Pediatric Critical Care Residency Training Program
McMaster University
Overall Goals and Objectives of Training
Preamble
Pediatric critical care medicine is a specialty concerned with the recognition and management of
acutely ill infants, children and adolescents with life threatening disease or illness. Through the
provision of immediate and ongoing observation and treatment, pediatric critical care medicine
aims to preserve life, restore health and prevent complications. The pediatric critical care
physician is competent in all aspects of identifying and treating life-threatening illness in
pediatric patients.
General Objectives of Training
The Pediatric Critical Care Residency Training Program at McMaster University will provide
residents with the knowledge, skills, experience and attitudes necessary to function as competent
and ethical specialists in pediatric critical care medicine.
The overall objectives of our residency training program outlined below are provided in the
CanMEDS format. The CanMEDS roles for physicians (and trainees) define wide range
knowledge, attitudes and skills required in order to be an effective, competent, knowledgeable
and professional physician.
The following paragraphs outline the components of the CanMEDS roles, methods by which the
objectives of such roles can be met and methods that will be used for evaluation. Detailed
objectives are provided thereafter and you are asked to familiarize yourself with them as well.
The Royal College Objectives of training for Pediatric Critical Care Medicine are also provided.
These objectives are given to trainees entering the program and the trainee is referred to these
documents for further information on expected competencies when presenting for certification
examinations.
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General Objectives of Training
1.
MEDICAL EXPERT/CLINICAL DECISION MAKER
General Requirements:
The pediatric critical care medicine resident must demonstrate:
i)
diagnostic and therapeutic skills for ethical and effective care of the critically ill patient
ii)
the ability to effectively and efficiently access and apply relevant information to the care
of the critically ill patient
iii)
effective and professional consultative ability with respect to patient care, education and
legal opinions
A) Knowledge
This area comprises the factual knowledge base that the consultant must have in order to
properly evaluate and manage acutely ill pediatric patients. In addition to general knowledge of
pediatric disorders, specific areas of knowledge include physiology of each of the major organ
systems and an understanding of clinical physiology, pathophysiology and homeostasis as it
applies to treating single or multiple organ failure. In addition, knowledge of the various
monitoring and therapeutic technologies pertinent to the care of the critically ill patient is
required.
Such knowledge can be acquired in several ways including PCCU bedside rounds, seminars,
didactic teaching rounds, conferences, academic half-day /small group learning sessions,
simulation, as well as individual study. Residents are advised to consult relevant critical care
journals, purchase appropriate pediatric critical care texts or use online resources in consultation
with staff and more senior residents and to make use of the excellent library facilities available at
McMaster University both online and real text books.
Knowledge base will be assessed in 5 main ways:
1) Case review with attending staff gives the staff insight into the depth of knowledge acquired
by the resident related to clinical cases as well as scientific knowledge when specifically
tested.
2) Discussions and presentations in academic half day / small group learning will allow
residents to evaluate their own progress and allow evaluation from their peers and tutor.
3) Simulated resuscitations observed by staff demonstrate the residents’ ability to apply
knowledge in the acute setting
4) Objective structured clinical exams (OSCES) and written practice exams provide the
opportunity to objectively assess depth of knowledge across various areas
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5) Direct observation and evaluation of resident performance by faculty on Entrustable
Professional Activities (EPAs) will assess the resident’s ability to integrate their knowledge in
the every day practice of pediatric critical care
B) Clinical Skills
Clinical skills comprise the acts of obtaining a history, performing a comprehensive general and
a focused, system oriented exam, formulating a differential diagnosis, devising an investigation
plan and planning therapy. These skills are best taught by the attending staff physician on the
clinical service during bedside rounds or new patient assessments. Likewise these skills are best
assessed through direct observation of the resident by staff physician in the clinical setting and
specifically on EPAs. The OSCE exams provide an additional forum for formally assessing
clinical skills.
C) Technical Skills
