Pharmacy Services

Home Residency Rotations Surgical Intensive Care Unit (SICU)

Residency

Surgical Intensive Care Unit (SICU)

Preceptors:

Nick Lonardo, PharmD
Kyle Ludwig, PharmD, BCPS
Wayne Shipley, PharmD, BCPS

 
Site Description:

The surgical intensive care unit at the University of Utah Hospital is a 20 bed unit. Typical patients admitted to the SICU are trauma, cardiothoracic, vascular, and transplant surgery patients. The acuity is very high and it is not unusual for patients to stay greater than 30 days.

The pharmacist functions as part of a multidisciplinary team comprised of an attending physician, surgical, anesthesia, and emergency medicine residents, clinical nurses, medical students, dietitians, and respiratory therapists.

As a clinical pharmacist in the SICU, daily rounds are expected to be in attendance as well as being available to answer questions and help facilitate delivery of medications. The pharmacist also participates in a weekly multidisciplinary meeting as well as any codes.

 
Rotation Description:

Typical expectations of resident include the following: working up approximately 12 critically-ill patients daily, interacting with attending physicians, surgical, anesthesia, and emergency medicine residents, clinical nurses, medical students, dietitians, and respiratory therapists during rounds. Resolve medication-related problems for these patients, documenting all patient care activities on the monitoring record, leading a weekly topic discussion with the preceptors, formal patient presentations to the preceptor at least 3x/weekly, attending surgery and pharmacy grand rounds when the schedule permits, responding to drug information requests from the providers, and precepting pharmacy students also on rotation.

 
Activities Evaluated:

Rotation Activity RLS Goal &
Teaching
Method
Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system by analyzing patient data (up to 12 SICU patients daily). All medication concerns should be identified and addressed before completing of the clinical day. R1.4
M,C,F
Place practice priority on the delivery of patient-centered care to patients. Patient care during this rotation is of the highest priority. Patient bedside assessment and involvement are expected during the SICU rotation. R2.2
M,C,F
Collect and analyze patient information for all assigned patients from all information resources - paper, people, and electronic. R2.4
I, M,C, F
Design evidence-based therapeutic regimens on a daily basis for each patient assigned in the SICU and present a systemic organ system base status. Formal patient presentations will takes place at least three days weekly during the SICU rotation. Discussions of patient-care plans will be reviewed with the preceptor daily. R2.6
I, M, C, F
Design evidence-based monitoring plans for each assigned SICU patient. R2.7
I, C, M, F
Recommend or communicate regimens and monitoring plans daily on rounds and when following up with the team after rounds. R2.8
M, F
Implement regimens and monitoring plans. All assigned patients (up to 12) will be reviewed for pharmaceutical interventions throughout the clinical day. Clinical daily rounds are expected for attendance as well as attentiveness. After daily rounds, a brief review of each patient will take place to make sure all interventions took place. R2.9
M, F
Communicate ongoing patient information through patient notes and pharmacist-to-pharmacist pass off. R2.11
M, F
Document direct patient care activities in our SICU monitoring book for each side. R2.12
M,C,F
Use information technology to make decisions and reduce error when preparing for rounds or answering questions. R6.1
I, C, F
Identify a core library for ICU practice. Some basic literature will be provided on a weekly basis (see below for list) and preceptors expect residents to acquire primary and secondary literature based on needs of the subject matter. E6.1
I, F
Communicate effectively with the rounding team, pharmacists at pass-off, patients and their families. E7.2
I, C, F
Manage time effectively to fulfill practice responsibilities in the ICU. Patient care is the upmost priority during this rotation. All practice duties are expected to be completed during a reasonable time period therefore, if residents need extra preparation time for rounds, he or she must come in early enough to ensure he/she is prepared in time. E7.4
M,F
I-Instruct, C-coach, M-mentor, F-facilitate

 
Readings as below and/or other readings, as appropriate:

ICU Introduction

  1. Sloniewsky D editor. The Medical Student's Guide to Intensive Care Medicine, SCCM publication 2005.
  2. Position Paper on Critical Care Pharmacy Services. Pharmacother 2000;20:1400-6.

Ventilators

  1. Barbarash RA, Smith LA, et al. Mechanical Ventilation. Ann Pharmacother 1990;24:959-70.
  2. Cawley MJ. Mechanical Ventilation: A Tutorial for Pharmacists. Pharmacother 2007;27:250-66.

Blood Gases

  1. Kirksey KM, Holt-Ashley M, Goodroad BK. An Easy Method for Interpreting the results of Arterial Blood Gas Analysis. Crit Care Nurse 2001;21:49-54.

