Pediatric Critical Care Fellowship: Pediatric Critical Care Rotation
CanMEDS Roles
CanMEDS Key Competencies
Methods to achieve
competencies
1. Medical expert
a. knowledge:
First Year Fellow should have an understanding of:
a) anatomy, physiology and pathophysiology of the respiratory system
b) the principles and theory of mechanical ventilation and other methods of
respiratory support
c) principles of invasive and non-invasive hemodynamic monitoring
d) the pathophysiology of heart failure
e) physiology of cardiac arrhythmias
f) anatomy and physiology of patients with congenital heart disease; pre and
post operatively
g) pathophysiology, monitoring and investigation of raised intracranial
pressure
h) criteria required for the clinical diagnosis of brain death
i) the major pathophysiologic entities associated with neuromuscular disease
j) the indications and ethical implications of long term mechanical ventilation
in neuromuscular disease
k) the pathophysiology of renal failure and renal transplantation
l) indications for peritoneal and/or continuous veno-venous hemofiltration
m) the interaction between drugs and the kidney in normal and diseased states
n) the differential diagnosis of an acute abdomen
o) diagnosis of GI bleeds and the presentation of abdominal trauma
p) the normal function of the liver and the pathophysiology of liver failure
q) the physiology of a patient following liver transplantation
r) the complications of pediatric oncologic diseases and their treatment
s) the pathogenesis and management of thrombocytopenia, anemia, and
neutropenia

Updated April 2014






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
simulation sessions
1
t)
u)
v)
w)
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
recognition of multiple organ dysfunction syndrome and implications for
prognosis
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-veno or veno-arterial cannulation
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) intravenous access in a critically ill child
d) insertions of femoral, internal jugular and subclavian venous lines
e) insertion of an intraosseous
f) airway management including performance of oro and nasotracheal
intubations, including use of the laryngeal mask
g) insertion of oro and nasogastric tubes and foley catheters
h) insertion of percutaneous hemodialysis catheters
i) insertion of chest tubes and thoracentesis
j) performance of lumbar punctures




performance of
procedures on patients
in the PICU
Anesthesia and
Adult ICU rotations
PALS, ATLS and NALS
courses
Simulation/Task trainer
sessions

Second Year Fellows:
a) familiarity with insertion of a Swan-Ganz catheter
b) pericardiocentesis with supervision
Updated April 2014
2
c) proficiency 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
b) to be able to explain complicated medical diagnoses and treatment in simple
terms to families
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
during times of stress or crisis
f) to effectively communicate appropriate positive and negative feedback on
performance of junior trainees





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
rotating ICU resident
evaluations
simulation – breaking bad
news
run family meetings with
staff present as
appropriate
Second Year Fellows:
a) to perform the above skills more independently
b) clearly explain the concept of brain death and the potential for organ
donation if indicated to families

3. Collaborator
Updated April 2014
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
fill out consult forms
specifically and speak to
consultants directly about
reasons for consults
3
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



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



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





Updated April 2014
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
simulation
discussing strategies with
attending staff
retreats, informal one on
one sessions with staff
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
4
5. Health
Advocate
First and Second Year Fellows:
a) Be aware of the relative costs of different diagnostic and treatment
modalities
b) Be aware of the programs available for prevention of many PICU
conditions such as motor vehicle collisions, bike safety, and near-drowning.
c) Be familiar with post injury rehabilitation programs and how to access them
d) Demonstrate proficiency with obtaining informed consent for medical and
diagnostic procedures as well as for research studies
e) counsel parents and families accordingly when patients face a terminal
illness or very poor prognosis




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



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
Updated April 2014


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
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
5
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



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

Updated April 2014
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
6