Timeline for PICU Resident Rotation

Timeline for PICU Resident Rotation

1984 / A. I. duPont Institute, new Hospital Building Opens
1988 / January / A. I. duPont Institute PICU Opens with four beds
Robert Kettrick MD, Chairman, Department of Pediatric Anesthesiology and Critical Care, Director PICU
1991 / Steve Lawless MD, new Medical Director, PICU
1992 / Thomas Jefferson Pediatric Residency Program moves to A. I. duPont Institute under the direction of Residency Director, Dr. Weiss
2nd-year pediatric residents start in the 16-bed PICU
Medical Center of Delaware Emergency Medicine 2nd-year residents start in PICU
1993 / Rob Walter, MD, named new Residency Director Thomas Jefferson Pediatric Residency Program
Thomas Jefferson Emergency Medicine 2nd-year residents begin in PICU
Abstract:
Lawless S, Kettrick R, Donar-Reale M, David Corddry, John McCloskey: Utilizing a program of continuing quality improvement to evaluate residents impact on a pediatric ICU (PICU). Abstr.Pediatric Research 1993; 33: 700A
1994 / March / First Education Focus Group Meeting of Division of Critical Care Medicine, Alfred I. duPont Institute, Thomas Jefferson University and Medical Center of Delaware, chaired by Robert Kettrick, MD
September / Formalized PICU Educational Program begins at A. I duPont Institute PICU
PICU Resident Rotation Coordinator Edward J. Cullen, Jr., DO
Multidisciplinary instructors involved in PICU Resident Education
Maryann Cunningham, Nursing Bad News Sept. 1994 - June, 1996
Mary Jo Rose, RN - Mock Codes 1994 -1997
1995 / June / University of Pennsylvania Pediatric Critical Care Nurse Practitioner Student
July / Mission, Vision, Values statement from Nemours
August / Second Education Focus Group of Division of Critical Care Medicine, Alfred I. duPont Institute, Thomas Jefferson University and Medical Center of Delaware , Chaired by Robert Kettrick, MD
Multidisciplinary instructors involved in PICU Resident Education
Mary Donar-Reale, RN, MSN Care of Children with Chronic Trach / Vent Care Needs, 12/95 - present
Shamin Tejani, PharmD Inotropes & Vasodilators; TPN in the PICU, 3/95 - present
Radiologists - bimonthly X-ray Rounds, 4/95 7/96
1996 / January / Dave Corddry, MD, new Chairman, Department of Pediatric Anesthesiology and Critical Care
April / Vinay Nadkarni, MD, new Medical Director, PICU
May / Abstract and Poster Presentation
Cullen E, Lawless, ST, Nadkarni VM, McCloskey JJ, Corddry DH, Kettrick RG (sponsored by Alan Spitzer) Department of Anesthesia/Critical Care, A. I. duPont Institute, Wilmington, DE: Assessing Resident (RES) Education in the Pediatric ICU (PICU). Abstr. Pediatric Res 1996; 39: 777A
American Pediatric Society, the Society for Pediatric Research, Washington, DC, May, 1996
June / Our PICU Resident Program becomes involved with the SCCM Pediatric Resident Education Committee
July / PICU Residents are asked by Pediatric Residency Program and Neonatology to cover SNICU on nights and weekends. Neonatologists provide weekly Interactive NICU Rounds and NICU Mock Codes during PICU rotation
Multidisciplinary Instructors involved in PICU Resident Education
Diane Necastro, Social Service Bad News / Loss, Grief, Mourning, 7/96 - 98
Radiology - Monthly PICU Radiology Rounds, Case Conferences, 7/96 7/97
Erin McCloskey, RN Mock Codes and Transport, 1996 -97
Cindy Harris, Computer Training - Jeffline Access in PICU Intro to residents, 7/96 - 6/97
1997 / February / Vinay Nadkarni, MD, presents information about our PICU Resident Rotation efforts to the SCCM Pediatric Resident Education Committee at its annual meeting, 2/9/97
