Pediatric Critical Care Resident Goals and Objectives: PACE/PCCRT Rotation
CanMEDS Roles
1. Medical expert
a. knowledge
CanMEDS Key Competencies
Methods to achieve competencies
First Year Fellows:
a) rapid assessment of children with acute illness for the purpose of identifying
the need for resuscitation, aggressive management and transfer to critical
care environment
b) recognition of the child in shock and implementation of early goal directed
therapy
c) recognition of the child in respiratory distress and the need for
implementation of supportive therapies including noninvasive and invasive
positive pressure ventilation
d) rapid assessment, management and diagnostic work up of the child with
altered mental status
e) rapid assessment and management of heart failure and cardiac arrhythmias
f) rapid assessment and management of disorders of fluid and electrolytes
g) rapid assessment and management of the acute abdomen and recognition of
indications for rapid surgical intervention
h) the complications of pediatric oncologic diseases and their treatment
i) differential diagnoses and management of thrombotic states and bleeding
disorders
j) transport physiology and problems associated with patient transport
k) The role of rapid response/medical emergency teams
l) important patient safety principles integral to medical emergency team
functioning including:
m) Characteristics of effective teams and strategies used to overcome
teamwork barriers
n) Features of a positive safety culture
o) The relationship between systems thinking, blame and accountability
Second Year Fellows:
a) advanced knowledge of congenital cardiovascular malformations and their
pre- and post-operative management
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patient consultations and followup assessments
1 on 1 review of patients with
staff intensivist
observer/participant (senior
trainees) on all pediatric critical
care transport calls
formal and informal
teaching sessions
self-directed reading
fellow seminars
journal club
PCCU teaching rounds
Weekly-in-review rounds
b) understanding of the factors guiding prognostication following
cardiopulmonary arrest
b) skills:
First Year Fellows:
a) recognition of the A,B,C’s of a critically ill child
b) application of skills from PALS, APLS and ATLS
c) obtain and perform measurement of all vital signs including oxygen
saturations and non-invasive blood pressures
d) intravenous access in a critically ill child
e) insertion of an intraosseous needle
f) demonstrates proficiency and safety in the steps of rapid sequence induction
for airway management
g) airway management including placement of oral and nasopharyngeal
airways and oro- and naso-tracheal intubations,
h) insertion of oro and nasogastric tubes catheters
i) insertion of chest tubes and thoracentesis
j) ECG interpretation
k) performance of transcutaneous synchronized cardioversion, defibrillation
and pacing
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PALS, APLS, ATLS
Instruction
In situ high fidelity simulation
in the PICU
Second Year Fellows:
a) proficiency and independence in the skills listed under the requirements for
first year fellows
2. Communicator
First Year and Second Year Fellows:
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
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patient consultations and followups
observation of family meetings
held by attending staff
communication with families to
update them on the condition
observation of nursing
interaction and families
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
i) convey information in structured communication to team members to
promote understanding (e.g. SBAR, IPASS, STAR, etc)
j) to demonstrate effective telephone communication skills when providing
consultation and advice to extramural referring physicians and critical care
transport team members
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observe/participate (senior
fellows) in providing telephone
advice for community care
providers
observe/participate (senior
fellows) in the organization of
interhospital transfers under the
supervision of the attending
physician
Second Year Fellows:
a) to perform the above skills more independently
3. Collaborator
First and Second Year Fellows:
a) to consult effectively and in a timely manner with other members of the
PCCU 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 all
member of the health care team
d) understanding team and personal accountability as a team member
4. Manager
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summarize assessment and care
plan for the patient, family
members and all members of the
medical and allied health care
team
week-in-review rounds
supervision and teaching of
junior trainees rotating on the
PACE service
First and Second Year Fellows:
a) understand the resource limitations of providing care on general inpatient
pediatric wards in both community and tertiary care hospitals
b) understand issues regarding health resource allocation and the impact on
patient management
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one on one discussion with staff
intensivist around every new
consult and follow-up patient
week-in-review rounds
Second Year Fellows:
a) familiarity with the organizational structure of in patient pediatric beds and
the manpower resources necessary to provide in patient pediatric care at
increasing levels of acuity (general care, intermediate care, step down care,
PICU care)
b) demonstrate increasing independence in decision making around patient
care and bed allocation
c) understand both the clinical and non-clinical indications for transfer of a
patient from a community hospital to inpatient tertiary care setting
5. Health
Advocate
First and Second Year Fellows:
a) an understanding of the diverse determinants of health across patients
b) understand the impact of critical care on the long-term functional outcome
and quality of life of patients
c) demonstrate proficiency with obtaining informed consent
d) understand the concepts of "best-interest" and "futility"
e) provision of caring and compassionate end-of-life care to patients and their
families
f) an understanding of the role of patient and family engagement including
family-triggered activation and the families role in detecting and preventing
adverse events
6. Scholar
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focus on family centered care
obtaining informed consent from
families as required
ethics consultations, seminars
and patient centered discussions
week-in-review
First Year Fellows:
a) 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 for
nursing and allied health care staff on pediatric wards
f) be familiar with key medical emergency team literature and how it impacts
on the structure and organization of the PACE team
g) application of patient safety evidence and current literature to management
decisions when applicable
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weekly case management rounds
week-in-review rounds
weekly PCCU teaching rounds
supervision and teaching of
junior house staff and allied
health professionals
7. Professional
First and Second Year Fellows:
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
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morning sign in and sign out
rounds
family meetings, discussions
with staff
organize interhospital transfers
under the supervision of the
attending physician