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Practice Analysis: Pediatric Critical Care MedicineIntroductionThe clinical practice of Pediatric Critical Care Medicine (PCCM) has been categorized into 10 performance domains (listed below). These performance domains correspond closely to the 11 PCCM Entrustable Professional Activities (EPAs), which served as a starting point in the development of this document. More information about the subspecialty EPAs (including those for PCCM) can be found on the ABP website at . On the following pages of this document, detailed information pertaining to each performance domain has been provided. More specifically, the critical tasks performed within each domain have been identified, along with a detailed listing of the knowledge and skills necessary for the safe and effective performance of those tasks. Performance Domains – major areas of responsibilityTasks – critical job functions performed within a domainKnowledge and Skills – the critical knowledge and/or skills required to perform a task or set of tasks within a domainPCCM Performance DomainsAcute management of the critically ill child Management and coordination of care within pediatric critical care unitsManagement of patients at the end of lifeConsultation and referral Public health, quality improvement, and health systems Leadership of interprofessional health care teams Handoff and transfer within or across care settings Scholarly activitiesLeadership and advocacy within the pediatric critical care community Education of medical trainees, allied health professionals, patients, and families/caregiversPerformance Domain 1: Acute management of the critically ill childGeneral description: Children with critical illness or injury must be managed with expertise to provide resuscitation and stabilization using sound clinical reasoning and principles of patient- and family-centered care and long-term consequences of critical illness.Tasks:Identify the key issues for the care of critically ill patients and form a provisional differential diagnosis with continued reevaluation and revision of the care plan as neededRapidly develop and implement management plans to restore normal or baseline physiology while recognizing and addressing relevant comorbiditiesPerform common procedures needed to optimally care for the patientUtilize relevant technology required for critical care practiceIncorporate considerations of long-term morbidities and special resource needs during and after hospitalizationAdminister and monitor sedation, analgesia, and neuromuscular blockade with identification and appropriate treatment of associated deliriumCoordinate care for an individual patient, including collaboration with and incorporation of recommendations by other health care team members and family/caregiversDemonstrate professional behavior and optimal communication (including clear and effective documentation) with all members of the health care team, as well as with the patient and his/her family/caregiversKnowledge/Skills:Common Conditions:Acute or chronic single-organ dysfunction/failureMultiple-organ dysfunction/failureRespiratory insufficiency and respiratory failure (includes ARDS, asthma, pulmonary hypertension, anatomic differences, infections, trauma, chronic respiratory failure, etc)Acute or chronic medical and surgical cardiac diseases, including congenital heart disordersCongenital heart disease (one or two ventricles)Shock states (hypovolemic, distributive, obstructive, cardiogenic, septic)Acute neurologic illness and injury (includes status epilepticus, stroke, traumatic brain injury, neuromuscular disease, spinal cord compression, hypoxic/ischemic injury, etc)Inflammatory, immunologic, sepsis and infectious syndromes and diseasesKidney disease and fluid and electrolyte disturbancesHematologic disorders and malignancies (including complications such as tumor lysis syndrome)Acute metabolic, endocrine, and toxicologic illness, and envenomations (including when a consequence of other illness)Hepatic and gastrointestinal disease, and nutrition of critically ill and injured childrenTrauma including burn injury. Transplant medicine (including solid organ and stem cell)Knowledge of:Normal and abnormal physiology, including (Task 1,2)Pressure-volume relationships in the respiratory system Acid-base relationships, gas exchange, and ventilation-perfusion matching Relevant assessments of, and associated calculations relevant to, respiratory function, such as blood oxygen content, alveolar-arterial PO2 difference, dead space ventilation, etc Pressure-volume relationships of the cardiovascular system Determinants of cardiac output, contractility, and vascular function Processes underlying cardiac conduction and rhythm disturbances Assessment of cardiac function and oxygen delivery, such as pressure measurements, ECG, Fick calculations, shunt calculations, etc Resuscitation science Consequences of structural heart disease (across all ages, including natural history of unrepaired lesions and long-term morbidity of both repaired and palliated lesions including pre- and post-operative management Consequences of functional heart disease Peripheral nervous system function, including sympathetic and parasympathetic systems Central nervous system function, including determinants of