Acid/Base Disturbances

  1. Adrogue HJ, Madias NE. Management of life-threatening acid-base disorders (2 parts). N Engl J Med 1998;338:26-34, 107-11.
  2. Gluck SL. Acid-base. Lancet. 1998;352:474-9.

Electrolyte Disorders

  1. Kraft MD, Btaiche IF, Sacks GS, et al. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health-Syst Pharm 2005;62:1663-82.
  2. Adrogue AJ, Madias NE. Hypernatremia. N Engl J Med 2000;342:1493-99.
  3. Adrogue AJ, Madias NE. Hyponatremia. N Engl J Med 2000;342:1581-91.
  4. Somerville KT, Wheeler M. Hypophosphatemia: Etiology, Clinical Manifestations, Current Treatments. Trends in Drug Therapeutics 1997, volume 11 number 5.

Pulmonary Artery Catheters

  1. Dvorak-King C. PA Catheter Numbers Made Easy. RN 1997;Nov.:45-49.
  2. Norris DL, Klein LA. What all Those Pressure Readings Mean.and Why. RN 1981;Oct.:35-42.

Vasoactive Agents

  1. Kellum JA, Pinsky MR. Use of Vasopressor Agents in Critically Ill Patients. Curr Opin Crit Care 2002;8:236-41.
  2. Holmes CL, Patel BM, et al. Physiology of Vasopressin Relevant to Management of Septic Shock. Chest 2001;120:989-1002.

DVT prophylaxis

  1. Geerts W, Selby R. Prevention of venous thromboembolism in the ICU. CHEST 2003;124:357S-363S.
  2. Rogers FB, Cipolle MD, et al. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J Trauma 2002;53:142-164.
  3. Williams MT, Aravindan N, et al. Venous thromboembolism in the intensive care unit. Crit Care Clin 2003;19(2):185-207.

Stress Ulcer Prophylaxis

  1. Cash BD. Evidence-Based Medicine as it Applies to Acid Suppression in the Hospitallized Patient. Crit Care Med 2002;30(Suppl. 6):S373-8.
  2. Allen ME, Kopp BJ, Erstad BL. Stress Ulcer Prophylaxis in the Postoperative Period. Am J Health-Syst Pharm 2004;61:588-96.

Sedation/Analgesia

  1. Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult. Crit Care Med 2002 Jan;30(1):117-141.

NMBAs

  1. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Critically Ill Adult Patient. Crit Care Med 2002 Jan;30(1):142-156.

Ventilator-Associated Pneumonia

  1. Porzecanski I, Bowton DL. Diagnosis and treatment of ventilator-associated pneumonia. Chest 2006;130:597-604.
  2. Chastre J, Fagon FY. Ventilator-associated Pneumonia. Am J Respir Crit Care Med 2002;165:876-903.
  3. ATS & IDSA. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.
  4. Chastre J, Wolff M, et al. Comparison of 8 vs 15 Days of Antibiotic Therapy for VAP in Adults. JAMA 2003;290(19):2588-2598.

Aspiration Pneumonia

  1. Marik PE. Aspiration Pneumonitis and Aspiration Pneumonia. N Engl J Med 2001;344:665-71.

ARDS/ALI

  1. Ware LB, Matthay MA. The Acute Respiratory Distress Syndrome. N Engl J Med 2000;342:1334-49.
  2. Brower RG, Ware LB, et al. Treatment of ARDS. CHEST 2001;120:1347-1367.
  3. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8.
  4. Meduri GU, Headley AS, et al. Effect of Prolonged Methylprednisolone Therapy in Unresolving Acute Respiratory Distress Syndrome. JAMA 1998;280:159-65.
  5. The NHLBI Acute Respiratory Distress Syndrome Clinical Trials Network. Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome. N Engl J Med 2006;354:1671-84.
  6. Meduri GU, Golden E, Freire AX, et al. Methylprednisolone Infusion in Early Severe ARDS. CHEST 2007;131:954-63.

Sepsis

  1. Dellinger RP, Carlet JM, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-872.
  2. Hotchkiss RS, Karl IE. The Pathophysiology and Treatment of Sepsis. N Engl J Med 2003;348:138-50.
  3. Jacobi J. Sepsis: A Frequent, Life-Threatening Syndrome. Pharmacotherapy 2002;22(12 pt 2):169S-181S.
  4. PROWESS Study N Engl J Med 2001;344:699-709.
  5. ENHANCE US CHEST 2004;125:2206-2216.
  6. Rivers E, Nguyen B, et al. Early Goal-Directed Therapy in the Treatment of Sever Sepsis and Septic Shock. N Engl J Med 2001;345:1368-77.
  7. Schrier RW, Want W. Acute renal failure and sepsis. N Engl J Med 2004;351:159-69.

