Critical care rotations for medical students?

Introduction: Advances in technology have dramatically changed the delivery of medical support in the last 25 years. In spite of this, undergraduate medical education has not traditionally dedicated time to teaching medical students how to care for the critically ill. Moreover, graduating medical students almost uniformly feel uneasy about primarily caring for severely ill patients. We hypothesized those medical students having completed medical and surgical basic clerkships would benefit greatly from a surgical critical care (SCC) rotation where basic goals of diagnosis and management of critical illness could be learned. Methods: Medical students were offered an every other day on call, 4-week SICU rotation. Prior to the start of this rotation the student met with one of the authors. During this interview, goals and objectives were established for the rotation and for each student. No student felt knowledgeable or capable regarding core goals prior to the rotation (Score of 1). Students were instructed to independency complete a computerized orientation program prior to starting their rotation. During the rotation the student was assigned to an in-house SICU resident. Fellows and ICU attendings provide on site daily education on rounds, at the bedside, and in a formal daily lecture series. At the completion of the rotation the students were interviewed and an evaluation completed. Methods of teaching to effect these goals were rated on a scale of 1-5, with 5 being optimal. Data are presented mean +/- SEM. Results: Overall the students rated the rotation at 4.7±1, with 22 of 33 students meeting their own educational objectives at an outstanding level. These goals included cardiovascular physiology (4.5±1), interpretation of SG catheter (4.5±1), use of vasoactwe agents (4.1±1), ventilator weaning (4.1±1), extubation (4.7±1), and use of antibiotics for nosocomial infections (4.1±1). The most effective student teaching occurred via attending daily lecture (4.7±1), morning attending rounds (4.4±1),fellow bedside teaching (4.4±1), and resident bedside teaching (4.3±1). Independent reading on selected topics was rated lower (3.9±1). At the end of the rotation, students felt increased knowledge, responsibility, and confidence compared to baseline. Conclusions: Medical students gain knowledge, responsibility, and confidence during a SCC rotation. A dedicated ICU ream led by an attending intensivist meets critical care educational goals and objectives. On-site supervision and teaching in lectures, rounds and at the bedside remains an effective means of education for medical students.