elevated intracranial pressure, determinants of cerebral blood flow, etc Innate and acquired immunity Congenital and acquired immunodeficienciesCommon organisms responsible for disease (bacterial, fungal, viral, parasitic) Transplant immunology Determinants and consequences of electrolyte disturbances Determinants and consequences of fluid status including fluid flux across biological membranes Metabolic pathways and illness caused by inborn errors of metabolism and glucose dysregulation Nutrition (including macronutrients and micronutrients), nutritional assessment, and modes of nutritional support Endocrinologic function (including adrenal, thyroid, pancreatic, renin-angiotensin-aldosterone axis, antidiuretic hormone, calcium regulation, and endocrinologic crises such as DKA, etc) Common toxidromes caused by ingestion, inhalation, and/or topical exposure Envenomations Relevant anatomy, including (Task 1,2) Upper and lower respiratory tract in health and diseaseNormal cardiac anatomyAnatomical heart disease (one and two ventricle) and common surgical procedures to palliate or repair congenital heart diseaseCentral and peripheral nervous system, including neurotransmitters and anatomic landmarksCellular components responsible for infectious and inflammatory diseaseKidney and renal collecting systemHematopoietic organs, bone marrow, and circulating blood cellsEndocrinologic axesGastrointestinal system and GI-associated organsDevelopmental differences across the age range from preterm to adult (Task 1,2) Mechanisms and manifestations of acute, chronic, and acute-on-chronic organ dysfunction (Task 1,2) Diagnostic data (including results of laboratory tests, imaging, monitoring, rhythm analysis, etc) (Task 1,2) Differential diagnosis of impending or actual organ failure using relevant history, physical examination, laboratory test results, and monitoring (Task 1,2) Indications, contraindications, risks, and complications of medical and mechanical support of the dysfunctional or failing organ (including extracorporeal support, renal replacement therapy, non-invasive and invasive mechanical ventilation, vasoactive infusions, sedation/analgesia/neuromuscular blocking agents, blood products, and anti-infective agents) (Task 1,2,6) Evidence underlying the use of organ-supportive therapeutic modalities, including evidence-based guidelines (such as those for TBI) (Task 1,2)Pharmacology, pharmacodynamics, and pharmacokinetics of medications used to support the failing organ (Task 1,2) Organ system interactions (such as cardiorespiratory, hepatorenal, and etiopathogenesis of multiple organ dysfunction syndrome [MODS]) (Task 1,2) Relationship between organ dysfunction and patient and family outcomes, including post-intensive care unit syndrome (Task 1,2)Risk factors for and complications associated with hospital-acquired conditions (Task 1,2) Transport physiology (eg, effects of pressure changes at altitude) related to patient care (Task 1,2) Ethical and legal principles relevant to the care of specific patients (Task 1,2) Relevant anatomy and physiology, indications/contraindications, risks, technical aspects, and complications of common procedures, including: (Task 3) Airway adjuncts (oral and nasal airways, laryngeal mask airway), oxygen delivery devices, and airway clearance techniquesBag-valve-mask ventilationTracheal intubationManagement of the difficult airwayArterial catheterizationCentral venous catheterizationIntraosseous cannulation Thoracentesis/thoracostomy tube placementPericardiocentesisAbdominal paracentesisDefibrillation/cardioversionCardiac pacingIndications/contraindications, risks, technical aspects (including positioning and monitoring of the patient) and potential complications of common procedures for which the intensivist provides assistance, including: (Task 3) Flexible bronchoscopyEndoscopy of body visceraBone marrow aspiration/bone marrow biopsyPlasmapheresis and other plasma-based therapies, and exchange blood transfusionPeritoneal dialysisHemodialysis, including CRRTCricothyroidotomyTracheostomyICP monitoringECMO cannulationIndications, technical aspects, complications, and outcomes of CPR/resuscitation Use, indications, graphical output (normal and abnormal tracings), interpretation, foundational principles of device mechanics, troubleshooting, and management for common monitoring systems including cardiorespiratory, venous catheters, arterial catheters, non-invasive blood gas measurement, intracranial pressure, near-infrared spectroscopy (NIRS), and other emerging technologies (Task 4) Use, indications, visual output, interpretation, and foundational principles of ultrasound (Task 4) The influence of chronic medical conditions on the occurrence and management of acute illness (Task 5) The key elements of a letter of medical necessity for resources required post-hospitalization (Task 5) Resources necessary for management of long-term morbidities including purpose, capacity, and limitations (Task 5)Additional comorbidities based on their syndromic co-existence with the presenting complaint (eg, recognizing that truncus arteriosus occurs in the setting of DiGeorge and associated issues) (Task 1,2,5) The different levels of sedation, potential complications, and steps for patient rescue (Task 6) Classes of anesthetics, sedatives, analgesics, and