Shock

  1. Dellinger RP. Cardiovascular management of septic shock. Crit Care Med       2003;31(3):946-953.

Insulin Therapy in Critically Ill

  1. Van den Berghe G, Wouters P, et al. Intensive Insulin Therapy in Critically Ill Patients. N Engl J Med 2001;345:1359-67.

Relative Adrenal Insufficiency

  1. Marik PE, Zaloga GP. Adrenal Insufficiency in the Critically Ill: A New Look at an Old Problem. Chest 2002;122:1784-96.
  2. Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003;348:727-34.
  3. Annane D, Sebille V, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862-871.

Nutrition

  1. Hodges BM, Mazur JE. Nutrition management in the intensive care unit. In: Schumock G, Brundage D, Chapman M, et al, eds. Pharmacotherapy Self-Assessment Program, 5th ed. Nutrition I. Kansas City, MO: American College of Clinical Pharmacy, 2005:141-157.
  2. Btaiche IF, Khalidi N. Metabolic Complications of Parenteral Nutrition in Adults, Part 1. Am J Health-Syst Pharm 2004;61:1938-49.
  3. Btaiche IF, Khalidi N. Metabolic Complications of Parenteral Nutrition in Adults, Part 2. Am J Health-Syst Pharm 2004;61:2050-9.

Atrial Fibrillation

  1. Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med 1997;336:1429-1434.
  2. Chung MK. Cardiac surgery: postoperative arrhythmias. Crit Care Med 2000;28:N136-N144.
  3. Mitchell LB, Exner DV, Wyse DG, et al. Prophylactic oral amiodarone for the prevention of arrhythmias that begin early after revascularization, valve replacement, or repair (PAPABEAR). JAMA 2005;294:3093-100.
  4. Vardas PE, Kochiadakis GE, et al. Amiodarone as a First-Choice Drug for Restoring Sinus Rhythm in Patients With Atrial Fibrillation. Chest 2000;117:1538-45.

Antibiotics

  1. Van Scoy RE, Wilkowske CJ. Antimycobacterial Therapy. Mayo Clin Proc 1999;74:1038-48.
  2. Marshall WF, Blair JE. The Cephalosporins. Mayo Clin Proc 1999;74:187-95.
  3. Wright AJ. The Penicillins. Mayo Clin Proc 1999;74:290-307.
  4. Hellinger WC, Brewer NS. Carbapenems and Monobactams: Imipenem, Meropenem, and Aztreonam. Mayo Clin Proc 1999;74:420-34.
  5. Edson RS, Terrell CL. The Aminoglycosides. Mayo Clin Proc 1999;74:519-28.
  6. Alvarez-Elcoro S, Enzler MJ. The Macrolides: Erythromycin, Clarithromycin, and Azithromycin. Mayo Clin Proc 1999;74:613-34.
  7. Smilack JD. The Tetracyclines. Mayo Clin Proc 1999;74:727-29.
  8. Smilack JD. Trimethoprim-Sulfamethoxazole. Mayo Clin Proc 1999;74:730-4.
  9. Kasten MJ. Clindamycin, Metronidazole, and Chloramphenicol. Mayo Clin Proc 1999;74:825-33.
  10. Wilhelm MP, Estes L. Vancomycin. Mayo Clin Proc 1999;74:928-35.
  11. Walker RC. The Fluoroquinolones. Mayo Clin Proc 1999;74:1030-7.

Antibiotic Dynamics

  1. Turnidge JD. The pharmacodynamics of beta-lactams. CID 1998;27:10-22.
  2. Lacy MK, Nicolau DP, et al. The pharmacodynamics of aminoglycosides. CID 1998;27:23-7.
  3. Carbon C. Pharmacodynamics of macrolides, azalides, and, and streptogramins: effect on extracellular pathogens. CID 1998;27:28-32.
  4. Lode H, Borner K, Koeppe P. Parmacodynamics of fluoroquinolones. CID 1998;27:33-9.
  5. Schentag JJ, Strenkoski-Nix LC, et al. Pharmacodynamic interactions of antibiotics alone and in combination. CID 1998;27:40-6.

Aminoglycosides

  1. Kashuba ADM, Nefziger AN, et al. Optimizing aminoglycoside therapy for nosocomial pneumonia caused by gram-negative bacteria. Antimicrob Agents Chemother 1999;43:623-629.

Antibiotics for Surgical Prophylaxis

  1. Antimicrobial Prophylaxis for Surgery: An Advisory Statement from the National Surgical Infection Prevention Project. CID 2004;38:1706-15.