Technical skills required for a pediatric critical care physician consist of knowledge and skill in
noninvasive and invasive airway and breathing management, conventional and nonconventional
ventilator management, insertion of peripheral and central venous catheters and arterial catheters,
application and interpretation of noninvasive and invasive cardiorespiratory and central nervous
system monitoring, ECG interpretation, cardioversion, defibrillation and temporary
transcutaneous cardiac pacing, emergent pericardiocentesis, naso/orogastric tube insertion,
thoracentesis and thoracostomy tube placement, bladder catheterization, intraabdominal pressure
monitoring, peritoneal tap, continuous renal replacement therapy, LPs, and bedside ultrasound.
Technical skills are taught in the clinical setting under direct supervision of staff physicians or
more senior resident trainees. In addition, instruction takes place using high fidelity simulation
and OSCE exams. Resident competence is assessed through direct observation by staff
physicians in the clinical setting and during mock resuscitations and OSCE exams.
2.
COMMUNICATOR
Communication skills refer to the ability to communicate effectively with patients and their
families around diagnosis, investigations needed, treatment plan, prevention and prognosis, and
breaking bad news. Communication skills are also needed to effectively interact with other
members of the interprofessional health care team and to provide colleagues with the results of
clinical assessments including recommendations. Communication skills are taught in the clinical
setting by staff physicians and during formal didactic sessions, practice with simulated patients,
mock resuscitations and OSCE exams. Residents’ abilities as a communicator are assessed by
direct observation of the resident by the staff physician in the clinical setting, performance on
EPAs, and during OSCE exams and mock resuscitations.
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3.
COLLABORATOR
The care of the critically ill patient relies on contributions of an inter professional health care
team. It is essential, that the resident in pediatric critical care develop skills in team leadership
and collaboration. These skills are learned by residents through direct observation of staff
pediatric intensivists and by formal didactic teaching in team dynamics. Resident skills as a
team member are assessed by direct faculty observation in the clinical setting and by
performance on EPAs.
Teaching skills are essential to a competent consultant who must be able to teach peers, residents
and medical students and other disciplines and lay individuals. Teaching can be very broadly
defined spanning formal lectures to informal one-on-one sessions. Teaching skills can be learned
by observing others, presenting at seminars and academic half days, and by presenting at
conferences. Such skills are assessed regularly and are components of the program
Supervisory skills include supervision of students and more junior residents including our
medical residents on the service, management of the PCCU service and interaction with other
members of the interprofessional health care team (nurses, therapists, pharmacists, social
workers, dieticians etc.) both in the hospital and in the community. Resident supervisory skills
are assessed by direct faculty observation and by performance on EPAs.
4.
MANAGER
This role includes a variety of skills including coordination of the inter professional health care
team, management of patient flow into and out of the PCCU and record keeping. Proper record
keeping requires recording of history and physical exam information, diagnostic and therapeutic
formulation, progress notes, discharge notes, discharge summaries and clinic letters. The
manager role also encompasses the residents’ ability to prioritize demands and balance
professional and personal responsibilities. Feedback by senior trainees and staff provides the
best method of instruction but residents will also receive formal didactic teaching sessions.
Evaluation is done by attending staff review of charts and letters, by performance on EPAs, and
through the use of a multisource feedback tool.
5.
HEALTH ADVOCATE
This role encompasses a variety of skills including the ability to identify the important
determinants of health affecting patients. As well, one should be able to contribute effectively to
improved health of patients and communities and recognize and respond to those issues where
advocacy is appropriate. Residents receive formal instruction and clinical experience in child
maltreatment, pediatric trauma, organ donation and end of life decision making. Evaluation will
consist of direct observation by staff physician, performance on EPAs and multisource feedback.
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6.
SCHOLAR
The role encompasses a variety of academic skills which include understanding the principles of
clinical and basic research, the ability to properly identify, read and evaluate literature, an
understanding of and interest in the scientific basis for clinical practice. Critical appraisal skills
