Pediatric Critical Care Residency Training: Pediatric Critical Care Rotation
CanMEDS Roles
/CanMEDS Key Competencies
/Methods to achieve competencies
1. Medical experta. knowledge / First Year Resident:
a) initial assessment and management of a critically ill child
b) anatomy, physiology and pathophysiology of the respiratory system
c) the principles and theory of respiratory support and mechanical ventilation
d) interpretation of normal and common abnormal findings on chest radiographs
e) interpretation of non-invasive and invasive hemodynamic monitoring
f) physiology of cardiopulmonary interactions
g) pathophysiology and management of shock
h) pathophysiology and management of heart failure and cardiac arrhythmias
i) anatomy and physiology of patients with congenital heart disease
j) pathophysiology and management of raised intracranial pressure
k) diagnostic criteria of brain death and indications for ancillary investigation
l) etiologies associated with neuromuscular disease
m) indications and ethical implications of long term mechanical ventilation
n) pathophysiology of renal failure and renal transplantation
o) pharmacokinetics and pharmacodynamics of drugs in normal and diseased states
p) the differential diagnosis and management of an acute abdomen
q) approach to and management of GI bleeds and abdominal trauma
r) pathophysiology of liver failure and liver transplantation
s) complications of pediatric oncologic diseases and their treatment
t) approach to and management of thrombotic states and bleeding disorders
u) assessment and management of fluid, electrolyte and nutritional requirements in critically ill patients
v) transport physiology and challenges associated with patient transport
w) knowledge of patient safety principles and how they apply to the management of the critically ill patient
Second Year Resident:
a) pathophysiology of disease processes across developmental stages of the pediatric respiratory system
b) advanced knowledge of congenital cardiovascular malformations and their management
c) management of the potential organ donor
d) physiologic principles, indications, and management of continuous renal replacement therapy
e) an advanced understanding of the management of the above disease states along with new and/or controversial therapies / · daily morning rounds and bedside management
· formal and informal
teaching sessions with faculty
· self-directed reading
· academic half day teaching
· journal club
· PCCU teaching rounds
· weekly case management rounds
· OSCES
b) skills: / First Year Resident:
a) application of skills from PALS and ATLS
b) obtain and perform measurement of all vital signs including oxygen saturations and non-invasive blood pressures
c) intravenous and arterial access in a critically ill child
d) ultrasound assisted insertion of femoral, internal jugular and subclavian venous lines using safe patient practices
e) insertion of an intraosseous needle
f) demonstrates proficiency and safety in rapid sequence induction for airway management
g) airway management including placement of oral and nasopharyngeal airways and oro- and naso-tracheal intubation
h) insertion of oro and nasogastric tubes and foley catheters
i) insertion of hemodialysis catheters for CRRT
j) insertion of chest tubes and thoracentesis
k) performance of lumbar punctures
l) insertion of naso- and orogastric tubes
m) performance of transcutaneous synchronized cardioversion, defibrillation and transcutaneous pacing
n) application and integration of patient safety skills including safe order writing, crisis resource management, standardized safety communication
Second Year Resident:
a) proficiency and independence in the skills listed above
b) knowledge of ultrasound assessment of: pericardial effusion, cardiac ventricular size and qualitative function, vascular volume status, pleural effusion, ascites, and focused abdominal sonography in trauma (FAST)
c) knowledge of the technique for: fiberoptic bronchoscopy in intubated patients, emergent cricothyrotomy, pericardiocentesis / · Faculty teaching of bedside procedures in PCCU
· PALS, ATLS course work
· Simulation
2. Communicator / First Year and Second Year Resident:
a) to be able to communicate bad news to families
b) to be able to explain complicated medical issues in clear language to families
c) to develop the ability to clearly communicate with families and the medical team in tense situations or crises
d) demonstrate respect and understanding for the role of each member of the health care team
e) effectively communicate with subspecialty services during consultation requests and follow-up discussions
f) recognize the importance of clear documentation in patient's health care record
g) demonstrate conflict resolution skills when interacting with aggressive or angry family members or members of the health care team
