Pediatric Critical Care Resident: Ultrasound rotation goals and objectives
CanMEDS Roles
/CanMEDS Key Competencies
/Methods to achieve competencies
1. Medical experta. Knowledge: / a) Acquire a basic knowledge of fundamental ultrasound physics
b) Gain knowledge of machine controls and transducer manipulation as they impact on ultrasound image acquisition
c) Gain knowledge of normal and abnormal ultrasound anatomy specifically as it relates to the internal jugular vein, subclavian vein, femoral vein, lung, heart, inferior vena cava, and peritoneal space
d) Gain knowledge of the clinical application of bedside point of care (POC) ultrasound in acute care, specifically, role of ultrasound in: cardiopulmonary resuscitation, trauma, shock, respiratory distress, and vascular access acquisition
e) Gain knowledge regarding the specific limitations of POC ultrasound in acute care
f) Gain knowledge of the scope of bedside POC ultrasound specifically, when the examination is beyond the technical or interpretative capability of the clinician performing the study / · one on one teaching with staff
· self-directed reading and learning
b) Skills: / a) Develop skill in image acquisition and interpretation in identifying and differentiating relevant veins and arteries (internal jugular vein, carotid artery, subclavian vein/artery, femoral vein/artery, peripheral veins (eg. Basilic, brachial, external jugular) and peripheral arteries (eg. Radial, posterior tibial, dorsalis pedis)
b) Develop skill in identification of normal anatomic variability (eg. Variability of carotid artery position relative to internal jugular vein)
c) Develop skill in integrating POC ultrasound imaging with vascular cannulation including proper machine placement, transducer preparation with sterile cover, transducer manipulation, and ability to identify wire placement in the target vessel and the needle tip throughout the insertion maneuver
d) Demonstrates knowledge (with limited experience) of image acquisition and interpretation of 5 standard cardiac views (parasternal long axis, parasternal short axis, apical four chamber, subcostal, and inferior venal cava) to identify normal and abnormal qualitative ventricular function, volume status, and pericardial fluid assessment
e) Demonstrate knowledge of (with limited experience) the effective and appropriate use of POC ultrasound assessment of pleural effusion and ascites
f) Describe the role of POC ultrasound for the following assessments: cardiac arrest, focused abdominal sonography in trauma (FAST), deep venous thrombosis (DVT) assessment, lung, abdominal aorta / · one on one staff teaching and supervision of clinical skills
· regular practice
· image acquisition and review with staff
· completion of online electronic modules
· simulation
2. Communicator / a) Develop the ability to explain the process for and indication of POC ultrasound to patient and family in clear language
b) Develop the ability to verbally communicate POC ultrasound findings to the care team using standardized language
c) Understand how to document POC ultrasound findings in the patient chart using standardized language / · staff ER supervised
interactions with patient and
family members
· interactions with all members of
the health care team
· supervised documentation .
3. Collaborator / a) Learn the importance of engaging with all members of the health care team through all phases of the POC ultrasound scanning to ensure safe and effective procedure
b) To gain knowledge and understanding regarding the indications for second opinion or further investigation beyond POC ultrasound assessment / · One on one teaching from staff ER/radiologist
4. Manager / a) Recognizes and responds to physical and emotional stressors associated
with the environment . / · discussing strategies with attending staff
· one on one sessions with staff
4. Health
Advocate / a) Obtain consent for POC ultrasound investigation
b) To gain an understanding that patient positioning and patient exposure for POC ultrasound exams may be stressful or disruptive for patients.
c) Learns how to thoroughly clean the machine and transducers after each use
d) To understand how to support family centred care by engaging the family at the bedside throughout the POC ultrasound assessment when appropriate
e) To gain an understanding of the indications of POC ultrasound, when the POC ultrasound is not needed or when POC ultrasound can be potentially disruptive to patient care. / · obtaining informed consent from families as required
· one on one teaching from staff ER/radiologist
6. Scholar / a) to gain a knowledge of published guidelines and recommendations on the use of POC ultrasound in pediatric critical care
b) To develop a practice of continuous quality improvement for reviewing POC ultrasound images and engaging in regular audit of the number, quality and reporting of ultrasound images / · act as a resource to the health care team, patient and family
7. Professional / a) Develop behaviors respectful of patient comfort and privacy while performing POC ultrasound
b) Develop appropriate personal and interpersonal professional behavior in interactions with other health care staff and patient and family members
c) To learn ones own limitations in image acquisition and interpretation of POC bedside ultrasound images. / · pre and post procedural patient/family interactions
· interactions with entire health care team
These goals and objectives were created with reference to the following sources:
Royal College of Physician and Surgeons of Canada. Objectives of Training in Pediatric Critical Care Medicine (2014)
Price, S. et al. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS). Cardiovascular Ultrasound. 2008. 6:49
Mayo, P.H. et al. American college of chest physicians/La Societe de Reanimation de langue Francaise statement on competence in critical care ultrasonography. Chest. 2009. 135:1050
International expert statement on training standards for critical care ultrasonography. Int Care Med. 2011. 37:1077
Neri, L et al. Toward an ultrasound curriculum for critical care medicine. Crit Care Med. 2007. 35(suppl):S290
Ultrasound Rotation February, 2015