are formally taught in didactic sessions in a journal club format. Independent learning of
scholarly skills also occurs as trainees complete a mandatory scholarly activity during their
training; this activity is formally evaluated by the faculty supervisor.
7.
PROFESSIONAL
Attitudes are difficult to teach and hard to evaluate given the subjective nature of some of these
topics. Included in this category are items such as sense of responsibility to patients and
colleagues, respect for the patient and self-assessment capabilities. Pediatric critical care
physicians are frequently faced with ethical issues related to life sustaining therapies, end of life
decision making, brain death and organ donation, and substitute decision making. The resident
acquires principles related to biomedical ethics from exposure to staff physicians as role models,
ethics consultations by ethics specialist, bedside inter professional rounds (including social
workers) and during small group case discussion. These attitudes are evaluated by direct staff
observation during rounds, academic half day tutorials and in the clinical setting by performance
on EPAs. The multisource feedback tool also provides a form of evaluating the professional role
of the resident.
EVALUATION
The above CanMEDS roles and the objectives outlined briefly above and in more detail below
form the basis of evaluation during the training program. Evaluation of each area can occur at
different times and by different individuals during the program. Attitudes and skills are in
general best evaluated by direct faculty observation in the clinical setting. Various tools are used
by the program to evaluate resident performance including ITERs, log books, OSCEs, EPAs,
Multisource Feedback, and In-training Exams. Residents receive feedback and evaluation by the
staff on a regular and on-going basis following clinical encounters. ITERs are completed as a
summary of all evaluation data over a 3 month period. The program director meets with the
residents on a semi-annual basis to discuss evaluations and point out the strengths and
weaknesses.
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Objectives of Training and Training Requirements
In Pediatric Critical Care
Supplement to Royal College of Physician and Surgeons of Canada Education Committee Objectives
of Training and Specialty Training Requirements in Pediatric Critical Care
GENERAL OBJECTIVES:
Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity
pertinent to pediatric critical care. In addition, all residents must demonstrate an ability to incorporate
gender, cultural and ethnic perspectives in research methodology, data presentation and analysis.
On completion of the educational program, the graduate physician will be competent to function as a
consultant pediatric critical care specialist. This requires the physician to:
1. Provide pathophysiological and evidence based, comprehensive and effective diagnosis and
management plan for acutely ill pediatric patients
2. Demonstrate the diagnostic and therapeutic skills necessary for the ethical and effective care of
critically ill patients
3. Communicate effectively with patients, their families and medical colleagues (particularly referring
physicians), and other health care professionals.
4. Counsel families and care givers on aspects of critical illness, life sustaining therapies and end of
life care, including risk factors, genetic and environmental concerns.
5. Maintain complete and accurate medical records.
6. Effectively coordinate the work of the inter professional health care team.
7. Be an effective teacher of other physicians (including medical students and residents), other health
care personnel and patients and their family.
8. Demonstrate personal and professional attitudes consistent with a consultant physician role.
9. Be willing and able to appraise accurately their professional performance.
10. Be willing and able to keep his or her practice current through reading and other modes of
continuing medical education.
11. Be able to access, critically assess and apply the critical care literature as it relates to patient
diagnosis, investigation and management.
12. Be able to participate in clinical or basic science studies as a member of a research team.
13. Be aware of and able to integrate patient safety concepts and skills to the overall care of patients
with critical illness
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SPECIFIC OBJECTIVES:
At the completion of training, the resident will have acquired, along with those outlined by the Royal
College of Physician and Surgeons of Canada Education Committee Objectives of Training and
Specialty Training Requirements in Pediatric Critical Care, the following competencies and will
function effectively in the following CanMEDS roles as:
1.
Medical Expert/Clinical Decision Maker
2.
Communicator
3.
Collaborator
4.
Manager
5.
Health Advocate
6.
Scholar
7.
Professional
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1. Medical Expert/Clinical Decision-Maker
General Requirements