Intraabdominal Infections

  1. Solomkin JS, Mazuski JE, et al. Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. CID 2003;37:997-1005.

Catheter-Related Infections

  1. Guidelines for the Management of Intravascular Catheter-Related Infections. CID 2001;32:1249-72.

VRE

  1. Murray BE. Vancomycin-Resistant Enterococcal Infections. N Engl J Med 2000;342:710-21.

Candidiasis

  1. Pappas PG, Rex JH, et al. Guidelines for treatment of candidiasis. CID 2004;38:161-89.
  2. Eggimann P, Francioli P, et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med 1999;27:1066-72.

Fever

  1. Marik PE. Fever in the ICU. Chest 2000;117:855-69.

Abdominal Compartment Syndrome

  1. The Abdominal Compartment Syndrome (Panel Discussion). Arch Surg 2004;139:415-422.

Pancreatitis

  1. Wyncoll DL. The management of severe acute necrotizing pancreatitis: an evidence-based review of the literature. Intensive Care Med 1999;25:146-56.
  2. Swaroop VS, Chari ST, Clain JE. Severe acute pancreatitis. JAMA 2004;291(23):2865-68.

Cirrhosis/Ascites

  1. Gines P, Cardenas A, Arroyo V, et al. Management of cirrhosis and ascites. N Engl J Med 2004;350:1646-54.

GI Bleeding

  1. Conrad, SA. Acute upper gastrointestinal bleeding in critically ill patients: causes and treatment modalities. Crit Care Med 2002;30(Suppl. 6):S365-8.

Promotility

  1. Booth CM, Heyland DK, Paterson WG. Gastrointestinal promotility drugs in the critical care setting: a systemic review of the evidence. Crit Care Med 2002;36:1929-37.

Fluids

  1. The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247-56.

Delirium in the ICU

  1. Pandhaipande P, Shintani A, Peterson J, et al. Lorazepam is an independent risk factor for transitioning to delirium in the intensive care unit. Anesthesiology 2006;104:21-6.
  2. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004;291:1753-62.
  3. Milbrandt EB, Deppen S, Harrison PL, et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004;32:955-62.
  4. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001;286:2703-10.

Alcohol Withdrawal

  1. Spies CD, Rommelspacher H. Alcohol withdrawal in the surgical patient: prevention and treatment. Anesth Analg 1999;88:946-54.

Head Injury

  1. Mayer SA, Chong JY. Critical care management of increased intracranial pressure. J Intensive Care Med 2002;17:55-67.
  2. Marik PE, Varon J, Trask T. Management of head trauma. Chest 2002;122:699-711.

Spinal Cord Injury

  1. Hurlbert RJ. The role of steroids in acute spinal cord injury. Spine 2001;26:S39-46.
  2. Bracken MB. Methylprednisolone and acute spinal cord injury. Spine 2001;26:S47-54.
  3. Bracken MB, Shepard MJ, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury: results of the third national acute spinal cord injury randomized trial (NASCIS III). JAMA 1997;277:1597-604.

Status Epilepticus

  1. Lowenstein DH, Alldredge BK. Status epilepticus. N Engl J Med 1998;338:970-6.
  2. Chapman MG, Smith M, Hirsch NP. Status epilepticus. Anaesthesia 2001;56:648-59.

Diabetes Insipidus

  1. Tisdall M, Crocker M, Watkiss J, et al. Disturbances of sodium in critically ill adult neurologic patients. J Neurosurg Anesthesiol 2006;18:57-63.
  2. Sands JM, Bichet DG. Nephrogenic diabetes insipidus. Ann Intern Med 2006;144:186-94.

Donors

  1. Rosendale JD, Kauffman HM, et al. Aggressive pharmacologic donor management results in more transplanted organs. Transplantation 2003;75:482-7.

Contrast Induced Nephropathy

  1. Merten GJ, Burgess WP, et al. Preventaion of contrast-induced nephropathy with sodium bicarbonate. JAMA 2004;291:2328-2334.
  2. Briguori C, Colombo A, Violante A, et al. Standard vs. double dose of N-acetylcysteine to prevent contrast agent associated nephrotoxicity. European Heart J 2004;25:206-11.
  3. Tepel M, van der Giet M, et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343:180-4.

CVVHD

  1. Bugge JF. Pharmacokinetics and drug dosing adjustments during continuous venovenous hemofiltration or hemodiafiltration in critically Ill patients. Acta Anaesthesiol Scand 2001;45:929-34.

