Competency-based Objectives PICU Rotation 1. Medical Knowledge a. First year fellows i. Demonstrate an investigatory and analytic approach to clinical situations. ii. Recognize the patterns of signs and symptoms of common problems and diseases that present in physiologically unstable an at-risk patients. iii. Explain the physiology and pathophysiology of common problems and diseases in patients that are physiologically unstable and/or atrisk. iv. Explain the indications and limitations of laboratory/diagnositic tests and monitoring systems commonly used in the PICU. v. Discuss concepts of futility, withdrawal of support and withholding care. vi. Recognize and describe criteria present for a diagnosis of brain death and organ donation. b. Second and third year fellows i. Recognize and explain the patterns of signs and symptoms of uncommon presentations of problems and diseases that present in physiologically unstable and at-risk patients. ii. Explain the physiology and pathophysiology of common and uncommon problems and diseases presenting to a pediatric ICU. iii. Explain the indications and limitations of less commonly used laboratory/diagnostic tests and monitoring systems used in the PICU. 2. Patient Care (communication objectives listed under interpersonal) a. First year fellows i. Obtain a focused history and perform a focused physical examination in order to initiate stabilization of children with physiologic instability. ii. Obtain a comprehensive history and perform a complete physical examination in order to complete the evaluation and development of an ongoing treatment plan relevant to the patient s problem. iii. Explain and perform appropriate resuscitation and stabilization in a timely fashion. iv. Create a problem list and differential diagnosis for common diseases and problems presenting to a pediatric ICU. v. Recognize and order appropriate diagnostic tests for common diseases and problems presenting to a pediatric ICU> vi. Make informed decisions about diagnostic and therapeutic interventions for common diseases and problems in patients with physiologic instability or at-risk for deterioration based on
acquired information, up-to-date scientific evidence and clinical judgment. vii. Develop and carry out patient management plans. viii. Adapt/adjust care plan/treatment with changes in patients physiologic status. ix. Anticipate and respond to common complications and physiologic deterioration. x. Competently perform the common technical procedures required in PICU care. xi. Address preventive health care issues in daily practice. xii. Coordinate care with multiple consultants as needed. xiii. Integrate an understanding of physiology and pathophysiology to determine the appropriate use of common PICU therapies. b. Second year fellows and third year fellows (in addition to first year objectives) i. Direct appropriate stabilization by junior fellows/residents. ii. Create a comprehensive problem list and differential diagnosis for uncommon presentations to the pediatric ICU. iii. Make informed decisions about diagnostic and therapeutic interventions for uncommon diseases/problems presenting to a pediatric ICU based on acquired information, up-to-date scientific evidence and clinical judgment. iv. Efficiently manage multiple patients during a typical day. v. Competently perform complex technical procedures. vi. Anticipate and respond to less common complication and physiologic changes. vii. Integrate an understanding of physiology and pathophysiology to determine the appropriateness of less commonly used PICU therapies. c. Third year fellows (in addition to above objectives) i. Participate in patient placement decisions. ii. Supervise, when appropriate, common technical procedures. 3. Communication and Interpersonal Skills a. First, second and third year fellows i. Create and sustain a therapeutic and ethically sound relationship with patients and their families. ii. Seek information from families and other health care professional to assure patient-centered care. iii. Provide information to families and other health care workers that is accurate, appropriate for their level of understanding and consistent with the overall treatment plan. iv. Recognize own personal biases that affect information provided. v. Document patient care in the medical record following guidelines in a timely fashion.
vi. Enter orders effectively and in a timely fashion. vii. Actively participate in work rounds. viii. Provide feedback to residents, peers and faculty. ix. Work effectively as a member of the health care team. 4. Practice-based Learning and Improvement a. First, second and third year fellows i. Analyze your own practice experience and perform practice-based improvement using a systematic methodology. ii. Locate, appraise and assimilate evidence from scientific studies related to your patients health problems. iii. Incorporate evidence (when possible) into the decision making and treatment plans of common PICU health care issues. iv. Seek feedback on performance on a regular basis from attendings and peers. v. Demonstrate the ability to critically appraise the medical literature. vi. Incorporate knowledge of study design and statistical methods to initiate substantive research/scholarly activity appropriate to critical car medicine. vii. Understand critical issues that impact research design. 5. Systems-based Practice a. First, second and third year fellows i. Describe how types of medical practice and delivery systems impact on health care costs and resource allocation. ii. Incorporate cost-effective health care practices and resource allocation that does not adversely impact quality of care. iii. Advocate for quality patient care and assist patients/families in dealing with system complexities. iv. Describe how critical care physicians can partner with health care managers/providers to improve health care and improve systems. v. Apply performance improvement methods and tools in projects focused on the critical care setting. 6. Professionalism a. First, second and third year fellows i. Identify cultural and personal issues of patients/families that affect patient care decisions. ii. Recognize personal biases that may conflict with patients/families in decisions-making and development of treatment plans. iii. Resolve conflicts in favor of the patient/family when possible. iv. Respect the input and importance of the family/patient and each member of the health care team. v. Accept responsibility for own actions. vi. Demonstrate accountability for actions of yourself and the health care team. vii. Recognize and address ethical issues confronted daily in the PICU.