Demonstrate diagnostic and therapeutic skills for ethical and effective care of the critically
ill patient

Access and apply relevant information to the practice of critical care

Demonstrate effective consultation services with respect to patient care, education and legal
opinions.
Specific Requirements

Demonstrate detailed knowledge of general and specialist aspects of critical illness

Demonstrate the safe and judicious use of equipment, monitoring, and drugs with a
coordinated provision of multidisciplinary care for effective organ support

Recognize, resuscitate and stabilize patients sustaining, or at risk of, cardiopulmonary arrest
or other life-threatening illness

Demonstrate knowledge and understanding of applied clinical physiology,
pathophysiology, homeostasis and pharmacology as it relates to the recognition and
treatment of single or multiple organ failure

Demonstrate an understanding of the unique aspects of physiology, psychosocial
development, developmental pharmacology and age-related diseases of the developing
infant, child and adolescent
Clinical Skills
Demonstrate basic and applied knowledge of the following:
Respiratory Dysfunction

Ability to determine the presence of respiratory failure, provide for its emergency support
and identify a plan for subsequent investigation and management

Demonstrate knowledge of normal anatomy, physiology and developmental physiology of
the respiratory system including gas exchange, respiratory mechanics, airway dynamics and
the control of respiration from intrauterine life through to adulthood
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
Understanding of the pathophysiologic states leading to respiratory failure and different
age-related disease

Knowledge of post-surgical respiratory problems and their management
Cardiovascular Dysfunction

Ability to identify cardiovascular dysfunction and provide emergency life support including
the methods and application of “Pediatric Advanced Life Support” (PALS) and “Neonatal
Advanced Life Support” (NALS) techniques

Knowledge and application of noninvasive and invasive hemodynamic monitoring

Knowledge of normal anatomy, physiology, developmental physiology, and
pathophysiologic states leading to cardiac failure in neonates through to adolescents and
treatment strategies including pharmacologic and nonpharmacologic therapies

Ability to recognize basic and complex cardiac arrhythmias and manage these with
pharmacologic and electrical therapies

Knowledge of the pathophysiology of shock and its treatment

Understanding of cardiopulmonary interactions in the presence of normal anatomy and in
congenital malformations of the cardiopulmonary system

Knowledge of the problems associated with surgical interventions in children with
congenital and acquired cardiac disease and application of knowledge in the preoperative
and postoperative management of these patients
Neurological Dysfunction

Ability to recognize, provide resuscitative, life-saving therapy and ongoing critical care
management of central nervous system (CNS) and peripheral nervous system (PNS) and
derive a differential diagnosis and appropriate diagnostic plan for these patients

Knowledge of the etiologies, pathophysiology, diagnostic investigation, monitoring and
management of altered level of consciousness, intracranial hypertension, status epilepticus

Ability to clinically diagnose brain death and knowledge of ancillary investigations and
their application

Knowledge of impact of critical illness and associated ICU admission on CNS and PNS
including coordination of interprofessional resources to mitigate these effects and provide
rehabilitative therapies

Understanding of the considerations associated with long-term mechanical ventilation in
patients with chronic neuromuscular disease
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
Ability to provide neuroprotective therapies in diseases of the CNS including trauma and
post neurosurgical states
Renal Dysfunction

Ability to recognize, investigate and manage acute kidney injury, renal dysfunction and
renal failure

Knowledge of renal physiology and pathophysiology of renal failure including
pharmacodynamics in states of altered renal function

Understanding of the perioperative management of renal transplant patients

Knowledge of continuous renal replacement therapy as a supportive measure in patients
with renal dysfunction
Gastrointestinal Dysfunction

Ability to recognize, investigate and manage the patient presenting with acute, lifethreatening gastrointestinal illness

Knowledge of the etiology, diagnosis and management of the acute abdomen, hollow
viscous dysfunction, upper and lower GI bleeding, abdominal compartment syndrome, and
intraabdominal trauma

Perioperative management of patients requiring abdominal surgery
Hepatic Dysfunction

Knowledge of normal hepatic physiology and ability to recognize, investigate and acutely
manage the various etiologies leading to hepatic failure

Understanding of the pathophysiology of acute and chronic liver failure, therapeutic options
and transplant indications

Knowledge of the perioperative management of liver transplant patients
Hematologic/Oncologic Disorders

