|Rotation: Pediatric Intensive Care Unit|
Institution: Vanderbilt Children’s Hospital
Year of Training: PGY-2
Medical Knowledge- To learn the pathophysiology and care of children with critical illnesses including:
1. Management of shock (profound dehydration, sepsis, cardiogenic)
2. Metabolic and acid-base disorders (diabetic ketoacidosis and adrenal disorders)
3. Respiratory failure (asthma, bronchiolitis, severe upper airway obstruction)
6. Acute and chronic renal failure
7. Ventilator management
9. Increased ICP
10. Trauma (accidental and non-accidental)
11. Status seizures
12. Fluid therapy
13. Pressor support
14. Indications for ECMO
15. Nutritional support
These will all be taught by close bedside teaching from faculty and fellows. These interactions form the basis of the individual and group evaluations of residents by faculty. There will also be observed patient encounters with evaluations by faculty. There will be testing sessions in the Simulation lab to assess these skills. The results of the In-Service examination will also be used to assess their competency. There will be nursing feedback.
Patient Care- There should be opportunities for procedural experience including rapid sequence intubation, central line placement and arterial line placement. In addition, the resident should avail themselves of experience in the ethical issues surrounding withdrawal of care, futility and death-telling. The resident should continue to learn efficiency and history/physical examination skills, especially with respect to the heart, pulmonary and cardiovascular systems. The resident should learn about dealing with families of the critically ill and expand their expertise in educating families. The residents should learn the differences between caring for the critically ill child compared to adults, including the dosing of medications in this setting.
These will be taught and assessed by close interactions with residents as they see patients. In addition these will be assessed by patients in real-time with feedback made available to residents. A consensus evaluation of the resident’s performance will be generated by the faculty and fellows with whom they interact. This will also be assessed by observed patient encounters and simulation testing.
Professionalism- The following are necessary components of this general competency:
1. To learn how to communicate effectively, efficiently and appropriately with patients and families.
2. To provide care in a competent, compassionate and professional manner, including sensitivity to cultural and gender issues.
3. To learn how to deal with difficult patients and families.
4. To learn how to deliver bad news.
5. To learn how to appropriately resolve conflicts with consultants and staff from other services.
6. To enhance teaching skills both to patients, nurses, and family.
7. To recognize appropriate dress codes.
8. To learn how to “recover” a situation that is going badly.
9. To learn how to interact with nurses, ancillary care providers and all other types of staff in the ICU.
10. To be exposed to common ethical dilemmas and to learn appropriate resolution techniques.
11. To understand how to disclose mistakes that may occur in the ICU setting.
12. To learn about futility, the appropriate use of resources and withdrawal of care.
The resident will be evaluated in this area by immediate verbal feedback in real time and by formatted on-line evaluation by the fellows, upper level residents and faculty with whom they work.
Interpersonal and Communication Skills- In this ICU-based month there will be ample opportunity to learn about dealing with the families of critically ill patients, including death-telling and education about procedures and disease process. The residents will learn about the differences in dealing with critically ill children and their families compared to adults. In addition there will be opportunities to learn about consent issues. Residents will be expected to continue to learn about how to deal with patients and families in an empathetic and compassionate manner. They will also learn about dealing with nurses and other staff in an emotionally charged environment. This will be evaluated by the faculty and fellows with whom they work in an on-line preformatted evaluation.
Practice-Based Learning- Repetitive opportunities at procedures and monitoring will breed expertise. They will learn how to collaborate with nurses and respiratory therapists for the coordinated care and management of specific problems. They will learn the appropriate frequency and examination techniques for reassessment in complicated ICU patients. There will be simulation testing of this knowledge base during their residency. This can also be assessed by written examinations on these topics in focused reading assignments and on the In-Service Examination. They will receive verbal feedback in real time as well as on a formatted on-line evaluation by the fellows and faculty physicians with whom they work.
Systems-Based Practice- The resident will learn the appropriate admission to an ICU environment, the available resources, the complexity of coordinating care and consultation, the use of adjunctive testing and how to access procedures outside the ED when the patient is sick. In addition the resident should learn specific protocols for the area in which they work and be able to contrast the Adult and Pediatric ICU environments. They should learn about the patient populations and unique features of care in the Pediatric system. The resident should become familiar with dealing with primary care pediatricians as well as team-team and level-of-care transfers. Evaluation will be by faculty, fellows and upper level residents in a preformatted on-line evaluation.
Description of Clinical Experience- The residents will work 2 weeks of night shifts, 1 week in the OR working with Pediatric Anesthesia on furthering pediatric airway skills and 1 week of day shifts. They will work under the auspices of the Pediatric Critical Care faculty and fellows. They will be subject to the duty hour requirements of the RRC for Pediatrics while on this service and their shift schedule. The residents will round daily with faculty from the Divisions of Pulmonary and Cardiology (Department of Medicine) with teaching at the bedside during rounds and patient encounters from faculty and fellows. In the Anesthesia setting they will be supervised by Pediatric Anesthesia faculty.
Description of the Didactic Experience- The residents will be given a syllabus of critical and up to date articles according to the PCC faculty and will be expected to read all. There are regular didactic lectures by faculty and staff. In addition there are quarterly lectures from the PCC faculty and Fellows during our 5 hour Tuesday required lecture sessions.
Evaluation Process- Written evaluations by faculty and fellows as well as direct clinical feedback at the bedside from faculty and fellows. The EM residents will also give written feedback on this rotation. There is an Pediatric Emergency Medicine faculty member, Sheila McMorrow, as well as 2 PCC faculty, Drs. Geoffrey Fleming and Bradley Strohler, assigned as liaisons for this rotation to coordinate feedback in a 360 degree fashion to the residents and leadership. The residents should use rotation summaries, written evaluations, and performance on the in-service to evaluate the effectiveness of this rotation.