Objectives for Anesthesiology Rotations during Pediatric Critical Care Fellowship 1. Medical knowledge a. Recognize and explain the patterns of physiologic changes that occur in pediatric patients receiving common anesthetic agents/surgical interventions under anesthesia. b. Explain the pharmacologic and physiologic effects of commonly used anesthetics and analgesics. c. Explain appropriate delivery systems used for anesthetics and analgesics. d. Explain the rationale for appropriate use of monitoring devices. 2. Patient Care a. Obtain a pre-operative history and perform an appropriate pre-operative physical examination, including assigning ASA levels. b. Make informed decisions about therapeutic interventions and anesthetic management for common intra-operative events based on acquired information, up-to-date-scientific evidence and clinical judgment. c. Maintain situational awareness about the patient s conditions and the surgeon s activities d. Adapt/adjust, under supervision, the patient s anesthetic management in response to changes in the patient s physiologic status. e. Competently perform the technical procedures commonly used during anesthesia/surgery (airway management, intravascular line placement) 3. Communication and Interpersonal Skills a. Seek information from patients, families and other health care professionals to assure patient-centered care. b. Provide information to the health care team that is accurate, appropriate for the professional and consistent with the overall treatment plan. c. Document patient care prior to, during and after anesthetic delivery following guidelines. 4. Practice-based Learning and Improvement a. Analyze your own experience during the rotation to develop a plan for continued improvement. b. Locate, appraise and assimilate evidence from scientific studies related to the patient s problems, surgical intervention and expected anesthetic management. c. Seek feedback on performance on a regular basis from attendings. 5. Systems-based Practice a. Function as an effective member of the OR team, recognizing and responding to task overload in self and other Participate in weekly anesthesia conference to identify opportunities to improve systems of care. b. Advocate appropriately for evidence-based management of patients c. Coordinate the peri-operative care of the patient with the surgical and anesthesiology team. d. Practice cost-effective health care and resource allocation that does not impact on quality of care. e. Demonstrate appropriate knowledge and skills about the monitoring technology used. f. Disclose slips, lapses and errors to appropriate personnel. 6. Professionalism a. Identify cultural and personal issues of patients/families that affect decisions regarding anesthesia and surgical procedures.
b. Recognize personal biases that may conflict with patient/families and resolve conflicts in favor of the patient/family when possible. c. Respect the input and importance of the family/patient and each member of the health care team. d. Accept responsibility and demonstrate accountability for own actions and those of the health care team.
Objectives for Cardiology/Cardiovascular Surgery Rotation during Pediatric Critical Care Fellowship 1. Medical knowledge a. Recognize and explain the patterns of signs and symptoms of common congenital and acquired pediatric problems and diseases that present for inpatient management. b. Explain physiology/pathophysiology of common problems and diseases in cardiology/cardiovascular patients, especially peri-operative management. c. Explain the indication and limitations of diagnostic and therapeutic interventions commonly used for the care of patients with cardiac disease (surgical palliation, surgical repair, transplantation, etc). 2. Patient Care a. Obtain and record an appropriate history and physical examination in order to adequately diagnose and treat patients with common cardiac diseases. b. Prioritize the care of the teams patients to optimize patient care c. Make informed decisions about therapeutic interventions and acute and chronic management for common cardiac diseases based on acquired information, up-todate-scientific evidence and clinical judgment. d. Identify and order appropriate diagnostic tests for patients with common cardiac diseases. e. Perform, observe and/or interpret, under supervision, the technical procedures commonly used for cardiac patients (cardiac catheterization, operative intervention.) 3. Communication and Interpersonal Skills a. Create and sustain therapeutic and ethically-sound relationships with patients/families. b. Seek information from patients, families and other health care professionals to assure patient-centered care. c. Provide information to families and health care team that is accurate, appropriate to the level of recipients and consistent with the overall treatment plan. d. Document patient care following guidelines. 4. Practice-based Learning and Improvement a. Analyze experience during the rotation to develop plan for continued improvement. b. Locate, appraise and assimilate evidence from scientific studies related to the patient s problems and treatment options. c. Seek feedback on performance on a regular basis from attendings. 5. Systems-based Practice e. Function as an effective member of the cardiac service, recognizing and responding to task overload in self and other f. Participate in cardiac/cardiovascular surgery conferences to identify opportunities to improve systems of care. g. Advocate appropriately for evidence-based management of patients h. Coordinate the care of acutely and chronically ill patients with the cardiac and referral teams i. Practice cost-effective health care and resource allocation that does not impact on quality of care. j. Demonstrate appropriate knowledge and skills about the technology used. 6. Disclose slips, lapses and errors to appropriate personnel 7. Professionalism
a. Identify cultural/personal issues of patients/families and yourself that affect decision-making. b. Resolve conflicts between you and patients/families in favor of the patient/family when possible. c. Respect input/importance of the family/patient and each member of the health care team. d. Accept responsibility and demonstrate accountability for actions of yourself and health care team.