Knowledge of the pathophysiology, investigation and management of thrombocytopenia,
anemia, neutropenia, haemolytic and vaso-occlusive disease, thrombosis, and bleeding
diatheses

Knowledge of the diagnosis and management of acute presentation and complications
associated with solid tumor and blood borne malignancies
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
Understanding of the indications and application of anticoagulant and fibrinolytic therapies
Metabolic/Endocrine Disorders

Ability to recognize, investigate, monitor and manage acute illness related to endocrine,
metabolic, fluid and electrolyte and acid-base disorders

Knowledge of the pathophysiology, diagnosis, and treatment of endocrine emergencies and
acute crisis from inborn errors of metabolism

Knowledge of normal homeostatic control and identification, diagnosis and management of
disorders of homeostasis including abnormal thermoregulation
Trauma

Ability to manage patients with single system or multisystem trauma according to
Advanced Trauma Life Support (ATLS) guidelines

Knowledge of the acute resuscitation, diagnostic evaluation, monitoring and ongoing
management of traumatized patients with regard to all body systems in the acute setting and
long term follow-up

Ability to recognize potential child maltreatment and appropriate workup of such cases
Septic Illness

Ability to recognize, investigate, monitor, acutely resuscitate according to goal directed
therapy and provide ongoing management for the patient presenting with systemic
inflammatory response syndrome (SIRS), sepsis, and septic shock with and without
multiple organ dysfunction syndrome (MODS)

Knowledge of the pharmacology, indications, complications, interactions, monitoring and
efficacy of usual antimicrobial agents

Knowledge of the investigation and management specific to the immunocompromised host

Knowledge of infection control practices including hospital isolation guidelnes and
indications for chemoprophylaxis
Intoxication

Ability to recognize, investigate and manage toxic syndromes including the indications and
contraindications for therapies affecting the absorption, distribution and elimination
(hemodialysis, hemoperfusion) of common intoxicants
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
Knowledge of pharmacokinetic and pharmacodynamic principles

Knowledge of the psychosocial, emotional and psychiatric support required by patients and
families
Burns/Electrical Injury

Ability to provide acute resuscitative care according to ATLS guidelines to patients
sustaining thermal/electrical injury and ability to subsequently diagnose the degree of
cutaneous injury according to depth and location of injury and vital organ injury and
institute therapy to minimize metabolic, fluid and electrolyte, infectious and organ system
complications

Knowledge of the pathophysiology, medical and surgical management of thermal and
electrical injuries
Nutritional Support

Knowledge of caloric/fluid requirements and the assessment of nutritional status and energy
expenditure in critically ill patients

Knowledge of the methods, indications, contraindications, limitations and complications of
enteral and parenteral nutritional delivery
Pharmacotherapy

Knowledge of pharmacodynamic and pharmacokinetic principles as they apply to
therapeutic agents in the PCCU

Knowledge of the indications, contraindications, risks, interactions and side effects of
common therapeutic agents including but not limited to sedatives, neuromuscular blockade,
antimicrobials, diuretics, and hemodynamic agents

Knowledge of indications, contraindications, complications and side effects rapid sequence
induction agents
Transportation

Knowledge of the factors peculiar to transport of critically ill patients including mode of
transportation, manpower requirements, monitoring and management challenges unique to
transport, communication and documentation nuances

Knowledge of altitude physiology as it applies to air transport of critically ill patients
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Transplantation

Knowledge of the perioperative care of the transplant patient

Knowledge in the management of the immunocompromised patient including
opportunistic/nosocomial infection, rejection, graft vs host disease

Knowledge of the diagnosis of brain death and organ preservation therapies

Ability to describe for families the concept of brain death and discuss the option of organ
donation in accordance with ethical and medical-legal considerations
End of Life Issue

Knowledge of the ethical, medical-legal, spiritual and social considerations in decisions
regarding withholding or withdrawal of life sustaining therapies

Knowledge of legislative requirements of substitute decision makers around patient best
interest and ability to manage conflict between substitute decision makers and the health
care team regarding end of life decision making

