Training and Education - Critical Care Medicine

Academic schedule at St. Johns critical care department:

The department of critical care at St. John's medical college hospital endeavours to challenge post-doctoral scholars as well as post MBBS students in a number of new and rewarding ways, from broadening their knowledge in critical care, gaining procedural skills, honing one’s clinical acumen and generating excitement about research methodology during their stay in SJMCH. Yet with all these new challenges, it also provides an atmosphere to develop the skills they need to be able to cope with stress, a hectic schedule and impending deadlines.

Each year’s academic schedule appropriately starts with lectures by senior faculty on epistemology, Epidemiology, statistics and concepts of research. This is usually followed by a detailed discourse on basic science approach to common clinical problems faced in critical as care as part of course work. This sets the tone and propels one in the quest for further knowledge as well as to understand science in action as they go about their clinical work and also helps raise interesting research questions.

Each month’s academic schedule is prepared and circulated well in advance keeping in mind both the academic requirements as well as practical clinical knowledge needed. These are decided based on the vast experience of the teaching faculty as well as after taking adequate inputs from all stakeholders. This usually includes morning classes on short topics which are clinically relevant followed by lectures on concept-based learning in critical care or paper reading of articles with relevant discussion pertinent to clinical application as well for academic requirements. Bedside teaching is usually in the form of clinical case discussion as well as demonstration of clinical assessment such as ultrasound techniques, understanding ventilator graphics etc. Simulation based learning is an important part of teaching with respect to ACLS, Trauma care and mini simulation sessions reflecting clinical scenarios for focused learning.

As part of their academic course the various post-doctoral scholars including DM graduates, IDCCM and IFCCM graduates are encouraged to take up research and are actively guided by able faculty during this time. The department also conducts various workshops for inhouse and external students such as ASTriCC, BEStriCC and CoBoStiCC- dealing with various topics such as bedside echocardiography to Acid base analysis. During which time the students/ Scholars are encouraged to attend as well as participate in the conduct of these workshops thereby giving an important fillip to learning the methods of presentation and speaking in a broad congregation.

“In vain have you acquired knowledge if you have not imparted it to others”- Deuteronomy. This understanding is exemplified by the methodology followed in the department where anyone and everyone who is involved in the above said teaching sessions endeavours to impart knowledge by a free-flowing discussion. As it is also true that “We owe almost all our knowledge not to those who have agreed, but to those who have differed” (Charles Caleb). On the whole idea is to provide an environment towards acquisition of knowledge and understanding by self-learning and allowing for unrestricted discourse on relevant topics as well as to excel in research and clinical wisdom.

DM Critical Care Medicine
DM in Critical Care Medicine is a 3 year medical council of India recognized program in Critical Care that our department is providing since 2013. The ideology of the department is to guide and help the trainee to acquire knowledge, develop the skills and qualities to become a successful leader and head of the unit. The department doesn’t aim to provide only academic knowledge but aims at overall holistic development of the trainee. The trainee is given opportunity and guidance to learn research, acquiring skills, organizing events apart from academics.

Academic program for DM trainee
The academic teachings involves, didactic lectures, presentations both short and concept clearing presentations, bedside demonstrations and clinical discussions as the stem. The program starts with course work which involves the philosophy of learning, epidemiology, statistics followed by critical care physiology in the first academic year. At later years the trainee is taught both formally and informally the core critical care topics through seminars, group discussions, tutorials and workshops and open book searches. This gives the trainee broad idea of the subject and stimulates more thinking and reasoning. Apart from critical care training the trainee is rotated in department of Medicine, Anaesthesiology, Emergency medicine, cardiology, Cardiovascular surgery, Neurology , Pulmonary medicine and Nephrology for additional exposure.

Each trainee is mandated to do an individual research project. The trainee is given guidance while framing the study protocol as well as all stages of research till analysis and publication. The department highly encourages any additional research project the trainee is willing to conduct and allow them to participate in various workshops and conferences.

Play and learn
The trainee along with their colleagues and other ICU staff take part in themed quiz. This gives them the opportunity to form their team and coordinate among members. Also, to apply what they learn, simulation based integrated clinical scenarios and clinical task are conducted as a play to develop their skills to identify problems, quick decision making and also provide opportunity to act as team leader.

Personal development
The department encourages the trainee to take part in department meeting and to provide their opinions and suggestions and also provides opportunity to take part in various workshops and CME that the department conducts as faculty to express themselves. Each trainee is given the responsibility of the consultant during their last 6 months of training to develop their decision making, analytical and communication skills.

Training in the Department of Critical care:
All faculty and residents of the Department have three roles: a) Patient care b) Knowledge dissemination: Teaching & Training of staff c) Knowledge production: Research relevant to the needs of the institution & society.
Training and Teaching (T&T) are taken very seriously in the department and this is an integral part of the work flow.

Schedule of Teaching and Training:
a) Every morning the handover will start at 0845 and it is never a work handover. Formal, detailed, standardized handovers are the norm. The resident who is presenting is encouraged and guided to actively think of differential diagnoses, the most effective pathways to accurate diagnoses and a risk-benefit analysis of the planned course of action. All students are encouraged to actively question each other and the faculty to foster intellectual development.
b) Morning class: Morning classes are scheduled and are aimed at brief 15 minute presentations which are aimed at elucidating concepts.
c) Tutorials: These are held at two monthly intervals, a topic is decided and all relevant literature is identified by a faculty member and distributed to students. Students will present in a chronological manner the literature and at the end of the session the aim would be to have a grasp of the extent of literature in the topic and the nuances and controversies.
d) Course work: This starts at the beginning of the academic year. Core basic sciences are taught over a month for each subject. Problems and projects are given weekly and internal assessments are recorded. Open book examinations with no time limits are held in certain subjects to let the students unleash their creativity and assess their analytic skills.
e) Paper reading, topic discussions: These are scheduled at regular intervals.

Indian Fellowship in Critical Care Medicine (IFCCM) is a fellowship program in critical care medicine awarded by Indian Society of Critical Care Medicine (ISCCM).
Out of 98 seats available throughout India, St. John’s medical college hospital is the only medical college in Karnataka to have IFCCM course. Two teachers who are eligible for the program are
Dr. Sriram Sampath
Dr. Bhuvana Krishna
The main aim of IFCCM course is to enhance the skills and knowledge of the candidate and to provide a standardized care and evidence-based practice in the field of critical care medicine. Candidates who have finished IDCCM successfully are eligible for fellowship program. Dept. of Critical Care Medicine is accredited for one IFCCM seat per year. The duration of this course is one-year post IDCCM.

The salient features of pursuing IFCCM in the department of Critical Care Medicine, St. John’s medical college hospital are:

Only medical college in Karnataka to possess fellowship course
Daily academic activities like seminars, symposiums and course work
Weekly real time case discussion at the bedside
Mandatory to do research project during the course
Develop the skills on how to read a paper in this evidence-based era
Develop your communication skills since it is the only department having a separate counselling session for patient’s relatives.
Develop your administrative and management skills since the department conducts regular CMEs and workshops in hard core critical care topics
For further queries regarding IFCCM course, kindly follow the link given below

Future Directions
The Department of Critical Care has earned a name nationwide over the last 2 decades for its academic and clinical excellence. The aim and motto of the department “Excellence -in all that we do”; to deliver the best patient care and train future intensivists and critical care nurses, who will carry on to foster the core values of the Institute and Department. The Department will strive to maintain quality in all aspects even as it grows, keeping in pace with recent evidence, critical care technologies and innovations. The surplus in clinical information will serve as the nidus for several research activities.

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