Pediatric Critical Care Rotational Objectives: Pediatric Cardiac Critical Care, Hospital for Sick Children

CanMEDS Roles

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CanMEDS Key Competencies

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Methods to achieve competencies

1. Medical expert
a) knowledge / a)interpretation of chest radiographs in congenital cardiac anomalies
b)principles and interpretation of invasive and non-invasive hemodynamic monitoring as applied to children with congenital and acquired heart disease
c)physiology and application of cardiopulmonary interactions in the PCCCU
d)the pathophysiology and pharmacologic and electrical management of heart failure and cardiac arrhythmias across the pediatric age-groups
e)anatomy and physiology of patients with congenital heart disease; pre and post operatively
f)problems associated with surgical interventions in children with cardiac disease /
  • daily morning rounds and bedside management with direct faculty observation
  • formal and informal
teaching sessions
  • self-directed reading
  • resident seminars
  • PCCCU teaching rounds

b) skills: / a)application of skills from PALS, APLS
b)obtain and perform measurement of all vital signs including oxygen saturations and non-invasive blood pressures
c)intravenous access in a critically ill child
d)insertions of femoral, internal jugular and subclavian venous lines
e)demonstrates proficiency and safety in the steps of rapid sequence induction for airway management
f)airway management including placement of oral and nasopharyngeal airways and oro- and naso-tracheal intubations,
g)insertion of oro and nasogastric tubes
h)insertion of hemodialysis catheters for CRRT
i)insertion of chest tubes and thoracentesis
j)performance of transcutaneous synchronized cardioversion, defibrillation and pacemaker
k)knowledge of utilization of dual chamber temporary pacemaker
l) knowledge of technique for emergent pericardiocentesis /
  • Bedside procedures in PCCCUwith direct faculty observation

2. Communicator / 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 /
  • observation of family meetings held by attending staff
  • daily communication with families to update them on the condition
  • observation of nursing interaction and families
  • daily communication with social work staff regarding difficult situations in the PCCCU
  • conduct family meetings with direct observation by faculty

3. Collaborator / a)to consult effectively and in a timely manner with other members of the PCCCU 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 fellow
learners /
  • fill out consult forms specifically and speak to consultants directly about reasons for consults
  • summarize the care plan at the end of daily work rounds
  • weekly interdisciplinary case management rounds
  • supervision and teaching of junior trainees rotating through the PCCCU

4. Manager / a)understand the demands of working in a PCCCU including the personal physical and emotional stressors associated with the environment
b)effectively balance time and priorize between patient care, learning needs, stress management and outside activities
c)utilize electronic resources to support patient care and learning needs
d)understand issues regarding health resource allocation and the impact on patient management /
  • discussing strategies with attending staff
  • informal one on one sessions with staff
  • discussion with staff mentor and resident trainees

5. Health
Advocate / a)an understanding of the diverse determinants of health across patients
b)an awareness of the medicolegal considerations in the PCCCU
c)understand the impact of critical care on the long-term functional outcome and quality of life of patients
d)demonstrate proficiency with obtaining informed consent
e)understand the concepts of "best-interest" and "futility"
f)provision of caring and compassionate end-of-life care to patients and their families /
  • focus on family centered care in the PCCCU
  • obtaining informed consent from families as required
  • ethics consultations, seminars and patient centered discussions

6. Scholar / a)learn the skills necessary to research and present critical care rounds
b)facilitate education of other learners in the PICU
c)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 /
  • PCCCU teaching rounds
  • supervision and teaching of junior house staff and allied health professionals

7. Professional / 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 and ethicists
  • organize interhospital transfers under the supervision of the attending physician

PCCCU ObjectivesSeptember, 2014