Knowledge of pain and symptom management

Knowledge of the role of the coroner in death investigation

Knowledge of the role of the interprofessional team in providing patients and families with
emotional, psychosocial and spiritual support
Technical Skills
Airway

Assessment of airway including ability to recognize potentially difficult airway

Maintenance of airway through positioning and toileting

Placement of oropharyngeal airway, laryngeal mask airway, orotracheal and nasotracheal
intubation

Indication for urgent surgical airways

Indication for tracheostomy for prolonged mechanical ventilation or airway control

Replacement of existing tracheostomy tube
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Breathing

Application of respiratory monitoring equipment including pulse oximetry, capnography,
end tidal CO2 detection

Bag mask ventilation

Interpretation of chest radiographs

Application and manipulation of noninvasive and invasive conventional and
nonconventional positive pressure ventilation

Delivery of inhaled pharmacotherapies and special gas admixtures (heliox, nitric oxide)

Measurement and interpretation of pulmonary mechanics during mechanical ventilation

Techniques for weaning mechanical ventilation

Thoracocentesis and thorocostomy tube insertion
Circulation

Insertion of intraosseus, peripheral venous, central venous, and peripheral arterial vascular
catheters

Mixed venous oxygen saturation measurement and interpretation

ECG interpretation

Defibrillation and cardioversion

Temporary transcutaneous cardiac pacing

Bedside cardiac ultrasound assessment in hemodynamically unstable patients

Knowledge of utilization of dual chamber temporary pacemaker
Central Nervous System (CNS)

Declaration of brain death

Lumbar puncture
Renal

Insertion of vascular hemodialysis catheters
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Gastrointestinal

Naso/orogastric tube placement

Duodenal intubation for enteral feeds

Interpretation of abdominal radiographs

Intra abdominal pressure monitoring

Peritoneal tap
Nutrition

Determination of nutritional plan
Transport

Organization and supervision of intra and extra-mural critical care transport
Other

Application of techniques to treat or induce hypo/hyperthermia
2. Communicator
General Requirements
The pediatric critical care resident must demonstrate an ability to:

Establish relationships with patients and families

Listen effectively

Obtain and synthesize relevant history from patients/families/health care professionals

Discuss appropriate information with patients/families and the health care team
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Specific Requirements
The pediatric critical care resident must be able to:

Assess, communicate with, and support patients and families facing critical illness

Explain life-sustaining therapies in clear and understandable and sensitive language and
describe and discuss expected outcomes and goals of therapy in the context of patient and
family goals, values, beliefs, and wishes including discussion of limitation, withholding or
withdrawal of invasive life sustaining therapies

Communicate effectively and minimize conflict with patients and families demonstrating
aggression, anger, confusion

Explain the concepts of brain death and organ donation
3. Collaborator
General Requirements
The pediatric critical care resident must demonstrate the ability to:

Consult effectively with other physicians and health care professionals

Contribute effectively to interdisciplinary team activities
Specific Requirements
The pediatric critical care resident must demonstrate the ability to:

Communicate and cooperate effectively with physician and nonphysician colleagues in the
clinical, educational and research environment

Prevent and resolve conflict in interactions with patients, families and members of the
health care team
4. Manager
General Requirements
The pediatric critical care resident must demonstrate the ability to:

Allocate finite health care resources and utilize hospital and community resources to
optimize patient care

Work effectively in a health care organization

Balance patient care needs, learning needs and personal needs
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Specific Reguirements
The pediatric critical care resident must demonstrate the ability to:

Work effectively with the administrative organization of the pediatric critical care unit
(PCCU), health care facility and community in order to operate a PCCU

Manage the staffing, educational, and operational requirements of a PCCU to support the
clinical, academic, and administrative functions of the unit
5. Health Advocate
General Requirements
The pediatric critical care resident must be able to:

Identify important determinants of health and contribute effectively to the advancement of
patient and community health
Specific Requirements
The pediatric critical care resident must be able to:

