Merits of a Resident-focused Neuro-intensive Care (NICU) Program—An Academic Quaternary-care Hospital Perspective
Amna Siddiqui1, Braden Dasovic2, Michael Schneck3
1Loyola University Medical Center, 2RUSH university medical center, 3Loyola University Chicago, Stritch School of Medicine
Objective:
To highlight the merits of a resident-run Neuro-critical care unit (NICU) in developing future neuro-intensivists.
Background:
Loyola University Medical Center’s NICU is a 13-bed closed bed unit that is managed by neurology and neurosurgery residents supported by board-certified (neurology) neuro-intensivists. This system differs from many other academic centers, where NICUs are primarily managed by fellows or nurse practitioners.
Design/Methods:
To assess the activity of trainees in a resident-run ICU, we evaluated the number of ICU procedures, as a surrogate measure of involvement, in managing critically ill patients. We recorded procedures performed by the residents in 5 residency classes from 01/01/2018-01/01/2023 using the Neurology program’s procedure log database (New Innovations®). We then compared the number of procedures performed by a resident, and the likelihood of subsequent pursuit of a neuro-critical care career.
Results:
A total of 1,245 procedures were performed by 27 Neurology residents across 5 residency classes from 2018-2023; data about 3 residents was not available. Residents placed 113 central venous catheters and 303 arterial lines. They also did 357 lumbar punctures (LPs), 375 arterial blood gasses, 85 paracenteses, and 6 external ventricular drains (Other than LPs, resident participation in procedures is voluntary). 8 of 27 (29.6%) residents pursued NCC careers.
6 of 8 (75%) residents who had >50 procedures subsequently pursued NCC fellowships; 1/19 (5.3%) who had <50 procedures pursued NCC fellowships. Performing >50 procedures was statistically associated with pursuit of an NCC career. (Chi-Square statistic 14.2562; p= 0.0016).
Conclusions:
A neurology resident-run ICU can enable trainees to gain confidence and skill in managing critically ill patients. The quantity and variety of complex procedures can serve as an indirect index of participation and motivation of resident interest in NCC.