Certain modules will need to be completed by certain dates (e.g., the module on Shock will need to be completed prior to the on-campus didactic session on shock).
VCCR Access: https://www.sccm.org/Education-Center
Reflective Writing Assignments
Students will be expected to complete a reflective writing assignment related to their experiences on the rotation (or related to experiences with critically ill patients on other clerkships or rotations) prior to the on-campus session entitled “Debriefing on Experiences in Critical Illness.” The reflections must be a minimum of one page in length (standard margins, font no larger than 12 point), but the assignments are expected to be thoughtful and thorough. These will not be graded for content, and will not be read by the facilitators before the session, but they will serve to inform your discussion and allow you to thoughtfully reflect on your experiences prior to the discussion. Assignments should be submitted online. Please also print them out or bring an e-copy to the session. Also see Reflective Writing Grading Rubric.
Final Presentation
Each student will be required to research and present a 20-30 minute presentation on a relevant critical care topic during the final academic session of the rotation. The presentation will be expected to be focused, evidence-based, and to draw and synthesize information from the primary literature. The presentation should cover core physiological and background information, current best practices, current research directions, and future directions for clinical care and research. See Presentation Grading Rubric.
Patient Experience and Procedure Logs
Students are expected to complete experiential and procedure tracking logs to ensure a complete educational experience in critical care.
Duty Hours
Students are expected to complete duty hour logs per UCR SOM policy and report violations to the selective director.
All sessions will be case-based and entirely interactive / simulation based. It is intended that these small-group learning sessions be based on group participation, discussion, and active learning. As such, it is critical that students come to the on-campus sessions prepared by having reviewed and / or completed the specified independent learning materials. The background materials are intended to give the student enough knowledge, supplemented by what they see and learn clinically, to engage in a reasonable discussion of related clinical cases. Students WILL be expected to have a basic understanding of the topics to be covered and to participate in an intelligent discussion of the cases presented. Small group facilitators will be instructed to actively assess the level of preparedness of each student as a part of the small group participation assessments.
All objectives and supplementary materials for each session are located on the Critical Care Selective folder in iLearn or Canvas.
Assessment is the mechanism used to measure progress in learning over a given period of time. Please refer to the Assessment Flow Diagram in Appendix A and the Critical Care Medicine Selective Assessment Process in Appendix C for additional details.
A mid-rotation formative assessment for each student is strongly suggested. This is scheduled at a specific time and students are required to pro-actively plan on timely completion in discussion with their faculty member. If there are identified challenges, the Selective Director should be notified as soon as possible. The mid-rotation assessment will be completed by a faculty member (designated by the site director or selective director) at the student’s primary clinical site. Student progress, achievements, strengths, weaknesses, and areas for improvement should be discussed. These are not summative and do not require a form to be completed, but are intended to guide the student in their learning and development on the rotation.
Additionally, throughout the four weeks of the selective, faculty and residents engaged in student teaching and supervision will provide formative feedback in a variety of formats (e.g. review of progress notes, H&P’s, direct observation forms, informal verbal feedback and written narratives) that may be communicated in writing or verbally. The purpose of this feedback is to identify strengths and opportunities for improvement. Any significant deficiencies or concern should be communicated to the selective and/or site director with written documentation that the feedback has been provided to the student.
A minimum of one clinical End of Rotation Assessment per rotation will be submitted for the student’s clinical grade by the site director or their appointee.
Where applicable, multiple End of Rotation Assessments will be considered in the clinical grade calculation (see below under “grading”) providing each assessor has had significant interaction with the student. In the instance that only one End of Rotation Assessment is submitted, it will be a collaborative assessment from the preceptors who had significant interaction (as defined by the selective director) with the student. Where only a single faculty member has been assigned to work with a student, this faculty member will provide an assessment for the student.
In addition, a student may request that the site director or designee seek assessment input from faculty the student feels have had significant interaction with that student. Additional assessors (such as residents, fellows, or other faculty) may use the Critical Care Selective Supplementary Feedback Form (PRIME) for such feedback (see below).
A Selective Director Final Assessment form will be completed by the selective director.
All End of Rotation Assessment Forms and the Selective Director Final Competency Assessment Form may be viewed by students.
Student evaluation of the selective is required. The student must complete the evaluation in the required time frame and submit the document on line. All comments will be expected to model constructive feedback, and must contain references and comments to specific behaviors and/or events (positive or negative).
Clinical performance will account for 50% of the composite score and is assessed using the End of Rotation Assessment forms. The selective director will review and include all of the available End of Rotation Assessments to complete the Selective Final Grade Form. Students may also distribute and submit feedback from residents, fellows, and other faculty with whom they have had significant contact using the Critical Care Selective Feedback (PRIME) Form.
Each of the criteria and components below will be compiled by the selective director to determine the non-clinical grade:
Participation in small group learning sessions 20 points possible
Aggregate of small group facilitator assessments (see attached facilitator assessment form in appendix); satisfactory participation in all sessions will earn 100% of points (includes completion of auxiliary learning items prior to sessions (e.g., modules or reflective writing assignments)).
Successful completion of online learning modules 28 points possible
100% awarded for completion of all modules by designated dates; three points deducted per module late or not completed.
Completion of Critical Care Procedure and Diagnosis Log and Duty Hour Logs 20 points possible
100% awarded for on-time completion of logs; 10 points deducted for late completion of either log.
Final presentation 32 points possible
See grading rubric for breakdown of points.
For the non-clinical assessment, a percentage will be calculated based on the students total points achieved, divided by the total possible (100)
For the non-clinical assessment (combining participation, online learning modules, procedure and diagnosis log, and final presentations), the following cutoffs will be used:
The grade will be a composite grade, using the clinical performance, completion of required supplementary activities, and participation in on-campus academic activities. The composite grade will be divided into four categories: Honors, High Pass, Pass, or Fail (H, HP, P, or F). The following guide will be used in determining the final grade:
| Clinical Grade | Non-clinical Grade | Final Grade |
|---|---|---|
| Honors | Honors | Honors |
| Honors | High Pass | Honors |
| High Pass | Honors | Honors |
| Honors | Pass | High Pass |
| High Pass | High Pass | High Pass |
| High Pass | Pass | High Pass |
| Pass | Honors | High Pass |
| Pass | High Pass | Pass |
| Pass | Pass | Pass |
| Fail | (Any Grade) | Fail |
| (Any Grade) | Fail | Fail |
Failure of the selective will require the selective to be repeated in its entirety.
Students are to have the following requirements completed by the defined deadline. In the absence of a significant extenuating circumstance determined by the Selective Director (e.g. software issues, illness, etc.) that preclude completion within the defined deadline, the medical student will receive a grade no higher than Pass once these assignments are completed:
The student will fail the selective if they receive a failing score on one of any of the following:
Comments: The selective director will complete a Final Grade Form indicating the individual and composite components of the grade. This is the final grade/evaluation form for the student that contains the final recorded transcript grade, comments from all of the End of Rotation assessments and a separate box with the summarized final comments which will be included in the MSPE (dean’s letter). The summary final comments are generally not a direct cut and paste but rather a sample summary determined by the selective director. The selective directors have the right to include or not include comments based on their interpretation of which comments best summarize the student’s performance over the entirety of the selective. Students may not pick specific, comments to be included or excluded in their narrative grade form. Students do not grade or summarize their own performance. Any concerns regarding narrative comments may be addressed to the selective director or senior associate dean of medical education.
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Source:
https://ume.ucr.edu/critical-care
Captured on May 6, 2021