neuromuscular blocking agents, including mechanisms of action, indications, duration of action, side effects, and contraindications (Task 1,2,6) Equipment needed to provide safe and effective sedation (including airway support, suction, monitoring, etc) (Task 6) Relevant monitoring needs, including type of monitoring, principles, equipment, and indications, during provision of sedation during critical illness and for procedural support (Task 1,2,6) The roles and skills of other health care team members and subspecialists (Task 7)Indications for family meetings, responsibilities of attendees, and goals of care conferences (Task 7)The role that spiritual and cultural background play in decision making by the family (Task 7)Principles of closed-loop communication with team members and families (Task 7) Requirements for, and content of, legible and complete clinical documentation (Task 7, 8) Behaviors that inform the care experience of families and patients, including timely and complete updates, personal responsibility, appropriate behavioral boundaries, and respectful communication (Task 7,8)Determinants and manifestations of stress, sleep deprivation, and fatigue in oneself and other members of the care team (Task 8)Skill in:Identifying the patient who is in impending or actual organ failure, including but not limited to: (Task 1,2) Physical findings and diagnostic data associated with respiratory failure in the spontaneously breathing childPhysical findings and diagnostic data associated with cardiac dysfunction and cardiac rhythm disturbancesPhysical findings and diagnostic data associated with neurologic dysfunction such as peripheral weakness and altered sensoriumPhysical findings and diagnostic data associated with fluid and/or electrolyte dysregulationSystematic evaluation of the trauma patientIntervening to prevent or minimize organ dysfunction, including applying appropriate resuscitation algorithms and interventions (Task 1,2) Leading a resuscitation event (Task 1,2)Synthesizing diagnostic data (including laboratory test results, imaging, monitoring, rhythm analysis, etc) to develop an evaluation strategy, create a focused differential diagnosis, and assess the impact of clinical interventions (Task 1,2) Using medical and mechanical support of failing organs effectively and safely, including: (Task 1,2,6)Oxygen delivery systems, noninvasive ventilation, invasive mechanical ventilationMechanical circulatory support devices including ECMO and ventricular supportRenal replacement therapyVasoactive medication supportSedation, analgesia, and neuromuscular blockadeAnti-infective agentsFluid resuscitation and electrolyte repletionBlood product administrationNutritional supportPre- and post-operative care of patients with congenital heart disease (Task 1,2) Judicious use of anti-infective agents (Task 1,2)Recognition of the risk factors for hospital-acquired conditions and incorporation of these into medical decision making (Task 1,2)Participating in and/or providing medical oversight of patient medical transport (Task 1,2,7)Performing common procedures, including: (Task 3)Airway adjuncts (oral and nasal airways, laryngeal mask airway), oxygen delivery devices, and airway clearanceOxygen delivery systemsBag-valve-mask ventilationTracheal intubationManagement of the difficult airwayArterial catheterizationCentral venous catheterizationIntraosseous cannulationThoracentesis/thoracostomy tube placementPericardiocentesisAbdominal paracentesisDefibrillation/cardioversionCardiac pacingCPRThe use of, and interpretation of, data obtained from common monitoring systems including cardiorespiratory, hemodynamic (venous catheters, arterial catheters), non-invasive blood gas measurement, intracranial pressure, near-infrared spectroscopy (NIRS), and other emerging technologies (Task 4) Using ultrasound appropriately in the critical care environment (Task 4)Prioritizing and addressing long-term morbidities and chronic medical conditions in the setting of acute medical illness (Task 5)Effective use of consulting services for acute and long-term management of comorbidities and chronic medical conditions (Task 5)Identifying and communicating with interprofessional members of the health care team to address patient and family needs for management of long-term/chronic medical conditions (Task 5)Providing clear, accurate, and timely documentation of assessment, management plans, and direction of care (Task 8)Providing procedural sedation (Task 6) Demonstrating respect for, and cognizance of, the roles, knowledge, and skills of other health care team members and other subspecialists (Task 7,8)Collaborating with and seeking input from other health care team members when developing plans for a patient while reconciling disparate viewpoints (Task 7,8)Leading care conferences with families and other health care team members (Task 7)Collaborating with primary care physicians in supporting families in decision making (Task 7)Demonstrating respect for diverse cultural and spiritual backgrounds of family and health care team members (Task 7)Demonstrating professionalism while interacting with families, patients, health care team members, and ancillary staff (Task 7,8)Behaving in a professional manner, including timely and complete updates to families, taking full responsibility for one’s