Resident Resources
PICU Resident Rotation
Alfred I DuPont Hospital for Children
Nemours Foundation
Resident Resources
Introduction to PICU Rotation
Residents given PICU Core Curriculum (see separate attached file)
Outlines expectations of residents and general educational plans
Residents given folder with additional information
PICU Procedure and Primary Patient Logs.
PICU Resident Systems Based Learning Project Quality Improvement Case Analysis form.
InfoLink information.
Copy of combined resident and critical care attending progress note form. This form is used to prepare for patient care rounds and for presenting patients’ clinical course on rounds.
Request to discuss TPN details on patient care rounds
Daily Goals sheet
Mechanical Ventilation Weaning Guidelines
PICU Order Entry Flow Sheet for writing orders during busy PICU times
Process for Patient Transfer Out of PICU
Alfred I DuPont Hospital for Children Transfer of responsibility for Patient Care and Medication Reconciliation Memo
Visiting residents receive Beeper, Proxy Card, Parking Passes, Meal Cards. (Pediatric and Medicine-Pediatric residents already have these resources).
Visiting medical students receive Proxy Card and Parking Pass.
Exposure to a pediatric medical-surgical PICU population
Participation in multidisciplinary-team care of critically ill children and adolescents
Clinical supervision by board-certified pediatric critical care medicine physicians 24 hours a day
Exposure to pediatric critical care fellows
PICU Resident Rotation Web Site*
Overview
Faculty
Curriculum
Orientation
Outcomes
Outcomes Measurement
Resources
Content
Administrative Issues
General information
Patient responsibilities
Transfer Out of PICU Algorithm
Solid Organ Transplant Handbook
Lectures and Presentations (in-house power-point presentations)
Pediatric Toxicology
Critical Care Respiratory
Diabetic Ketoacidosis
Post-op Liver transplantation
Multiple Organ Dysfunction
Narcotic Withdrawal and Methadone taper
Nutrition in Critical Care
Pediatric Shock
Respiratory Failure
Septic Shock and MOF in Newborns and Children
Sold Organ Transplantation, Pharmocologist’s View
SIRS and ARDS in the PICU
Traumatic Brain Injury
Evidence Based Clinical Practice
Definition and Skills
Asking a Focused Clinical Question
Literature Search Strategies
Summary Criteria
Reports
2001-2002 through 2007-2008
Contact Information
Links
PCCM web site
PICU Rotation Time Line
Pediatric Critical Care Goals for PICU Resident Rotation
Code Blue Roles
Presenting Difficult PICU Cases on Rounds
Daily Note
Difficult Airway Cart
Pre-Rotation Questionnaire
PICU Post Test
*Internet site is reviewed and updated yearly in June/July
Interactive case-based bedside teaching
Supervised participation in critical care procedures: intubation, central venous line placement, arterial line placement, chest tube placement
Radiology reviews patient XRAYs in PICU (Monday-Friday)
PICU Mock Code (Fridays, 1400) (availability depends on PICU acuity)
Evidence Based Journal Club (monthly)
Presented by Pediatric Critical Care Medicine Attendings and Fellows and PICU Nurses
Monthly lecture by Pediatric Critical Care Fellows
Internet access to Society of Critical Care Medicine power-point presentations for residents participating in a PICU resident Rotation
Airway
Mechanical Ventilation
HFOV
Respiratory Failure
ARDS
Blood gas Analysis
Shock States
Shock and Sepsis
Cardiogenic Shock
DIC
Vasoactive Drugs
Arrythmias
Fluid and Electrolyte Emergencies
Sedation/Analgesia and Neuromuscular Blockade
Enteral and Parenteral Butrition
Hyponatremia
Head Injury
Coma
Guidelines for Medical Management Traumatic Brain Injury
Spinal Cord Injury
Renal Failure
Hepatic Failure
Asthma
Status Epilepticus
Thromboembolic Dosorders
DKA
Toxicology
Strokes in Children
Oncologic Emergencies
Sickle Cell, critical care
Pharmokinetics / Pharmodynamics
Endocrine Emergencies
Extracorporeal Life Support
Renal Replacement Therapy
Post-Op Cardiac Management
Single Ventricle Physiology
Pulmonary Artery Catheterization
Stabilization and Transport
Pediatric Disaster and terrorism Preparedness
Medical errors-The PICU Perspective
Ethics in PICU
Pediatric Office Emergencies
Textbooks available in PICU
Pediatric Critical Care
Third Edition
Fuhrman/Zimmerman
Pediatric Critical Care Medicine
Slonim / Pollock
Pediatric Intensive Care, Third Edition
Mark C. Rogers
The Difficult Pediatric Airway
Anesthesiology Clinics of North America
Jalil Riazi, MD, Editor
1999
Principles and Practice of Mechanical Ventilation
2nd Edition
Tobin
Management of Pediatric Trauma
Buntain
Illustrated Textbook of Pediatric Emergency and Critical Care Procedures
Dieckmann, Fiser, Selbst
Textbook of Pediatric Emergency Medicine
Ludwig Fleisher
The Pharmacologic Approach to Critically Ill Patients
Chernow, Third Edition
Principles and Practice of Intensive Care Monitoring
Tobin
Supportive Care of Children with Cancer
Current Therapy and Guidelines from the Children's Cancer Group
2nd Edition, 1997
Edited by Arthur R. Ablin M
Proxy Card access to medical library, ground floor Alfred I DuPont Hospital for Children
Internet access to InfoLink, an integrated resource that combines clinical applications, medical search engines, specific PICU educational material and evidence based medical textbooks and learning modules. Each resident receives material that will guide them through the InfoLink available resources. Below is a partial list of resources on InfoLink.
