Pediatric Critical Care Resident Goals and Objectives: PACE/PCCRT Rotation

CanMEDS Roles

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CanMEDS Key Competencies

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Methods to achieve competencies

1. Medical expert
  1. knowledge
/ First Year Fellows:
a)rapid assessment of children with acute illness for the purpose of identifying the need for resuscitation, aggressive management and transfer to critical care environment
b)recognition of the child in shock and implementation of early goal directed therapy
c)recognition of the child in respiratory distress and the need for implementation of supportive therapies including noninvasive and invasive positive pressure ventilation
d)rapid assessment, management and diagnostic work up of the child with altered mental status
e)rapid assessment and management of heart failure and cardiac arrhythmias
f)rapid assessment and management of disorders of fluid and electrolytes
g)rapid assessment and management of the acute abdomen and recognition of indications for rapid surgical intervention
h)the complications of pediatric oncologic diseases and their treatment
i)differential diagnoses and management of thrombotic states and bleeding disorders
j)transport physiology and problems associated with patient transport
k)The role of rapid response/medical emergency teams
l) important patient safety principles integral to medical emergency team functioning including:
m)Characteristics of effective teams and strategies used to overcome teamwork barriers
n)Features of a positive safety culture
o)The relationship between systems thinking, blame and accountability
Second Year Fellows:
a)advanced knowledge of congenital cardiovascular malformations and their pre- and post-operative management
b)understanding of the factors guiding prognostication following
cardiopulmonary arrest /
  • patient consultations and follow-up assessments
  • 1 on 1 review of patients with staff intensivist
  • observer/participant (senior trainees) on all pediatric critical care transport calls
  • formal and informal
teaching sessions
  • self-directed reading
  • fellow seminars
  • journal club
  • PCCU teaching rounds
  • Weekly-in-review rounds

b)skills: / First Year Fellows:
a)recognition of the A,B,C’s of a critically ill child
b)application of skills from PALS, APLS and ATLS
c)obtain and perform measurement of all vital signs including oxygen saturations and non-invasive blood pressures
d)intravenous access in a critically ill child
e)insertion of an intraosseous needle
f)demonstrates proficiency and safety in the steps of rapid sequence induction for airway management
g)airway management including placement of oral and nasopharyngeal airways and oro- and naso-tracheal intubations,
h)insertion of oro and nasogastric tubes catheters
i)insertion of chest tubes and thoracentesis
j)ECG interpretation
k)performance of transcutaneous synchronized cardioversion, defibrillation and pacing
Second Year Fellows:
a)proficiency and independence in the skills listed under the requirements for first year fellows /
  • PALS, APLS, ATLS
Instruction
  • In situ high fidelity simulation in the PICU

  1. Communicator
/ First Year and Second Year Fellows:
a)to understand the issues involved in communicating bad news to families in stressful situations
b)to be able to explain complicated medical issues regarding diagnosis and prognosis 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
i)convey information in structured communication to team members to promote understanding (e.g. SBAR, IPASS, STAR, etc)
j)to demonstrate effective telephone communication skills when providing consultation and advice to extramural referring physicians and critical care transport team members
Second Year Fellows:
a) to perform the above skills more independently /
  • patient consultations and follow-ups
  • observation of family meetings held by attending staff
  • communication with families to update them on the condition
  • observation of nursing interaction and families
  • observe/participate (senior fellows) in providing telephone advice for community care providers
  • observe/participate (senior fellows) in the organization of interhospital transfers under the supervision of the attending physician

  1. Collaborator
/ First and Second Year Fellows:
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 allied health teams
c)to demonstrate leadership and work in a collaborative manner with all member of the health care team
d)understanding team and personal accountability as a team member /
  • summarize assessment and care plan for the patient, family members and all members of the medical and allied health care team
  • week-in-review rounds
  • supervision and teaching of junior trainees rotating on the PACE service

4. Manager / First and Second Year Fellows:
a)understand the resource limitations of providing care on general inpatient pediatric wards in both community and tertiary care hospitals
b)understand issues regarding health resource allocation and the impact on patient management
Second Year Fellows:
a)familiarity with the organizational structure of in patient pediatric beds and the manpower resources necessary to provide in patient pediatric care at increasing levels of acuity (general care, intermediate care, step down care, PICU care)
b)demonstrate increasing independence in decision making around patient care and bed allocation
c)understand both the clinical and non-clinical indications for transfer of a patient from a community hospital to inpatient tertiary care setting /
  • one on one discussion with staff intensivist around every new consult and follow-up patient
  • week-in-review rounds

5. Health
Advocate /

First and Second Year Fellows:

a)an understanding of the diverse determinants of health across patients
b)understand the impact of critical care on the long-term functional outcome and quality of life of patients
c)demonstrate proficiency with obtaining informed consent
d)understand the concepts of "best-interest" and "futility"
e)provision of caring and compassionate end-of-life care to patients and their families
f)an understanding of the role of patient and family engagement including family-triggered activation and the families role in detecting and preventing adverse events /
  • focus on family centered care
  • obtaining informed consent from families as required
  • ethics consultations, seminars and patient centered discussions
  • week-in-review

6. Scholar /

First Year Fellows:

a)application of evidence based medicine principles 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 for nursing and allied health care staff on pediatric wards
f) be familiar with key medical emergency team literature and how it impacts on the structure and organization of the PACE team
g) application of patient safety evidence and current literature to management decisions when applicable /
  • weekly case management rounds
  • week-in-review rounds
  • weekly PCCU teaching rounds
  • supervision and teaching of junior house staff and allied health professionals

7. Professional / First and Second Year Fellows:
a)exhibit appropriate personal and interpersonal professional behaviour in
interactions with other health care staff and patient and family members
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 attended to prior to transfer to another attending /
  • morning sign in and sign out rounds
  • family meetings, discussions with staff
  • organize interhospital transfers under the supervision of the attending physician