March / Dave Berger begins designing and creating our Access PICU Resident Education Data Base
May / Abstract and Poster Presentation
Cullen E, Lawless ST, Corrdry DH (Spon. by John Stefano) Pediatric Anes/Critical Care, duPont Hospital for Children, Wilmington, DE: The Mismatch Between Attending (Attnd)and Resident (Res) Desired Education Delivery Styles in Pediatric Intensive Care (PICU). Abstr. Pediatr Res 1997; 41: 1774A
American Pediatric Society/The Society for Pediatric Research, Washington, DC, May 1997
July / Monthly Individualized Resident Reports Pre- and Post-rotation block distributed to the Critical Care Physicians to help acquaint them with the new residents and give immediate resident feedback about the PICU rotation experience
Interactive PICU Teaching Rounds replace formal lectures by the Critical Care Physicians
Residents given choice of PICU Rotation Exit Test: Oral Interview, Presentation or Essay Response to two pediatric critical care scenarios
Multidisciplinary Instructors involved in PICU Resident Education
Radiology - Daily PICU X-ray Reviews with radiologist, 7/97 6/98
Donna Corddry, RN, Mock Codes 1997 - present
Nancy Blackburn, RN, Mock Codes 1997 - present
Intranet PICU Resident Education Web Page initial development with Karen Hartis and Dan Hart
September / Poster Presentation
Cullen E, Lawless ST, Corrdry DH, Pediatric Anes/Critical Care, duPont Hospital for Children, Wilmington, DE: The Mismatch Between Attending and Resident Desired Education Delivery Styles in Pediatric Intensive Care
Tenth Annual Pediatric Critical Care Colloquium, Sept 19, 1997, Hot Springs, Arkansas
November / Original Article
Edward J. Cullen, DO; Stephen T. Lawless, MD, MBA, FCCM; Vinay M. Nadkarni, MD; John J. McCloskey, MD; David H. Corddry, MD; Robert G. Kettrick, MD. Evaluation of a pediatric intensive care residency curriculum. Crit Care Med 1997; 25: 1898-1903
Editorial Response
Timothy S. Yeh. Give a little, take a little: Resident education in the evolving healthcare environment. Crit Care Med 1997; 25:1782
1998 / July / SCCM Pediatric Resident Education Committee distributes first national Pre- and Post-tests for PICU rotation residents. This replaces our optional PICU Exit Tests and compliments our PICU pre-test (Edward J. Cullen, Jr., DO, a contributor to test)
Residents have time in the operating room with John McCloskey, MD, in order to practice pediatric intubations under controlled situations
Multidisciplinary instructors involved in PICU Resident Education
Julie Harrison, RT, and Dawn Selhorst, RT - Introduction to Ventilators, BiPAP Negative Pressure Ventilator July, 1998 ? present
Converting monthly PICU resident individualized files to a monthly updated menu page that critical care attendings can access in order to learn about new residents and get immediate feedback about the previous months rotation (menu page developed by Dave Berger)
Dave Berger designing menu page for our Intranet Web page that will allow access to PICU Resident Education facts from 1994 to present
Re-evaluating our available time / resources and clinical ? research - administration commitments and their impact on maintaining the one month PICU Resident Rotation
Steve Selbst, MD, becomes new Residency Director for the Thomas Jefferson Pediatric Residency Program
November / Increased clinical load / night call due to loss of one critical care physician
Increased clinical load for critical care physicians leads to:

