ROTATION INFORMATION
DEPARTMENT OF ANESTHESIA
RESIDENCY TRAINING PROGRAM
UNIVERSITY OF MANITOBA
PEDIATRIC INTENSIVE CARE
INTRODUCTION
The University of Manitoba Training Program for Residents in Anesthesia has been
developed in accordance with the guidelines of the Royal College of Physicians and
Surgeons of Canada. Along with the other Critical Care rotations, this Pediatric Intensive
Care rotation is designed to allow the resident to:
a)
develop primary skills (patient assessment, use of laboratory tests, special
investigations, and technical skills) with critically ill patients
b)
participate in the team management of patients and, when appropriate, supervise
more junior members of the team (the opportunities for these are more limited in
anesthesia rotations)
c)
acquire both general medical knowledge, and specific Pediatric Critical Care
knowledge, necessary to function as a competent consultant in anesthesia.
GOALS AND OBJECTIVES
The following Rotation Specific Goals and Objectives for Pediatric Intensive Care,
provide specialty specific emphasis to particular components of the general Program
Goals and Objectives. These Goals and Objectives are written in the CanMEDS format.
The resident is expected to achieve the following goals and objectives in an appropriately
incremental manner, with increasing experience.
Please refer also to the National Curriculum for Canadian Anesthesia Residency for more
information on expected knowledge and skills.
All appropriate Program Goals and Objectives also apply to this rotation.
1. Medical Expert/Clinical Decision Maker
By the end of this rotation, the resident will be able to perform the following:
A. Discuss the etiology, pathophysiology, diagnosis, treatment and complications
of:
i. Respiratory problems including:
a. Respiratory obstruction and stridor (croup, epiglottitis,
tonsillar)
b. Respiratory failure
c. mechanical ventilation and weaning.
d. Bronco-pleural dysplasia
e. Cystic fibrosis
ii. Cardiac emergencies including
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B.
C.
D.
E.
F.
a. Arrest
b. Arrhythmias
c. Failure
d. Tamponade
e. severe hypotension and hypertension.
iii. Cardiac diseases including:
a. Congenital heart disease
b. Persistent fetal circulation
c. Pulmonary hypertension
d. Shock
iv. Neurological disorders including:
a. coma, status epilepticus
b. neuromuscular diseases
c. neuro trauma
d. CNS malformations
e. Diagnosis of brain death and the management of organ donors
v. Sepsis
vi. Acid-base, fluid and electrolyte disorders
vii. Renal disease, preservation and support
viii. Gastrointestinal disorders including:
a. Hemorrhage
b. hepatobiliary disease
c. Acute abdomen
ix. Endocrine disturbances in the critically ill.
x. Coagulation disorders (congenital and acquired) and blood and
component replacement therapy
xi. Nutrition of the critically ill child: enteral and parenteral
xii. Hypothermia and hyperthermia
xiii. Trauma and burns
xiv. Intoxications
Coordinate transportation of the critically ill child
Perform the following technical skills in a pediatric population(adding to
those skills learned in the practice of clinical anesthesia):
i. Thoracentesis
ii. Tube thoracostomy
iii. Invasive and noninvasive physiological monitoring in the pediatric
critical care setting
Apply an organized method of assessment of critically ill pediatric patients
and communicate a succinct evaluation and management plan to Attending
Staff.
Explain the indications for and the information derived from common
diagnostic tests and monitoring systems used in pediatric critical care units
Discuss the pharmacology, indications, and complications of medications
commonly used in pediatric critical care units (e.g. antiarrythmics,
antihypertensives, vasodilators, inotropes, antibiotics etc.), and the indications
and use of other therapies such as ventilators, dialysis and pacemakers.
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G. Formulate and implement an appropriate plan for patient management based
on understanding of critical pediatric illness, coexisting problems, and patient
factors such as anxiety, discomfort, culture, language, ethnicity, age, and
gender
2. Communicator
By the end of this rotation, the resident will be able to perform the following:
A. Establish a therapeutic relationship with pediatric critical care patients
emphasizing understanding, trust, empathy, and confidentiality
B. Elicit and synthesize relevant information from the patient and/or family, and
other caregivers in the difficult or crisis situations of critical illness, and be
able to assess and take into account, the impact of a patient's age, gender,
ethnocultural background, social supports, and emotional influences on
critical illness
C. Discuss appropriate information with the patient, his/her family to facilitate
optimal management of the critically ill child
D. Effectively communicate bad news to family members in a compassionate and
professional manner
E. Appreciate the importance of cooperation and communication among healthcare professionals regarding areas of responsibility and consistent patient
information
3. Collaborator
By the end of this rotation, the resident will be able to perform the following:
A. Communicate a succinct assessment and management plan to Attending Staff
and to other physicians requesting consultation
B. Effectively consult with other physicians and health care professionals and
demonstrate appropriate judgment regarding the assessment of critically ill
children
C. Coordinate the care of critically ill children with other members of the critical
care team, especially intensivists, or physicians requesting or providing
consultation, nurses, pastoral care, respiratory therapy and others
D. Demonstrate skill in managing urgent and crisis situations such as
hemodynamic instability, cardiac arrest, and respiratory compromise both as a
team member and leader
4. Manager
By the end of this rotation, the resident will be able to perform the following:
A. Manage time and assign priorities for:
i. Efficient use of time for patient assessment
ii. Changes in response to emergencies
B. Prioritize concerns and patient needs in urgent situations
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C. Make treatment plans taking into account the cost-effective use of critical care
resources such as beds for admission, drug, ventilator, or other therapeutic
choices
D. Delegate duties to others appropriately to optimize overall care of children in
the ICU
E. Demonstrate knowledge of outcome evaluation as a guide to management
5. Health Advocate
By the end of this rotation, the resident will be able to perform the following:
A. Demonstrate knowledge and recognition of broad health and societal issues
with impact on the care of the patient with critical pediatric illness including:
i. Risk factors and demographics which contribute to the development
of critical pediatric illness
ii. Factors that identify high-risk children
iii. Lifestyle changes and programs which may aid in the prevention of
critical illness
B. Intervene on behalf of pediatric patients and groups regarding their care and
safety
C. Promote colleague well-being through recognition and concern regarding
stress
6. Scholar
By the end of this rotation, the resident will be able to perform the following:
A. Develop, implement, and monitor a personal continuing education strategy
B. Search and critically appraise current pediatric critical care literature, and
apply new knowledge based on appropriate evidence
C. Demonstrate effective oral presentation of case reports, journal club, or rounds
with sound synthesis of pertinent information
D. Formulate questions for ongoing appraisal
E. Facilitate learning of patients, housestaff, students and other professionals
7. Professional
Throughout this rotation, the resident shall:
A.
B.
C.
D.
Deliver highest quality care with integrity, honesty, and compassion
Demonstrate appropriate interpersonal and professional behavior
Practice medicine ethically consistent with the obligations of a physician
Be aware of the ethical and legal aspects of patient care, especially regarding
parental concerns, rights, and obligations, consent, DNR orders, end of life
decisions, organ donation etc.
E. Show recognition of personal limits through appropriate consultation (with
staff supervisors, other physicians, and other health professionals) and show
appropriate respect for those consulted
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F. Demonstrate including the child and/or family in discussions of care
management
G. Recognize potential conflict in patient care situations, professional
relationships, and value systems, and demonstrate the ability to discuss and
resolve differences of opinion. Additionally, be able to accept constructive
feedback and criticism and implement appropriate advice
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