HIT

  1. Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. British J Haematol 2003;121:535-55.
  2. Spinler SA, Dager W. Overview of heparin-induced thrombocytopenia. Am J Health-Syst Pharm 2003;60:S5-11.
  3. Greinacher A. Treatment options for heparin-induced thrombocytopenia. Am J Health-Syst Pharm 2003;60:S12-18.

Anemia in Critical Care

  1. Hebert PR, Wells G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999;340:409-17.
  2. Corwin HL, Gettinger A, et al. Efficacy of recombinant human erythropoietin in critically ill patients. JAMA 2002;288:2827-35.
  3. Corwin HL, Gettinger A, et al. Efficacy of recombinant human erythropoietin in the critically ill patient: a randomized, double-blind, placebo-controlled trial. Crit Care Med 1999;27:2346-2350.

Factor VII use in critical care

  1. Levi M, Peters M, Buller HR. Efficacy and safety of recombinant factor VIIa for treatment of severe bleeding: a systematic review. Crit Care Med 2005;33:883-90.
  2. Boffard KD, Riou B, Warren B, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma 2005;59:8-18.
  3. O'Connell KA, Wood JJ, Wise RP, et al. Thromboebolic adverse events after use of recombinant human coagulation factor VIIa. JAMA 2006;295:293-8.
  4. Meng ZH, Wolberg AS, Monroe DM, et al. The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients. J Trauma 2003;55:886-91.

Hypertensive Crisis

  1. Varon J, Marik PE. The diagnosis and management of hypertensive crisis. Chest 2000;118:214-27.

DKA

  1. Magee MF, Bhatt BA. Management of decompensated diabetes: diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Crit Care Clin 2001;17:75-106.

Toxicology

  1. MokhlesiB, Leikin JB, et al. Adult toxicology in critical care part I: general approach to the intoxicated patient. Chest 2003;123:577-92.
  2. MokhlesiB, Leikin JB, et al. Adult toxicology in critical care part II: specific poisonings. Chest 2003;123:897-922.

ACLS

  1. Dager WE, Sanoski CA, Wiggins BS, et al. Pharmacotherapy Considerations in Advanced Cardiac Life Support. Pharmacother 2006;26:1703-29.

Hepatorenal Syndrome

  1. Cardenas A. Hepatorenal Syndrome: A Dreaded Complication of End-Stage Liver Disease. Am J Gastroenterol 2005;100:460-7.

 
Core Topics To Be Covered:

  1. Ventilator modes
  2. Deep vein thrombosis prophylaxis
  3. Stress ulcer prophylaxis
  4. Acid-base disorders
  5. Electrolyte replacement
  6. Sedation and analgesia
  7. Neuromuscular blockade
  8. Nutrition support
  9. Glycemic control
  10. Acute renal failure
    1. Replacement therapies
  11. Respiratory failure
    1. Acute lung injury
    2. Acute respiratory distress syndrome
  12. Shock
    1. Fluid resuscitation
  13. Vasopressors
  14. Inotropes
  15. Adrenal insufficiency
  16. Pharmacokinetic changes in the critically ill
  17. Antibiotics
    1. Renal and/or hepatic adjustments
    2. Proper indications
    3. Proper duration
  18. Systemic candidiasis
  19. Post-operative atrial fibrillation

 
Elective Topics:

  1. Vancomycin-resistant enterococcus
  2. ACLS medications
  3. Surgical antibiotic prophylaxis
  4. Empiric antibiotic selection
  5. Vasopressin use in ACLS
  6. Crystalloids vs. colloids
  7. Traumatic head injury
  8. Sympathetic storming
  9. Seizure prophylaxis in head injury

 
Project Description:

The resident maybe required to complete one project/presentation while on rotation with the SICU. The choice of project will depend on the interests of the resident and the needs of the multidisciplinary team.

Sampling of Possible Projects

  1. Assist with current QI/QA projects
  2. Analyze trends on drug utilization
  3. Provide an in-service on newly approved medication
  4. Provide a journal club relating to critical care issues

 
Typical Schedule:

Typical hours are 7AM until 4PM.

7AM - 8:30 AM - Work-up patients
8:30 AM - 12 PM - Rounds with multidisciplinary team
12 PM - 1 PM - Finish patient care items (i.e. medication reconciliation, order clarification, review orders, follow-up drug levels and microbiology)
1 PM - 3 PM - Discuss topics/patient care presentations
3 PM - 4 PM - Follow-up any other patient care items

 
Evaluation:

The resident will receive daily feedback on their patient care plans, roundsmanship, preparation, and communication. A summative evaluation at the midpoint and last day of the rotation will be done face-to-face and then posted in ResiTrak.