Interactive rounds changed to occur during clinical rounds
Initially oral interviews continued at end of month as a teaching tool to compensate for less formal interactive rounds; dropped soon thereafter due to lack of time with increased clinical needs
OR time less consistent for residents
Weekly resident status updates initiated but becomes harder to accomplish on routine basis

1999 / January / Abstract
Vinay Nadkarni, Edward Cullen, Stephen Lawless, John McCloskey, David Corddry. Jefferson Medical College, AI duPont Hospital for Children, Wilmington, DE. Resident Pediatric Specific Cardiopulmonary Resuscitation Experience Prior To Entering A Second Year PICU Rotation. Abstr. Crit Care Med 1999 Vol 27, No 1 (Supple) A102
February / Meeting with Pediatric Residency Program to discuss concerns about PICU Rotation:

Autonomy issues: residents are not enough of a part of decision making process
Very few "dedicated" teaching rounds
Few or no didactic lectures
Residents not allowed to do procedures even when they are available

SCCM, Pediatric Resident Education Committee meeting
Informal consensus that what we are actually teaching during the PICU rotation is acute care pediatrics. Nuances (modes of ventilation, NO, ECMO, etc) should be left to fellow level training. It was felt that we need to train pediatric residents to recognize and stabilize critically ill children. We need to teach the "basics"
Critical Care Attendings from Wilmington and Florida sites PICUs met and discussed ways to interact between sites including resident education
April / Abstracts
Edward J Cullen, Stephen T Lawless, Vinay M Nadkarni, John J McCloskey, David Corddry. Pediatric Anesthesia and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, DE (Sponsored By: John L Stefano). Adjusting to Resident Learner (RL) Needs During Pediatric (PICU) Rotation. Abstr. Pediatr Res 1999; 45: 76A
Edward J Cullen, Stephen T Lawless, Vinay M Nadkarni, John J McCloskey, David Corddry, Pediatric Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE. (Sponsored By: John L Stefano). Does Pediatric ICU (PICU) Residency Curriculum Match General Pediatric Practice (GP) Needs? Abstr. Pediatr Res 1999; 45: 76A
Edward J Cullen, Stephen T Lawless, Vinay M Nadkarni, John J McCloskey, David Corddry. Pediatric Anesthesiology and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, DE. (Sponsored By: John L Stefano). PICU Resident Learner (RL), Resident Educator (RE) and Utility Scores. Abstr. Pediatr Res 1999; 45: 76A
Our Web page will interact with other sites that are already involved in resident educational activities including the PedsCCM Web site which is developing a pediatric critical care medicine on-line lecture series
Continuous Quality Improvement issues that require ongoing attention:

How Do We Know That Information We are Teaching Is Correct and Updated?
How Best to Present the Above Info During a PICU Rotation?
Do Residents Who Come Through Our PICU Need the PICU Experience for Their Future Practice Settings?
How Do We Evaluate if the PICU Rotation Provides Residents With the Skills to Recognize and Stabilize a Critically Ill Child/ Adolescent?

