May 4-5, 2016 or October 19-20, 2016 Stabile Building Rochester, Minnesota

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1 Mayo School of Continuous Professional Development Fundamental Critical Care Support (FCCS) May 4-5, 2016 or October 19-20, 2016 Stabile Building Rochester, Minnesota Registration Deadline: April 4, 2016 (for May course) and September 19, 2016 (for October course) or first 16 Participants. Limited Enrollment Skills Course

2 General Information This is a standardized two-day course that provides an exposure to basic principles of critical care. Its primary goal is to enhance the ability of primary care practitioners to perform the initial assessment, management, and stabilization of critically ill patients so that they may be prepared for transfer to a higher level of acute care. Specific topics include: airway management, cardiopulmonary resuscitation, acute respiratory failure, mechanical ventilation, basic hemodynamic monitoring, and shock. In addition, management of specific disease states in the realm of neurologic emergencies, trauma, myocardial ischemia, life-threatening infection, and life threatening metabolic disturbances are reviewed. Recognizing the changing needs of adult learners, we are incorporating the Mayo Clinic Multidisciplinary Simulation Center to augment instruction in airway management, team organization, and cardiopulmonary resuscitation. Simulationbased medical education is an artificial (or simulated) learning environment created to imitate a real-life patient care setting where learners can practice and master skills without putting patients at risk. This will include debriefing after the exercise so that students can reflect on the experience and solidify key points. This course is limited to 16 attendees. Please register early to secure your participation. Payment must be received at the time of enrollment. Although registration deadlines are April 4, 2016 (for May course) and September 19, 2016 (for October course), it is anticipated that the course will fill early. This is the only registration notice you will receive. Course Learning Objectives Upon completion of this course, the participant should be able to: Demonstrate how to assess the critically ill patient in an organized fashion. Prioritize clinical critical care management issues. Identify appropriate diagnostic tests for specific patient populations. Identify and respond to significant changes in critically ill patients status. Identify essential roles of care providers in managing acute care scenarios. Attendance at this Mayo course does not indicate nor guarantee competence or proficiency in the performance of any procedures that may be discussed or taught in this course. Intended Audience This course is designed for primary care physicians, mid-level providers, general surgeons, and critical care trainees. Credit College of Medicine, Mayo Clinic, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. College of Medicine, Mayo Clinic, designates this educational live activity for a maximum of AMA PRA Category 1 Credits per session. Physicians should claim only credit commensurate with the extent of their participation in the activity. Other health care professionals will be provided a certificate of attendance for requesting credits in accordance with state nursing boards, specialty societies, or other professional associations.

3 Date and Location The Fundamental Critical Care Support (FCCS) course will be held May 4-5, 2016 and October 19-20, 2016 in the Simulation Center (Stabile Building), Mayo Campus, Rochester, Minnesota. Meeting facilities are easily accessible by skyway and pedestrian subway, which connect Mayo Clinic to shops, restaurants, and hotels. Registration To register, complete the attached registration form and return by , mail or fax. You cannot register for this course online. Advanced registration is required. Onsite registrants are not allowed due to the nature of this course. The $600 registration fee includes tuition, course syllabus (text book), continental breakfasts, break refreshments, and lunches. We strongly urge you to read the course syllabus in advance to pass the course successfully. The text book is an excellent resource for future use. An of confirmation will be sent upon receipt of payment and completed registration form. Until written confirmation is received, please do not consider yourself registered for this course. Cancellation Policy Your registration fee, less a $100 administrative fee, will be refunded when written notification is received by the Department of Surgery ( rsttcgsedu@mayo.edu). No refunds will be made on or after April 4, 2016 (for the May course) and September 19, 2016 (for the October course). Lodging Accommodations Hotel registrations are the responsibility of the individual registrant. Rooms are blocked for the Fundamental Critical Care Support (FCCS) course at the Kahler Grand Hotel with a special room rate of $119 for standard room or $159 for an executive room a night plus tax. Reservations may be made by calling Kahler Grand at Please reference the Fundamental Critical Care Support (FCCS) course to secure the discounted rate. For other accommodation options, you may also wish to visit the Rochester Convention and Visitors Bureau web site: Parking Parking is available in hotel, city, and Mayo patient/visitor ramps. The cost for parking is not included in the registration fee and is not validated. A map indicating the location of downtown parking facilities will be mailed with the registrant confirmation letter. Faculty Disclosure As a provider accredited by ACCME, Mayo Clinic College of Medicine (Mayo School of CPD) must ensure balance, independence, objectivity and scientific rigor in its educational activities. Course Director(s), Planning Committee Members, Faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty also will disclose any off label and/ or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of these relevant financial relationships will be published in activity materials so those participants in the activity may formulate their own judgments regarding the presentation.

4 REGISTRATION FORM Fundamental Critical Care Support (FCCS) 2016 Stabile Building Rochester, Minnesota Mail form and payment to:: Mayo Clinic Department of Surgery Telephone: Attn: Dawn Steinfadt Fax: FCCS Course First Street SW Web site: Mary Brigh Rochester, MN REGISTRATION DEADLINES: April 4, 2016 (for May course) and September 19, 2016 (for October course) or first 16 Participants. Contact Information Name of Registrant first name, middle name or initial, and last name Name of Institution Degree select all that apply MD DO PHD PA NP Other (Specify): Medical Specialty Preferred Mailing Address select one Work/Business Home Work/Business Address street address Work Phone include all country and city/area codes as needed along with complete phone number City State or Province ZIP or Postal Code Country Home Address street address Home Phone include all country and city/area codes as needed along with complete phone number City State or Province ZIP or Postal Code Country Address FAX include all country and city/area codes as FAX Location select one needed along with complete phone number Work/Business Home SPECIAL NEEDS If you have special assistance needs or dietary restrictions, describe here: Registration Course Options: Please indicate if you will attend: May 4-5, 2016 OR October 19-20, 2016 Registration Fee (includes textbook, valued at $55): $600 Total Payment Enclosed: $ $ Payment Information Check enclosed in the amount shown at right make checks payable to Mayo Clinic FCCS Company/PAU: Credit Card We accept Discover, MasterCard, or Visa To Pay by Credit Card, please call to process. We are no longer able to collect credit card information electronically per new regulations. Payment Total:

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6 MAYO CLINIC 200 First Street SW Rochester, MN Mayo School of Continuous Professional Development Fundamental Critical Care Support (FCCS) May 4-5, 2016 or October 19-20, 2016 Stabile Building Rochester, Minnesota Registration Deadline: April 4, 2016 (for May course) and September 19, 2016 (for October course) or first 16 Participants Mayo Foundation for Medical Education and Research MC rev0316