ROTATION INFORMATION
DEPARTMENT OF ANESTHESIA
RESIDENCY TRAINING PROGRAM
UNIVERSITY OF MANITOBA
NEONATAL 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 Neonatal 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 neonates
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 Neonatal Critical Care
knowledge, necessary to function as a competent consultant in anesthesia.
GOALS AND OBJECTIVES
The following Rotation Specific Goals and Objectives for Neonatal 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 2005
format.
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 pathophysiology, diagnosis, treatment and complications of:
i. Respiratory disease including:
a. Respiratory distress syndrome
b. Pneumothorax
c. Meconium aspiration
d. Tracheo-esophageal fistula
e. Mechanical ventilation and weaning.
ii. Congenital heart disease including patent ductus arteriosis.
iii. Prematurity
iv. Neurological disorders including:
a. Inter-ventricular hemorrhage
b. Status epilepticus
c. Neuromuscular diseases
d. Hydrocephalus
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B.
C.
D.
E.
F.
G.
H.
I.
v. Sepsis
vi. GI problems including:
a. Omphalocele/Gastroschisis
b. Necrotizing enterocolitis
vii. Renal disease, preservation and support
viii. Acid-base, fluid and electrolyte disorders
ix. Hypothermia and hyperthermia
x.Coagulation disorders and blood and component replacement therapy
xi. Nutrition of the critically ill infant: enteral and parenteral
xii. Infant of diabetic mother/addicted mother
Coordinate the transportation of the critically ill neonate
Perform the following technical skills in neonates (adding to those skills
learned in the practice of clinical anesthesia):
i. Neonatal resuscitation and stabilization
ii. Endotracheal intubation
iii. Noninvasive physiological monitoring in the critical care setting
iv. Umbilical and arterial and venous access
v. Peripheral arterial and venous access
Interpret ABG, cord and cap. gases
Apply an organized method of assessment of critically ill neonates 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 neonatal critical care units
Utilize medications commonly used in neonatal critical care units (e.g.
vasoconstrictors, vasodilators, inotropes, antibiotics etc.), and provide a
rationale base on the pharmacology, indications, and complications
Utilize other therapies such as ventilators and provide a rationale based on the
indications, contraindications, and complications.
Formulate and implement an appropriate plan for patient management based
on understanding of the critical illness, coexisting problems, and patient
factors in the neonate
2. Communicator
By the end of this rotation, the resident will be able to perform the following:
A. Establish a therapeutic relationship with neonatal critical care patients and
their family emphasizing understanding, trust, empathy, and confidentiality
B. Elicit and synthesize relevant information from the patient and 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, the
family’s ethnocultural background, social supports, and emotional influences
on critical illness
C. Discuss appropriate information with the family, to facilitate optimal
management of the critically ill patient
D. Effectively communicate bad news to family members in a compassionate and
professional manner
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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
neonates
C. Coordinate the care of critically ill neonates with other members of the critical
care team, especially Neonatologists, 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 and treatment
ii. Changes in response to emergencies
B. Prioritize concerns and patient needs in urgent situations
C. Formulate 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. Appropriately delegate duties to others to optimize overall care of patients in
the neonatal 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 newborn with critical illness including:
i. Risk factors and demographics which contribute to the development
of critical illness
ii. Factors that identify high-risk patients
iii. Changes and programs which may aid in the prevention of critical
illness
B. Intervene on behalf of patients, families and groups regarding their care and
safety
C. Promote colleague well-being through recognition and concern regarding
stress
6. Scholar
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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. Formulate questions for ongoing appraisal
C. Search and critically appraise current neonatology literature, and apply new
knowledge based on appropriate evidence
D. Demonstrate effective oral presentation of case reports, journal club, or rounds
with sound synthesis of pertinent information
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 neonatal patient care, especially
regarding maternal/parental/fetal/ interactions, consent, end of life decisions
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
F. Demonstrate including the 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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