July / Scott Penfil, MD, joins Pediatric Critical Care staff
Weekly interactive teaching rounds and oral interviews re-introduced into PICU rotation
August / Jim Hertzog, MD, joins Pediatric Critical Care staff
September / Monthly Pediatric Chief Resident directed PICU Resident Evidence Based Medicine Clinical Practice Journal Club begins (ran through December 1999)
October / Begin introduction of evidence based clinical practice principles during PICU rounds through the educational prescription technique. Residents will be introduced to the EBCP principles for asking focused clinical questions on patient problems, searching for information, evaluating the validity / results / and applicability to patient care
Cerner computer system introduced
2000 / February / Jeanette Murphy, computer instructor, spends one hour during the first rotation week with new PICU residents on specific PICU Cerner computer ordering
April / Critical Care Journal Club resumes: Basic Science Article and Clinical Article with Evidence Based Clinical Practice review
May / David Corddry, MD, relinquishes Anesthesiology & Critical Care Chairman position
Steve Lawless, MD, Interim Chairman, Department of Anesthesiology & Critical Care
July / Oral interviews discontinued
August / Nemours Education Innovation Program Application: Promoting PICU Evidence-Based Clinical Practice
September / Kathleen Bradford, MD, joins Pediatric Critical Care staff
October / PICU Resident Rotation Goals updated to meet Thomas Jefferson Pediatric Residency needs
2001 / January / PICU Resident Rotation information initiated through Nemours Intranet under a developing Anesthesiology & Critical Care Web site
February / Edward J Cullen, Stephen T Lawless, Vinay M Nadkarni, Scott Penfil, James H Hertzog David E Corddry. GME Reimbursement for PICU Resident Training, Is It Enough?
Crit Care Med 2000; 28 (12) Suppl 424/T11, A146
March / Nemours Education Innovative Program project entitled Promoting PICU Evidence based Clinical Practice begins March 1 for a one year period
July / Kathleen Bradford, MD, new Associate Director, Thomas Jefferson Pediatric Residency Program
Andrew T. Costarino, Jr., new Chairman, Department of Anesthesiology and Critical Care
August / PICU Resident Rotation web site opens on the Nemours Foundation Internet site
October
December / Vinay Nadkarni, MD, departs Alfred I. duPont Hospital for Children
Clinical Research Project, Accidental Extubation in the PICU
2002 / January / University of Pennsylvania Pediatric Critical Care Nurse Practitioner Student
March / Begin second year grant from Nemours Education Innovation Project: Promoting PICU Evidence Based Clinical Practice
June / University of Pennsylvania Pediatric Critical Care Nurse Practitioner Student
July / Glenn Stryjewski, MD and John McCloskey, MD join Critical Care.
PICU residents receive an hour introduction to Evidence Based Clinical Practice. They use these skills to address a focused clinical question during two interactive sessions on ARDS and Sepsis.
A Critical Care attending mentor is assigned to each PICU resident for the month rotation.
Mock Codes at Christiana Care are briefly reduced to once a month then to twice a month.
Journal Club reinstituted.
PICU residents requested to present a PICU patient to hospital resident morning report on 2nd Tuesday and 3rd Thursday of rotation block.
Neonatology interactive rounds discontinued.
Transport/OR-Intubation/Sedation Elective for residents - coordinated by Jim Hertzog, MD.
Shamin Tejani, Clinical Pharmacist, offers monthly lecture on Immunosuppressive Medications for Patients with Organ Transplants.
Alfred I duPont Hospital for Children GME office discussion about resident restricted duty work hours due to take effect in July 2003.
All desktop computers in the PICU have access to PICU Vividesk, an Internet resource for Evidence Based Clinical Practice and Search engines.
August / PICU Resident rotation post-test now on-line from the SCCM Pediatric ICU Resident Education Committee
John Giamalis, Clinical Pharmacist, joins PICU rounds.
September / ACGME Outcome Project and general competencies discussed at meeting with Thomas Jefferson University GME Subcommittee.
December / Radiologist comes to PICU Monday through Friday morning in order to review patient radiographs with PICU team.
2003 / January / Begin third year Nemours Education Innovation Grant: Promoting PICU Evidence Based Clinical Practice. Closer interaction with Centre for Health Evidence and upgrade of PICU Vividesk to Nemours Users Guides Interactive Desktop
Jim Hertzog, MD, continues his Nemours Education Innovation Grant studying a Mechanial Ventilator Laboratory for Residents.
April / All PICU bedside wireless computers have access to Nemours Users Guides Interactive Desktop
June / Division Teaching Award is presented to Critical Care Medicine by the Thomas Jefferson University Pediatric Residents
July / Edward Cullen, Stephen Lawless, James Hertzog, Scott Penfil, Kathleen Bradford, Vinay Nadkarni, David Corddry, Andrew Costarino, A Model of Determining a Fair Market Value for Teaching Residents. Who Profits? Pediatrics 2003; 112(1):40-48
Pediatric Critical Care Medicine Fellowship begins under direction of Scott Penfil, MD
Caroline Boyd MD begins Pediatric Critical Care Medicine Fellowship
PICU Residents can now fill out on-line the pre and post rotation questionnaires and tests as well as Nemours Education Innovation Grant questionnaires and tests.
Pharmacy Residency Program begins rotating through the PICU under theleadership of Shamin Tejani, clinical pharmacist
Alfred I duPont Hospital for Children Graduate Medical Education (GME) officebegins its official oversight of local medical training
Alfred I duPont Hospital for Children Graduate Medical Education (GME) officebegins its official oversight of local medical training
New ACGME Resident Duty Hours Take Effect
Duty Hours

80 hours per week, averaged over 4 weeks. May increase by 10% in some circumstances.
One day off out of seven, averaged over 4 weeks.
No in-house call more than once every three nights, averaged over 4 weeks.
24 hours on call, maximum, with up to six additional hours to hand off patients and attend educational activities.
10 hours off between duty periods and after in-house call.