actions and decisions, demonstrating appropriate behavioral boundaries, and communicating respectfully (Task 7,8)Recognizing and mitigating stress and sleep disturbance in oneself and other team members (Task 8)Using constructive criticism and reflective practice to improve personal performance (Task 8)Serving as a role model to trainees and other members of the health care team (Task 8)Performance Domain 2: Management and coordination of care within pediatric critical care unitsGeneral description: Intensivists must have the ability to integrate and manage care within pediatric critical care units to optimize the outcomes of critically ill children in a fiscally responsible mannerTasks:Prioritize and arrange patient flow within pediatric critical care unitsIdentify and allocate resources (including staff) within pediatric critical care units based on acuity and patient/family needIntegrate input from other members of the health care team, reconciling disparate opinions, understanding ethical issues, and managing conflict and moral distressMake decisions cognizant of financial implications for the unitUtilize resources responsibly and in a manner consistent with high-value careKnowledge/Skills:Knowledge of:Principles of triage (Task 1,2) Principles of conflict resolution (Task 3)Common isolation requirements (Task 2) Factors associated with patient readmission to the PICU (Task 1,2) Context-specific barriers to smooth transitions of care between caregivers (Task 1,2,3)Core principles of medical ethics (Task 3) Improvement science (Task 1,2)Current health care payment systems and billing requirements relevant to practice (Task 4)Cost/benefit considerations for diagnostic and therapeutic interventions (Task 4,5)Fundamental aspects of value-based care (Task 5)Skill in:Developing and implementing clinical protocols, checklists, and guidelines (Task 2,3)Applying improvement science in unit operations (Task 5)Allocating resources based on patient acuity and resource capacity (Task 2, 3)Differentiating the factors associated with patient readmission to the PICU (Task 1,2)Ensuring safe transition from the PICU to the wards (Task 1,2,3)Applying appropriate billing practices for level of services provided (Task 4) Reviewing and reducing unnecessary testing/procedures/therapeutics (Task 5)Performance Domain 3: Management of patients at the end of lifeGeneral description: Intensivists must be able to manage care at the end of life, including minimization of suffering, within ethical and legal boundaries while remaining empathetic and culturally sensitive.Tasks:Lead end-of-life discussions with patients and families in a culturally appropriate mannerEstablish and manage goals of care, including relief of suffering, at the end of lifeCoordinate care with palliative care teams and other health care providers to support the care of the child, family, and staff at the end of lifeUnderstand the definitions of death (including irreversible cessation of neurologic function and circulatory death) and the implications to health care professionals and families Effectively communicate goals of care and decisions about end-of-life care to other team members, including documentation within the medical record Facilitate compassionate management of patients who become donors and their familiesKnowledge/Skills:Knowledge of:The conditions under which the brain death examination should be performed based on national and local guidelines and policies (Task 4) Components of the brain death examination (Task 4) Institution-specific processes related to organ donation (might include donation after circulatory death) (Tasks 2,4,6)The ethical and legal principles around futile or potentially inappropriate care (Task 5) The pharmacologic and non-pharmacologic methods to manage pain/discomfort at the end of life (Tasks 2,3) The roles of diverse team members (including social work, spiritual care, child life, etc) in end-of-life care (Tasks 3,5)The cultural implications for leading end-of-life discussions (Task 1)The legal, ethical, and scientific practices during end-of-life care (eg, organ donation, terminal extubation) (Task 6) Assent as developmentally appropriate, advanced directives, and competence in decision making (Tasks 1,2) Skill in:Performing a brain death examination (Task 4)Interpreting findings of the brain death examination (Task 4) Differentiating circumstances when brain death examination may or may not be appropriate (Task 2,4) Employing and utilizing relevant regulations/practices around organ donation, including donation after cardiac death (Task 6)Arranging seamless transitions to organ procurement agencies when organ donation is appropriate (Task 6)Identifying and explaining situations where care might be considered futile (Task 1,2,5)Effectively communicating and documenting the family’s wishes at end of life (Tasks 3,5)Performance Domain 4: Consultation and referralGeneral description: Pediatric intensivists need to effectively serve as consultants to other health care providers, specialists, and subspecialists engaged in the care of children. Pediatric intensivists must also be able to effectively refer patients for further consultation for issues outside the scope of their knowledge and skills. Tasks:Recognize the indication for consultation with subspecialty colleagues