Objectives for Transport Rotation 1. Medical knowledge a. Recognize and explain the patterns of signs and symptoms of diseases that frequently require interhospital transportation. b. Explain the physiology and pathophysiology of common problems/diseases encountered on the transport service including the impact of transport by helicopter or airplane. c. Explain the indications for and limitations of interhospital transport services. 2. Patient Care a. Prioritize clinical tasks needed to assess and stabilize a patient on transport b. Acquire and report the clinical information needed to transfer care from one institution/physician to another. c. Interpret data available on transport and adjust/adapt medical care appropriately. d. Develop the skills needed to provide effective, efficient care during transport of acutely ill and injured patients. 3. Interpersonal skills & Communication a. Create and sustain a therapeutic and ethically-sound relationship with patients and their families. b. Seek information from patients, families and other health care professionals to assure patient-centered care. c. Provide information to the families/health care team that is accurate, appropriate to the level of the recipient of the information and consistent with the overall treatment plan. d. Document patient care following guidelines. 4. Practice-based learning and improvement a. Analyze experience during the rotation to develop plan for continued improvement. b. Locate, appraise and assimilate evidence from scientific studies related to the patient s problems and treatment options. c. Seek and provide feedback from/to team members to improve team function and efficiency d. 5. Systems-based practice a. Participate in scheduled reviews of transport patients focused on systems improvement. b. Maintain situational awareness during transport and hand-offs. c. Advocate effectively for timely, effective stabilization of patients without compromising quality. d. Demonstrate the effective use of technology used during intra- and interhospital transport. e. Incorporate cost-effectiveness and resource allocation during the care of transport patients. f. Ensure the safe transportation of patients through effective teamwork, use of protocols/guidelines and appropriate communication with the Medical Control physician.
g. Disclose slips, lapses and errors. 6. Professionalism a. Address ethical issues confronted in transport services. b. Identify cultural and personal issues of patients/families that affect the care of the patient during and after transportation c. Recognize personal biases that may conflict with patients/families during transport and resolve in favor of patients/families when possible. d. Accept responsibility for own actions and demonstrate accountability for yourself and the transport team
Objectives for Research Rotation The purpose of the research rotation is to investigate opportunities for ongoing research projects, identify a potential project for the 2 nd and 3 rd year of fellowship and review the principles of research design. Fellows may actively participate in an ongoing research project(s) and/or initiate their own research project under supervision. 1. Medical Knowledge a. Generate hypotheses for substantive research in critical care medicine. b. Explain principles of study design and statistical methods needed to perform substantive research. c. Explain critical issues that impact on research design and implementation. d. Access and use IRB/IACUC guidelines/requirements 2. Patient Care a. Appropriately identify patients eligible for enrollment in well-designed research studies. b. Obtain informed consent from patients/families for enrollment in research studies. 3. Communication/Interpersonal Skills a. Participate in multidisciplinary discussions of research ideas and projects. b. Provide information to families and other health care workers that is accurate, appropriate for their level of understanding and consistent with IRB guidelines for research. 4. Practice-Based Learning a. Analyze your own research experiences and strive to improve using a systematic methodology. b. Locate, appraise and assimilate evidence from scientific studies related to your research projects. c. Seek feedback on your performance as a researcher from attendings and peers. 5. Systems-based Practice a. Incorporate cost-effectiveness and resource allocation in research design. b. Describe how research impacts on health care costs and resource allocation. 6. Professionalism a. Address ethical issues confronted in research programs. b. Identify cultural and personal issues of patients/families that affect participation in research studies. c. Recognize personal biases that may conflict with patients/families during implementation of research projects. d. Accept responsibility for own actions and demonstrate accountability for yourself and the research team.