h) effectively communicate appropriate positive and negative feedback on performance of junior trainees
Second Year Resident:
a) to perform the above skills more independently
b) demonstrates the ability to conduct and lead a family meeting
/ · observation of family meetings held by attending staff
· direct observation by faculty of trainee led family meetings
· daily communication with families to update them on the condition
· observation of nursing interaction and families
· participation in monthly rotating ICU resident evaluations
· daily communication with social work staff regarding difficult situations in the PCCU
· didactic teaching with simulated patients/families
3. Collaborator / First and Second Year Resident:
a) to consult effectively and in a timely manner with other members of the PCCU health care team and with subspecialty services
b) to communicate care plans clearly and precisely to all members of the health team
c) to demonstrate leadership and work in a collaborative manner with fellow
learners / · complete consult forms and communicate consultants directly
· summarize the care plan at the end of daily work rounds
· conduct weekly interdisciplinary case management rounds
· supervision and teaching of junior trainees rotating through the PCCU
4. Manager / First and Second Year Resident:
a) appreciate the demands of working in a PCCU and recognize impact on personal physical and emotional stress
b) priortize patient care and learning when on clinical service and manage , stress and work/life balance
c) access resources to support patient care and learning needs
d) understand issues regarding health resource allocation and the impact on patient management
Second Year Resident:
a) familiarity with the organizational structure of the PCCU and the manpower resources necessary to operate a PCCU
b) learn the practical skills necessary to effectively run the Unit
c) demonstrate increasing independence in decision making around patient care and bed allocation
d) demonstrate the ability to lead the health care team in the overall management of the PCCU
e) demonstrate leadership skills in identifying, addressing and following through on potential patient safety concerns in the PCCU / · discussing strategies with attending staff
· informal one on one sessions with staff
· discussion with staff mentor and fellow trainees
· run rounds independently several times per week
· function as the junior attending
· participation in monthly pediatric morbidity and mortality reviews
5. Health
Advocate /
First and Second Year Resident:
a) appreciate the diverse determinants of health across patientsb) be aware of the medicolegal issues in the PCCU
c) be aware of societal programs for the prevention of many PICU conditions such as head injury, near drowning, burns etc.
d) understand the impact of critical care on the long-term functional outcome and quality of life of patients
e) demonstrate proficiency with obtaining informed consent
f) understand the concepts of "best-interest" and "futility"
g) provide compassionate end-of-life care to patients and their families / · focus on family centered care in the PCCU
· obtaining informed consent from families as required
· ethics consultations, seminars and patient centered discussions
6. Scholar /
First and Second Year Resident:
a) develop critical care appraisal skillsb) facilitate education of other learners in the PICU
c) apply evidence based medicine and current literature to patient management decisions on a daily basis
d) organize and present critical care rounds
e) lead formal and informal teaching sessions on basic critical care topics
Second Year Residents
a) demonstrate skills of research methodology and research ethics as they apply to the design and implementation of critical care research trials
b) conduct and present results of a scholarly project in pediatric critical care / · monthly journal club
· fellows seminar series
· weekly case management rounds
· weekly PCCU teaching rounds
· supervision and teaching of junior house staff and allied health professionals
· participation in university run teaching seminars
7. Professional / First and Second Year Resident:
a) exhibit appropriate personal and interpersonal professional behaviour in
interactions with patients, families and health care staff
b) understand the impact of personal moral and ethical value systems on
the care of individual patients and families
c) ensure detailed and complete follow-up and handover of all patients
under the residents care
d) demonstrate effective conflict resolution skills and appropriate code
of conduct
e) ensure that there is continuity of care and that all details of the patient’s
care have been addressed prior to patient transfer / · morning sign in and sign out rounds
· family meetings, discussions with staff and ethicists
· organize interhospital transfers under the supervision of the attending physician
· function as a junior attending