Be knowledgeable of the broad determinants of health including environmental, socioeconomic, and life style factors relevant to critical illness

Understand the importance of medico-legal considerations in critical illness

Contribute to the overall advancement of childhood health and critical care medicine within
the community
6. Scholar
General Requirements
The pediatric critical care resident must demonstrate the ability to:

Encourage and facilitate learning of medical trainees, members of the health care team and
patients and families

Contribute to the advancement of critical care knowledge

Develop and maintain lifelong learning skills
Specific Requirements
The pediatric critical resident must be able to:

Demonstrate knowledge, skills and expertise in literature retrieval and the application of
evidence based medicine in the clinical and academic setting
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
apply concepts of evidence based medicine and health research methodology in the
appraisal of health care research and literature

Understand basic concepts of biostatistics, study design, research ethics requirements,
protocol and manuscript preparation and research grant application
7. Professional
General Requirements
The pediatric critical care resident must demonstrate the ability to:

Deliver highest quality care with integrity, honesty and compassion

Exhibit appropriate personal and interpersonal professional behaviours

Practice medicine and research ethically and consistent with hospital and governing body
policies and procedures
Specific Requirements
The pediatric critical care resident must be able to:

Demonstrate an awareness of the moral and ethical issues that affect patients, families and
health care providers in the PCCU

Understand the various roles and responsibilities of the critical care physician at the local,
regional, national and international levels

Demonstrate knowledge of ethical concepts including informed consent, autonomy,
substitute decision making, transparency, fiduciary relationships, conflict of interest, and
justice in resource allocation

Periodically review their own personal and professional performance against national
standards set for the specialty.

Be willing to include the patient in discussions concerning appropriate diagnostic and
management procedures.

Show appropriate respect for the opinions of fellow consultants and referring physicians in
the management of patient problems and be willing to provide means whereby differences
of opinion can be discussed and resolved.
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Pediatric Critical Care Residency Training Program
McMaster University
Specific Goals of Training
1. Medical Expert
Clinical Knowledge
First Year Residents

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
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






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





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
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Assessment and management of the A,B,C’s of a critically ill child
anatomy, physiology and pathophysiology of the respiratory system
the principles and theory of mechanical ventilation and other methods of respiratory support
interpretation of normal and common abnormal findings on chest radiographs
principles and interpretation of invasive and non-invasive hemodynamic monitoring
physiology and application of cardiopulmonary interactions in the PCCU
physiology and pathophysiology of shock
the pathophysiology and management of heart failure and cardiac arrhythmias across the
pediatric age-groups
anatomy and physiology of patients with congenital heart disease; pre and post operatively
pathophysiology, investigation and monitoring of raised intracranial pressure
criteria required for the clinical diagnosis of brain death and indications for ancillary
investigation
the major pathophysiologic entities associated with neuromuscular disease
the indications and ethical implications of long term mechanical ventilation in
neuromuscular disease
the pathophysiology of renal failure and renal transplantation
the interaction between drugs and the kidney in normal and diseased states
the differential diagnosis of an acute abdomen
diagnosis of GI bleeds and the presentation of abdominal trauma
the normal function of the liver and the pathophysiology of liver failure
the physiology of a patient following liver transplantation
the complications of pediatric oncologic diseases and their treatment
differential diagnoses of thrombotic states and bleeding disorders
fluid, electrolyte and nutritional requirements of critically ill patients
transport physiology and problems associated with patient transport
Second Year Resident

pathophysiology of disease processes across stages of development of the pediatric
respiratory system
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


advanced knowledge of congenital cardiovascular malformations and their pre- and postoperative management
management of the potential organ donor
physiologic principles, indications, and application of continuous renal replacement therapy
an advanced understanding of the management of the above disease states along with an
awareness of the controversial therapies
demonstrates the ability to provide telephone advice for extramural pediatric critical care
consultations
Technical Skills
First Year Residents