and/or the need for further referralCarry out the process of consultation and/or referral efficiently and professionallyDetermine the need for ongoing critical care involvement, and communicate effectively to referring providers and/or consultantsCalibrate recommendations to the available resources of a referring site, for example when accepting a patient in transportKnowledge/Skills:Knowledge of:The difference in documentation between being a consultant and the primary team (Task 1,2)Local policy regarding required time frame to respond to a consultation request and expected documentation procedures (Task 2)The typical scope of practice and institutional privileging for pediatric intensivists, and how this might influence when consultation and referral may be needed (Task 4)Transfer of patient care within and between institutions, including issues related to referral recommendations, protocols, and regulatory requirements Skill in:Working with the patient’s primary care provider to ensure longitudinal follow-up and events of the PICU stay (Task 3)Acting in a consultative role (Task 2)Demonstrating effective use of consulting services for management of comorbidities/chronic medical conditions (Task 1,2,3,4)Performance Domain 5: Public health, quality improvement, and health systemsGeneral description: All physicians engaged in the clinical practice of pediatric critical care medicine should promote wellness, optimal health behavior, and injury prevention.Tasks: Demonstrate ability to identify populations at risk for critical illnessApply epidemiologic, economic, and statistical methods to analyze and interpret scientific data, including risk-benefit and cost-benefit analysesCollaborate with others in the development and/or implementation of projects aimed at improving health or health care deliveryUtilize resources to advance quality improvement and safety and population healthKnowledge/Skills:Knowledge of:Methods of risk stratification of critically ill children (Task 1)Epidemiology of critical illness and injury (Tasks 1,4) Principles of health systems and population research (Task 2,3)Importance of economic analysis in research involving critically ill children (Task 2,4)Economic implications of incorporating new technology into pediatric critical care practice (Task 4)Factors underpinning the distribution of, and access to, pediatric critical care services (Task 3,4)Research study design and types of research studies (Task 2) The process of program evaluation in pediatric critical care practice (Task 3)The use of performance improvement strategies in pediatric critical care medicine (Task 2,3)Components of quality improvement methods and their application to critical care medicine (Task 3) The impact of resource capacity and constraints on the delivery of pediatric critical care services (Task 4)The pediatric intensivist’s professional responsibility to populations, communities, and society at large (Task 3,4)Principles of quality improvement (Task 2,3)Principles of disaster preparedness, including surge capacity (Task 4)Skill in:Interpreting measures of association and risk (Task 1)Interpreting results of quality improvement initiatives (Task 4) Measuring meaningful system- and patient-centered outcomes (Tasks 2,3,4)Incorporating current scientific literature into daily practice in the care of critically ill children (Tasks 1,2,4)Applying principles of performance improvement toward improving the health and health care of critically ill children (Tasks 3,4)Collaborating with national and local efforts to improve the health and health care of critically ill children (Tasks 3,4)Performance Domain 6: Leadership of interprofessional health care teamsGeneral description: A pediatric intensivist must be able to lead and collaborate with the members of an interprofessional health care team.Tasks:Establish a shared vision, goals, expectations, and outcome measures for the care of critically ill and injured childrenEngage other team members in a way that utilizes their specific roles and capabilities, eliciting and valuing their perspective and contributions Monitor the performance of each team member to enable oversight and management of current and evolving situationsBalance autonomy and supervision of team members by assigning/delegating unsupervised work that aligns with their knowledge, skills, and attitudes (KSAs) and supervising work of team members that is designed to expand their KSAs.Monitor team performance and provide feedback, including crisis resource management as neededRecognize and manage the social cues, emotional responses, and the personal and professional needs of team membersRole model as the team leader, including developing skills of self-awareness and self-management, including risk of burnoutIntegrate input from other members of the health care team, reconciling disparate opinions, understanding ethical issues, and managing conflict Knowledge/Skills:Knowledge of:Leadership styles, including one’s own preferred method of leadership (Task 1,6,7,8)Roles of different team members (Task 2,3,4,5,6)Signs and symptoms of professional burnout (Task 7) Factors associated with higher risk of burnout, relationship between burnout and patient care (Task 7)Factors associated with clinician well-being, work-life integration, and the effects of