[SP1-4] Current status of ICU and intensive care medicine in USA
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同時通訳付き】
Education
Medical:
UMDNJ- New Jersey Medical School
(Now known as Rutgers)
Newark, New Jersey; MD 1994
Undergraduate:
Alfred University
Alfred, New York; Cum Laude, BA in Biology 1990
Postgraduate
Intern, Resident, Chief Resident, Emergency Medicine
Medical College of Pennsylvania
(Now known as Drexel University College of Medicine)
Philadelphia, PA
July 1994 – June 1997
Employment
Medical College of PA – Hahnemann University
Instructor of Emergency Medicine
Faculty-Fellow in Division of Critical Care
July 1997 – June 1998
Medical College of PA – Hahnemann University
Assistant Professor of Emergency Medicine
July 1998 – 2009
Medical College of PA – Hahnemann University
Assistant Program Director
January 1999 – June 2001
Drexel University College of Medicine (formerly Medical College of PA – Hahnemann University)
Department of Emergency Medicine
Associate Program Director
Assistant Professor
July 2001 – June 2007
Drexel University College of Medicine
Department of Emergency Medicine
Director of Critical Care Education
Associate Program Director
Assistant Professor
September 2002 – June 2007
Drexel University College of Medicine (formerly Medical College of PA – Hahnemann University)
Department of Emergency Medicine
Director of Critical Care Education
Student Clerkship Director Mercy ICU
Assistant Professor
July 2007 – December 2009
Duke University Medical Center
Director of Critical Care Education
Assistant Professor of Surgery
Department of Surgery
Division of Emergency Medicine
2301 Erwin Rd
Durham, NC 27710
January 2009 – May 2015
VA Medical Center
Department of Emergency Medicine
508 Fulton St
Durham, NC 27705
March 2015- present
Certification and License
Board Certified in Emergency Medicine
(Written exam October, 1997; Oral examination October 1998)
Recertification 2008, 2018
Pennsylvania MD License 1996 – 2010
DEA 1996 – Current
North Carolina 2009 - Current
Honors and Awards
National League of Women Voters Award 1986
Leadership in community service
Alfred University Herrick Scholarship 1986-1990
Excellence in academic performance
Psy Chi Psychology Honor Society - Alfred University 1990
NJMS Award for Outstanding Research 1991
NJMS Alumni Scholarship 1991, 1992
Outstanding scholarship and leadership
New Jersey Medical School Rosemary A. Gellene Memorial Scholarship 1993
Alumni Associations highest honor given to a 4th year student.
Society of Academic Emergency Medicine Medical Student Excellence in Emergency Medicine Award 1994
PA Chapter of the Society of Critical Care Medicine
Best Abstract Award August 1999
International Ain Shams Medical Student Congress
8th Annual Meeting, Cairo, Egypt
Best Poster Presentation February 6-9, 2000
American Medical Association - Womens Physician Congress. Physician Womens Mentoring Award. November 2007
Presidential Citation. Society of Critical Care Medicine. 2008
Dr. Joseph and Rae Brown Award. Society of Critical Care Medicine. 2008
Fellow College of Critical Care Medicine 2009
American Board of Emergency Medicine Oral Board Examiner Service Award 2014
PROFESSIONAL SOCIETY MEMBERSHIPS
Society of Critical Care Medicine 1998 - present
PA Chapter of the Society of Critical Care Medicine 1998 – 2009
Carolina Virginias Chapter of the Society of Critical Care Medicine 2010-present
Society of Academic Emergency Medicine (1997-2009)
Council of Residency Directors (1999 -2008)
American Academy of Emergency Medicine 1996 - present
International Trauma Anesthesia and Critical Care (1998-2007)
Society for the Advancement of Blood Management (Founding Member) (2001- 2009)
PROFESSIONAL SOCIETY ACTIVITIES
Committees:
American Board of Emergency Medicine
Oral Board Examiner 2006 - present
Association for Surgical Education
Curriculum Committee 1999 – 2002
International Trauma Anesthesia and Critical Care Society
Critical Care Committee 1999 –2007
Research Committee 2002 –2007
Society for the Advancement of Blood Management
Young Physicians Committee 2002- 2004
Chairman
Society of Academic Emergency Medicine
CPC Judge and task force member 2003- 2007
Society of Critical Care Medicine
Guidelines for ICU Admission, Discharge, and Triage Task Force 2008-2015
Chapter and Affiliates Committee
Secretary 2005-06
Chair elect 2006-07
Chair 2007-08
Council member ex – officio 2006-2008
Creative Community Volunteer 2003-present
Volunteer Liaison 2003-present
American College of Critical Care Medicine Inducted Fellow 2009
MCCKAP Task Force 2009-2012
Nominating Committee Member 2009-2010
ACGME Resident Duty Hours White paper task force 2010-2011
Council Liaison FDM task force 2011-2016
Council Liaison Uniformed Services 2011-2016
Council Liaison Online MCCKAP 2012-2015
Council Liaison Neurosciences 2012-2016
Council Liaison Emergency Medicine 2013-2016
Strategic Education Committee 2012-2015
Chair task force on Violence and Critical Care 2013-2015
Senior Council Member Fundamentals Business Line 2014-2016
Strategic Planning Committee 2014-present
Vice-Chair 2015
Chair 2016-2018
Council Liaison Section Chairs 2015-2016
Finance Committee 2015-present
ACCM Board of Regents Nominating Committee 2015-present
Moderator Professor Walk Rounds Congress 2015 Phoenix
Executive Council Member 2016 – present
Secretary 2016 – 2018
Co-Chair Save A Life Event 2017 _ 2018
President – Elect 2018 - 2019
President 2019 - present
PA Society of Critical Care Medicine
Education committee 2003-2009
NJPA SCCM Combined Meeting Organizer and Curriculum committee 2003, 2004
Council of Residency Directors
LLSA committee 2005-2007
Offices :
SCCM
SCCM Council Ex-officio 2006 – 2008
SCCM Chapter and Affiliate
Secretary 2005 – 06
Chair elect 2006 – 07
Chair 2007 – 08
SCCM elected At-Large Seat 1 yr term 2011-2012
Council Elected Collective Seat 2012-2015
Council reelected Collective Seat 2015-2016
Executive Council Secretary 2016-2018
Save A Life Co event Co-Chair 2017-1018
Executive Council President-Elect 2018-2019
PASCCM
PASCCM President-Elect 2002-2003
PASCCM President 2003-2005
Carolinas/Virginia Chapter SCCM
Board Member 2010-2014
The continuum of care is a very important concept in the treatment and management of the critically ill and injured patient. This concept is important not just in the longitudinal sense of patients moving from the pre-hospital setting to the Emergency Department to the ICU but also that at each stage of care there is the presence and interaction of a cohesive and highly trained team.