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
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
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application of skills from PALS, APLS and ATLS
obtain and perform measurement of all vital signs including oxygen saturations and noninvasive blood pressures
intravenous and intraarterial access in a critically ill child
ultrasound guided insertion of femoral, internal jugular and subclavian venous lines
insertion of an intraosseous needle
demonstrates proficiency and safety in the steps of rapid sequence induction for airway
management
airway management including placement of oral and nasopharyngeal airways and oro- and
naso-tracheal intubations,
insertion of oro and nasogastric tubes and foley catheters
insertion of hemodialysis catheters for CRRT
insertion of chest tubes and thoracentesis
performance of lumbar punctures
insertion of naso- and orogastric tubes
performance of transcutaneous synchronized cardioversion, defibrillation and pacing
Second Year Residents
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proficiency and independence in the skills listed under the requirements for first year
fellows
knowledge of ultrasound assessment of: pericardial effusion, cardiac ventricular size and
qualitative function, vascular volume status, pleural effusion, asicites, focused abdominal
sonography in trauma (FAST)
knowledge of the technique for: fiberoptic bronchoscopy in intubated patients, emergent
cricothyrotomy, pericardiocentesis
2. Communicator
First and Second Year Residents

to understand the issues involved in communicating bad news to families in stressful
situations
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to be able to explain complicated medical issues regarding diagnosis and prognosis in clear
language to families
to develop the ability to clearly communicate with families and the medical team in tense
situations or crises
demonstrate respect and understanding for the role of each member of the health care team
effectively communicate with subspecialty services during consultation requests and
follow-up discussions
recognize the importance of clear documentation in patient's health care record
demonstrate conflict resolution skills when interacting with aggressive or angry family
members or members of the health care team
effectively communicate appropriate positive and negative feedback on performance of
junior trainees
Second Year Residents
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
to perform the above skills more independently
demonstrates the ability to conduct and lead a family meeting
3. Collaborator
First and Second Year Residents
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to consult effectively and in a timely manner with other members of the PCCU health care
team and with subspecialty services
to communicate care plans clearly and precisely to all members of the allied health teams
to demonstrate leadership and work in a collaborative manner with fellow
learners
4. Manager
First and Second Year Residents
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understand the demands of working in a PCCU including the personal physical and
emotional stressors associated with the environment
effectively balance time and prioritize between patient care, learning needs, stress
management and outside activities
utilize electronic resources to support patient care and learning needs
understand issues regarding health resource allocation and the impact on patient
management
Second Year Residents
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familiarity with the organizational structure of the PCCU and the manpower resources
necessary to operate a PCCU
learn the practical skills necessary to effectively run the Unit
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demonstrate increasing independence in decision making around patient care and bed
allocation
demonstrate the ability to lead the health care team in the overall management of the PCCU
demonstrate leadership skills in identifying and addressing potential patient safety concerns
in the PCCU
5. Health Advocate
First and Second Year Residents
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an understanding of the diverse determinants of health across patients
an awareness of the medicolegal considerations in the PCCU
awareness of societal programs available for prevention of many PICU conditions such as
head injury, near drowning etc.
understand the impact of critical care on the long-term functional outcome and quality of
life of patients
demonstrate proficiency with obtaining informed consent
understand the concepts of "best-interest" and "futility"
provision of caring and compassionate end-of-life care to patients and their families
6. Scholar
First and Second Year Residents
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learn the skills necessary to research and present critical care rounds
facilitate education of other learners in the PICU
application of evidence based medicine principles and current literature to patient
management decisions on a daily basis
organize and present critical care rounds
lead formal and informal teaching sessions on basic critical care topics
Second Year Residents
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
demonstrate skills of research methodology and research ethics as they apply to the design
and implementation of critical care research trials
conduct and present results of a scholarly project in pediatric critical care
7. Professional
First and Second Year Residents


exhibit appropriate personal and interpersonal professional behaviour in interactions with
other health care staff and patient and family members
understand the impact of personal moral and ethical value systems on the care of individual
patients and families
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ensure detailed and complete follow-up and handover of all patients under the residents
care
demonstrate effective conflict resolution skills and appropriate code of conduct
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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