Pediatric Critical Care Medicine Resident: Pediatric CV ICU Rotation
CanMEDS Roles
CanMEDS Key Competencies
1. Medical expert
a. knowledge:
First Year Fellow should have an understanding of:
a) anatomy, physiology and pathophysiology of the cardiovascular system
b) principles of invasive and non-invasive hemodynamic monitoring
c) the pathophysiology of heart failure in neonates, infants, children and
adolescents
d) pharmacology of drugs used to treat heart failure
e) physiology of cardiac arrhythmias
f) pharmacological and electrical management of cardiac arrhythmias
g) anatomy and physiology of patients with congenital heart disease; pre and
post operatively
h) congenital malformations of the vascular system leading to heart failure
and/or hypoxemia
i) common complications status post repair of complex congenital heart
disease and their treatment
j) pathophysiology of shock syndromes
k) pathophysiology of cardiorespiratory interactions
l) the methods and application of “Pediatric Advanced Life Support” (PALS)
techniques
m) the methods and application of “Neonatal Advanced Life Support” (NALS)
techniques
Second Year Fellows:
a) management of (and controversies in) the above conditions.
b) the basic management of infants and children requiring ECLS support and
the indications for veno-arterial cannulation
Methods to achieve
competencies
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Weekly PICU seminar
series
daily morning rounds and
bedside teaching
formal and informal
teaching sessions
self-directed reading
computer based teaching
program in PICU
journal club
b) skills:
First Year Fellows:
a) recognition and management of basic life support measures in a critically ill
child
b) obtain and perform measurement of all vital signs including oxygen
saturations and non-invasive blood pressures
c) manage cardiac arrest
d) intravenous access in a critically ill child
e) insertions of femoral, internal jugular and subclavian venous lines
f) airway management including performance of oro and nasotracheal
intubations
g) insertion of chest tubes and thoracentesis
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performance of
procedures on patients
in the PICU
Anesthesia and
Adult ICU rotations
PALS and NALS courses
Simulation exercises
Second Year Fellows:
a) familiarity with insertion of a Swan-Ganz catheter
b) pericardiocentesis with supervision
c) proficiency in the skills listed under the requirements for first year fellows
2. Communicator
First Year and Second Year Fellows:
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a) to understand the issues involved in communicating bad news to families
b) to be able to explain complicated medical diagnoses and treatment in simple
terms to families
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c) to explain life support measures clearly and concisely to patients and family
members
d) to develop the ability to communicate with families and the medical team in 
tense situations or crises
e) to resolve conflict between families and members of the health care team
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during times of stress or crisis
observation of family
meetings held by
attending staff
daily communication
with families to update
them on the condition
observation of nursing
interaction and families
participation in monthly
f) to effectively communicate appropriate positive and negative feedback on
performance of junior trainees
rotating ICU resident
evaluations
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run family meetings with
staff present as
appropriate
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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
learn about all patients in
the unit during rounds
and regularly ask fellow
learners about their need
for help
Second Year Fellows:
a) to perform the above skills more independently
3. Collaborator
First and Second Year Fellows:
a) to communicate effectively and in a timely manner with consulting services
b) to communicate care plans clearly and precisely to all members of the allied
health teams
c) to manage differing opinions from all members of the health care team
c) to work in a collaborative manner with fellow learners
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4. Manager
First and Second Year Fellows:
a) effectively balance time between patient care, learning and stress
management
b) manage fatigue and recognize when they are unsafe
c) effectively prioritize a heavy workload
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discussing strategies with
attending staff
retreats, informal one on
one sessions with staff
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Second Year Fellows:
d) learn the practical skills necessary to effectively run the Unit
e) be the final person in the decision making ladder
f) understand the basic principles and develop a proactive role in regard to risk
management
g) triage beds according to severity of illness and resource allocation
h) organize and manage off-site transportation of critically ill infants and
children
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5. Health
Advocate
First and Second Year Fellows:
a) Be aware of the relative costs of different diagnostic and treatment
modalities
b) Demonstrate proficiency with obtaining informed consent for medical and
diagnostic procedures as well as for research studies
c) Counsel parents and families accordingly when patients face a terminal
illness or very poor prognosis
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use of organizational aids
such as to do lists, etc
run rounds independently
several times per week
function as the junior
attending
Bi-monthly Critical Care
section meeting
monthly PICU and
pediatric morbidity and
mortality reviews
MD management
workshops as they are
available
discuss cost issues on
rounds with attending and
pharmacists
discussions on rounds
and with families
obtaining informed
consent from families for
blood transfusions and
research studies
ethics seminars and
patient centred
discussions
6. Scholar
First Year Fellows:
a) learn the skills necessary to research and present critical care rounds and
journal club
b) facilitate education of other learners in the PICU
c) demonstrate a basic understanding of biostatistics, study design, grant and
manuscript preparation
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Second Year Fellows:
a) organize and present critical care rounds
b) lead informal teaching sessions on basic critical care topics to both fellow
residents and other members of the health care team
7. Professional
First and Second Year Fellows:
a) ensure detailed and complete follow-up and handover of all patients under
the resident’s care
b) develop the appropriate conflict resolution skills necessary in a high stress
environment
c) understand the responsibility, and the liability involved with the transfer of
a patient from an institution to another
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Second Year Fellows:
a) 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
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present PICU noon
rounds
teach junior house staff
and allied health
professionals using both
informal and formal
teaching methods
membership and
participation in the PICU
research committee
participation in at least
one research project
fellow seminars
morning sign in and sign
out rounds
family meetings,
discussions with staff and
ethicists
organize transfers of
patients to and from
referring hospitals under
the supervision of the
attending physician
function as a junior
attending