There are many challenging issues currently affecting the state of critical care and the ICU team in the US. There are many pathways for physician fellowship available in the US. Despite that, a significant issue that is driving many of the other problems in the ICU is a shortage in the workforce. This shortage has led to several major areas of focus and impact in critical care. With the shortage of physician providers, there has been an expansion in the role of the Advanced Practice Provider (APP). Both physician assistant’s and nurse practitioners may focus their area of practice in critical care and in turn have expanded their role in the critical care environment.
This work force shortage has in turn led to innovations using technology to bring virtual care to the bedside in the form of telemedicine. Many systems have created tele-icu programs to ensure excellent care to ICU patients typically during the overnight hours. Another unfortunate outcome of the workforce shortage is the national epidemic of burnout syndrome in health care providers across the US. This syndrome has encompassed all fields of medicine but is particularly problematic in critical care where estimates are 50% of providers suffer from burnout. It is a national professional crisis in the US.
The Surviving Sepsis Campaign (SSC) continues to strive for early identification and early intervention of patients with sepsis and septic shock. This early action has in turn led to improved patient care and outcomes. Several states in the US have government mandates for criteria that must be met when caring for patients with sepsis and septic shock.
Post intensive care syndrome (PICS) is related to critical illness and the care that is required to treat patients. PICS patients exhibit impairment in cognition, mental health and physical function after ICU admissions. SCCM is focusing on how ICU care impacts long term outcomes and is researching ways to mitigate this entity.
The use of ECMO has expanded significantly both in number of facilities supporting advanced hemodynamics and in the scope of practice. ECMO can provide both respiratory and hemodynamic support. A decade ago the CESAR trial from the UK suggested that early use of ECMO in patients failing to respond to conventional therapy would be of benefit. The use of ECMO is transitioning to early care for severe acute respiratory failure in non-responders instead of being reserved for rescue therapy.
This is just a sampling of current issues in critical care in the US.
There are many challenging issues currently affecting the state of critical care and the ICU team in the US. There are many pathways for physician fellowship available in the US. Despite that, a significant issue that is driving many of the other problems in the ICU is a shortage in the workforce. This shortage has led to several major areas of focus and impact in critical care. With the shortage of physician providers, there has been an expansion in the role of the Advanced Practice Provider (APP). Both physician assistant’s and nurse practitioners may focus their area of practice in critical care and in turn have expanded their role in the critical care environment.
This work force shortage has in turn led to innovations using technology to bring virtual care to the bedside in the form of telemedicine. Many systems have created tele-icu programs to ensure excellent care to ICU patients typically during the overnight hours. Another unfortunate outcome of the workforce shortage is the national epidemic of burnout syndrome in health care providers across the US. This syndrome has encompassed all fields of medicine but is particularly problematic in critical care where estimates are 50% of providers suffer from burnout. It is a national professional crisis in the US.
The Surviving Sepsis Campaign (SSC) continues to strive for early identification and early intervention of patients with sepsis and septic shock. This early action has in turn led to improved patient care and outcomes. Several states in the US have government mandates for criteria that must be met when caring for patients with sepsis and septic shock.
Post intensive care syndrome (PICS) is related to critical illness and the care that is required to treat patients. PICS patients exhibit impairment in cognition, mental health and physical function after ICU admissions. SCCM is focusing on how ICU care impacts long term outcomes and is researching ways to mitigate this entity.
The use of ECMO has expanded significantly both in number of facilities supporting advanced hemodynamics and in the scope of practice. ECMO can provide both respiratory and hemodynamic support. A decade ago the CESAR trial from the UK suggested that early use of ECMO in patients failing to respond to conventional therapy would be of benefit. The use of ECMO is transitioning to early care for severe acute respiratory failure in non-responders instead of being reserved for rescue therapy.
This is just a sampling of current issues in critical care in the US.