St. Barnabas Hospital Department of Pediatrics
Required PL-2 Pediatric Intensive Care Rotation
At Montefiore Medical Center
Goals and Objectives
Revised June 2009
The following will describe the educational goals and objectives of the Pediatric Intensive Care
Unit rotation for St. Barnabas PL-2 residents.
Patient Care
1. Obtain and interpret information relevant to the critically ill pediatric patient.
2. Evaluate and manage, under supervision of an intensivist, patients with signs and
symptoms that present commonly to the intensive care unit.
3. Use a logical and effective approach to the assessment and daily management of critically
ill children and their families, under the guidance of an intensivist, using evidence-based
decision making and problem solving skills.
4. Perform a physical examination of the critically ill child and identify normal and
abnormal findings.
5. Use and interpret clinical tests commonly used in the pediatric intensive care unit:
a. CBC with differential, platelet count, RBC indices
b. Blood chemistries: electrolytes, glucose, calcium, magnesium,
phosphate
c. Renal function tests
d. Tests of hepatic function (PT, albumin) and damage (ammonia,
bilirubin, liver enzymes)
e. Serologic tests for infection (e.g., hepatitis, HIV)
f. C-reactive protein, erythrocyte sedimentation rate.
g. Therapeutic drug concentrations
h. Coagulation studies: platelets, PT/PTT, fibrinogen, FSP, D-dimers
i. Arterial, capillary, and venous blood gases
j. Detection of bacterial, viral, and fungal pathogens
k. Urinalysis
l. CSF analysis
m. Gram stain
n. Stool studies
o. Toxicologic screens/drug levels
p. Other fluid studies (e.g. pleural fluid, joint fluid)
q. Chest x-ray, Abdominal series, Skeletal survey, Cervical spine films
r. CT scans of abdomen, chest and head
s. MRI scans
t. Basic concepts of cerebral blood flow studies
6. Use and interpret physiologic monitoring and special technology that are
commonly used in the pediatric intensive care unit under the supervision of an
intensivist:
a. Central venous pressure monitoring
b. Invasive arterial blood pressure monitoring
c. Intracranial pressure monitoring
d. Pulse oximetry
e. End-tidal carbon dioxide monitoring
7. Utilize appropriately or be familiar with the following treatment and techniques in
the intensive care unit, including monitoring effects and anticipating potential
complications specific to each therapy:
a. Oxygen administration by cannula, masks, hood
b. Positive pressure ventilation including non-invasive modalities
such as nasal/mask BiPAP/CPAP, bag and mask ventilation
c. Principles of ventilator management, intubation and extubation
procedures and criteria
d. Analgesics, sedatives, and paralytics
e. Enteral and parenteral nutrition
f. Blood and blood product transfusions
g. Vasoactive drugs (pressors and inotropes)
Medical Knowledge
1. Know and/or access medical information efficiently, evaluate it critically, and apply it
appropriately to the care of patients in the pediatric intensive care unit.
2. Demonstrate knowledge of the etiology and management of common conditions in the
critically ill child.
a. Cardiovascular: Acute life-threatening event, bradycardia,
cardiopulmonary arrest, congestive heart failure, cyanosis, hypertension,
hypotension, poor capillary perfusion, rhythm disturbances, tachycardia
b. Endocrine: Signs and symptoms suggestive of hypo- and hyperglycemia
and adrenal insufficiency/crisis
c. GI: Abdominal distension, hematemesis and melena, icterus, peritoneal
signs, vomiting
d. Hematologic:, Pallor, petechiae, purpura, uncontrolled bleeding
e. Infectious Diseases: Endotoxic shock, fever
f. Neurologic: Acute weakness, altered mental status, coma, delirium,
encephalopathy, seizures, tetany, thermoregulatory abnormalities
g. Renal: Anuria, hematuria, oliguria, polyuria, severe electrolyte disturbance
h. Respiratory: Apnea, cyanosis, dyspnea, hemoptysis, hypercarbia,
hyperpnea, hypoxemia, increased or decreased respiratory effort, poor air
movement, pulmonary edema, respiratory failure, stridor, tachypnea,
wheezing
Practice-Based Learning and Improvement
1. Use scientific methods and evidence to investigate, evaluate, and improve one’s patient
care practice in PICU setting.
2. Establish and become actively involved in a feedback process, which includes open
discussion with preceptors and other faculty members, ample time to respond to feedback,
and opportunity to implement a plan of action with specific goals aimed at overall
improvement.
3. Facilitate the learning of students and other health care professionals in the PICU.
Interpersonal Skills and Communication
1. Provide sensitive support to patients with serious illness and to their families, and arrange
for ongoing support or preventive services if needed.
2. Maintain comprehensive, timely, and organized medical records.
3. Communicate and collaborate effectively as part of a functional team with physicians,
other health care professionals, staff, and students.
Professionalism
1. Conduct oneself in a respectful and professional manner when interacting with patients and
their families with careful awareness and consideration of their culture, age, race, gender,
sexual preference, and disabilities.
2. Demonstrate a commitment to acquiring the knowledge base expected of general
pediatricians caring for seriously ill children under the guidance of an intensivist.
3. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment.
4. Practice ethically and within medical-legal constraints in the care of critically ill children.
5. Collaborate respectfully with staff and health care professionals.
6. Recognize the limits of one’s knowledge and expertise and take steps to avoid medical
errors.
Systems-Based Practice
1. Understand key aspects of health care systems, cost control, and mechanisms for payment
as they relate to the intensive care setting
2. Advocate on behalf of patients experiencing challenges with health care system
complexities
3. Implement appropriate discharge plans, including involvement of social work services
and/or visiting nurse services if necessary
4. Participate in the detection and critical evaluation of medical errors in order to make
corrections in practice strategies and thereby prevent future occurrences.
Evaluation
Any problems or concerns regarding the resident’s performance in the Pediatric Intensive Care
Unit will be immediately be brought to the attention of the St. Barnabas Hospital Pediatric
Residency Program Director in order to affect corrective measures. At the completion of the
rotation Pediatric Critical Care faculty will assess the educational accomplishments of the
resident and forward a completed evaluation form to the St. Barnabas Pediatric Residency
Program Director. The St. Barnabas PL-2 resident will complete an evaluation of the Pediatric
Intensive Care rotation regarding clinical experience, faculty supervision and didactic program.
While on the Pediatric Intensive Care Unit rotation, the St. Barnabas PL-2 resident will assume
duties and responsibilities equivalent to those of other residents rotating at the Pediatric Intensive
Care Unit in the same year of training. The St. Barnabas resident will be fully integrated into
daily activities of the Pediatric Intensive Care Unit. The St. Barnabas PL-2 resident on the
Pediatric Intensive Care Unit rotation will have the same access to resources and facilities,
including but not limited to library and medical records as other residents rotating in the Pediatric
Intensive Care Unit. The resident hours will be consistent with the requirements and limitations
of the ACGME Duty Hours and New York State 405 regulations.