High Quality Education and Safe and Effective Patient Care

Priority of clinical and didactic education in the allotment of residents? time and energies.
Schedules of teaching staff structured to provide ready supervision and faculty support/consultation to residents on duty.
Duty hour assignments that recognize that faculty and residents collectively have responsibility for patient safety and welfare.
Monitor residents for the effects of sleep and fatigue by Program director and faculty with appropriate action when it is determined that fatigue might affect safe patient care or learning.
Education of faculty and residents in recognizing the signs of fatigue and in applying preventive and operational countermeasures.
Appropriate backup support when patient care responsibilities are difficult and prolonged, and if unexpected needs create resident fatigue sufficient to jeopardize patient care

2004 / January / PICU continues to participate in the fourth Nemours Education Innovation Grant: Promoting Evidence Based Clinical Practice
Society of Critical Care Medicine now houses the Pediatric Critical Care Resident powerpoint presentations and post-PICU test. Our PICU continues to participate.
June / Kathleen Bradford, MD departs PICU
July / Nicholas Slamon, MD begins Pediatric Critical Care Medicine Fellowship
September / John McCloskey MD and Glenn Stryjewski MD depart PICU.
Computer difficulties with powerpoint presentations and SCCM test page as well as removal of Interactive Teaching Rounds due to reduced critical care physician staff decreased efectiveness of PICU resident educational process.
Ilene Sivikoff takes over data entry responsibilities for PICU Resident Data Base.
Clinical Research Project, SIRS in Pediatrics
2005 / Jaunary / Nemours Education Committee - Grant to Promote Evidence Based Clinical Practice throughout the Nemours Foundation,
PICU Article Collection developed for the Nemours UGI Desktop
June / Tania Burns MD joins the pediatric critical care staff.
Scott Penfil MD receives Teaching Award from Thomas Jefferson Emergency Medicine Residency Program.
July / New combined PICU Resident and Critical Care Attending daily progress note instituted.
PICU Residents are asked to hand in a critically appraised topic on a pediatric critical care patient problem. A copy will be forwarded to their respective program directors at the completion of the PICU rotation. Additionally, PICU Resident test scores on the national Society of Critical Care Medicine Post-PICU Rotation Test will be sent to residents’ respective program directors.
August / Brian Binck MD joins the pediatric critical care staff.
2006 / May / Anesthesiology and Critical Care Medicine and Sedation develop Team Projects: Patient Care; Learning Environment; Organization Support and Leadership; Respectful Workplace and Family Centered Care. PICU Resident and Fellowship activity included in Learning Environment Team.
June / Nicholas Slamon, MD, Pediatric Critical Care Fellow, receives Teaching Award from ThomasJefferson Pediatric Residents
July / Rahul Bhattia, MD and Meg Fizzola, MD begin Pediatric Critical Care Medicine Fellowship.
Alfred I duPont Hospital for Children designated as Levell III Trauma Center
Caroline Boyd MD begins joint appointment with Pediatric Critical Care and Pediatric CardiacCritical Care
August / Glenn Stryjewski, MD joins Pediatric Critical Care and as Associate Director Thomas Jefferson Pediatric Residency
Clinical Research Project, BiS Monitor Use in Peds
2007 / June / Nick Slamon, MD graduates from Critical Care Medicine Fellowship
Recipient of Thomas Jefferson University Pediatric Residency Program Fellow Teaching Award
July / Kevin Couloures DO begins Critical Care Fellowship program
July / Mentor program for residents during their PICU rotation discontinued
Pediatric residents do 8 weeks in the PICU during their second residency year
2009 / February / Glenn Stryjewski MD initiates PICU Systems Based Project: Quality Improvement Case Analysis.Eaxch resident is asked to identify a PICU problem and suggest ways to make improvements.
April / Epic Medical Record goes live. Cerner ordering system discontinued. Visiting PICU residents need to take a 4 hour on-line computer training session before starting their PICU rotation and then complete 4 hours of instructor led training when they arrive for their PICU rotation.
June / Faculty Teacher of the Year Award.
For outstanding Teaching and Dedication to the Education of the Pediatric Residents.
Selected by the Pediatric Residents
Scott Penfil MD
Glen Stryjewski MD
Rahul Bhatia, MD - completes Pediatric Critical Care Fellowship
July / New SCCM pre and post test as well as audio powerpoints for Residents during their PICU Rotation
Yosef Lowenbrown DO begins Pediatric Critical Care Fellowship

AugustBrian Binck MD departs PICU staff.