EPIC
Radiology I-Site
Lexicomp
Micromedex
Escription
Epocrates
Medical Calculator
Up To Date
Dynamed
STA!Ref
Practice Guidelines
ACPJ
Cochrane Library
MD Consult
OVID
CINAHL
PubMed
Google Scholar
Gene Tests
OMIM
Nemours eJournals
Dermatology textbook
Pediatric Critical Care Medicine
Literature
Interesting Cases
Evidence Based Journal Club
Web connections for critical care
PICU Rotation (link)
SCCM power-point lectures (link)
Critical Care Projects
Infant Botulism Treatment and Prevention Program
Mechanical Ventilation Weaning Protocol
PICU Evidence Based Guideline Conferences.
Internet access to our previous reviews:
Steroids and Septic Shock.
Use of Saline in Suctioning Artifical Airways.
Severe Traumatic Brain Injury in Children: Management and Monitoring.
Review of Evidence for Daily Interruption of Continuous Sedation in Mechanically Ventilated Children.
Mucous Plugs in Kid’s Airways, What’s the Evidence for Treatment.
Insulin Infusion Protocols in the PICU.
Oral Decontamination to Prevent Ventilator Associated Pneumonia.
Induced Hypothermia (NeuroProtectant).
CVP and Intravascular Volume.
Is There Evidence for the Use of N-acetylcysteine as a Protectant Agent
Against Contrast Induced Nephropathy?
Ventilator Associated Pneumonia.
PICU Nursing web site
PICU Case of the Week (under construction)
PICU Article Collection
Pertinent articles that we can enter and maintain. Mainly sepsis, ARDS, TBI.
Users’ Guide to The Medical Literature
Learning Modules (Evidence Literacy)
Calculators used in evidence based medicine
Searching medical engines
Personal Evidence Project – Developing a Critically Appraised Topic
Rational Clinical Exam
Individual Workspace
URL Search
ACGME Resident Duty Hours followed
Each pediatric critical care physician completes an on-line specific program evaluation for each resident at the completion of their PICU rotation. Evaluations are based on the ACGME six competencies :Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems Based Practice.
Requests of Residents
Prior to beginning the PICU rotation, complete 8 hours of internet based instructions regarding EPIC electronic medical record.
Review Resident PICU Core Curriculum
Complete on-line Pre-Rotation Questionnaire at the beginning of their rotation
Maintain a PICU Procedure Log and List of Primary Patients responsible for (age and diagnoses) and hand it in at the end of their PICU rotation
During patient care rounds, ask focused clinical questions about patient clinical problems, find medical literature that addresses these questions, using evidence based medicine techniques evaluate the validity, results and patient applicability of the information and bring information back to the PICU team.
Participate in Quality Improvement Case Analysis that identifies a PICU system problem.
At the end of their PICU rotation, complete on-line SCCM national test for residents who have completed a PICU rotation
Return Beeper and Proxy Card.
Complete their respective residency program’s on-line evaluation of the PICU rotation
Monitoring of PICU Resident Rotation
If completed, Pre-Rotation Questionnaires, SCCM post-test scores, critical care procedures done and critical care patient logs entered into our Access Data Base. (Partial data from1992 to present). We also have partial data of residents’ evaluations of the PICU rotation that was collected before individual programs developed their individual on-line forms.
Since 1992, we sent a survey to physicians now in practice who participated in our PICU rotation as residents. Survey requested information about their need to use pediatric critical care knowledge and skills in their practice settings. If survey returned, data entered into our Access data Base.
Presently, we request from their respective program directors a yearly summary of their residents’ evaluations of the PICU rotation
Reports of our PICU Rotation overview and plans 2001-2008 are available on our PICU Resident Rotation Web Site, under Reports.
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