these on individual and team performance (Task 2, 3, 4, 5, 6)Strategies for increasing personal/professional resilience (Task 7)Principles of crisis resource management (task 2,3,5)Skill in:Communicating effectively to families and team members (Task 8)Deploying team members in the most effective manner (Task 2,3,4,5,6,8)Resolving conflicts among team members when disparate opinions arise (Task 3,5,8)Recognizing stress (and signs and symptoms of burnout) in self and team members (Task 6,7)Performing regular evaluations of team member performances and giving effective feedback (Task 2,3,5)Demonstrating willingness to receive and incorporate honest constructive feedback (Task 7)Fatigue management including strategies related to sleep disturbance (Task 3,6)Serving as a role model to trainees and other members of the health care team (Task 7)Performance Domain 7: Handoff and transfer within or across care settingsGeneral description: Efficient and accurate transfer of care are an essential part of critical care practice, both within the hospital and between referring and accepting hospitals.Tasks:Engage in bidirectional communication of plans and conveyance of family and patient preferencesEnsure that information provided at the time of the transfer of care is current and accurate Communicate situational awareness, illness severity, patient summary, action planning, and contingency planning to other health care providers, using a standardized template to improve reliability of the information transferKnowledge/Skills:Knowledge of:Handoff principles and tools (Task 2)The importance of a structured handoff process to continuity of patient care (Task 2)The association of a structured handoff process with reduction in medical errors and preventable adverse events (Task 2)The relationship between pre-transfer severity of illness and outcomes and resource use for children who undergo interhospital transfer (Task 1,3)The relationship between the completeness of pre-transfer handoff and efficiencies of care at the accepting hospital (Task 3)Skill in:Ensuring communication of timely and complete patient information between caregivers (Task 1)Ensuring conveyance of salient information regarding goals of care and any limitations to care (Task 1,2)Understanding the importance of complete and accurate transfer of information to patient safety (Task 2)Ensuring timely update of the handoff information, ensuring its currency at the time of transfer (Task 3)Accurately identifying and conveying the severity of patient illness (Task 2,3)Adjusting the communication approach to the receiver of information (Task 3)Ensuring there is sufficient opportunity for clarifying questions and contingency planning (Task 3)Performance Domain 8: Scholarly activitiesGeneral description: Pediatric intensivists completing training are expected to be able to engage in a range of scholarly activities that promote lifelong learning, reflective practice, critical thinking, and discovery.Tasks:Appraise and assimilate new knowledge, concepts, and techniques related to pediatric critical care medicineCritically analyze one’s scholarly work as well as the scholarship of others Design and conduct high-quality scholarly activities in clinical, educational, laboratory, and other settings to generate new knowledgeEngage with colleagues, teams and/or networks to conduct scholarly activitiesApply new knowledge to other settings (eg, clinical, policy)Disseminate findings of scholarly work through different formats of communication to relevant stakeholders Demonstrate ethical and legal principles and practices in conducting scholarly activitiesEngage in mentee-mentor relationships to advance scholarshipKnowledge/Skills:Knowledge of:Principles of biostatistics in researchTypes of variables (eg, continuous, ordinal, nominal)Distribution of data (eg, mean, standard deviation, skewness)Hypothesis testing (eg, type I and type II errors, P values, statistical power)Common statistical tests (eg, ANOVA, chi‐square, nonparametric tests)Measurement of association and effect (eg, correlation, relative risk, odds ratio)Regression (eg, linear, logistic, survival analysis)Diagnostic tests (eg, sensitivity and specificity, predictive values, disease prevalence, receiver operating characteristic [ROC] curves)Systematic review and meta‐analysisQualitative research methods and analysisPrinciples of epidemiology and clinical research designStudy design, performance, and analysis (internal validity)Generalizability (external validity)Bias and confoundingCausationIncidence and prevalenceScreeningCost benefit, cost effectiveness, and outcomesMeasurement (eg, validity, reliability)Ethics in researchProfessionalism and misconduct in research (eg, conflicts of interest, falsification)Principles of research involving human subjectsPrinciples of consent and assentQuality improvementProject design (eg, models, aims, key drivers, tools, Plan‐Do‐Study‐Act [PDSA] cycle)Data and measurement (eg, outcomes, balancing measures, run charts, control charts, common cause and special cause variation)Performance Domain 9: Leadership and advocacy within the pediatric critical care communityGeneral description: Practicing pediatric intensivists must often serve in the role of leader at various local (hospital, departmental), regional, and national levelsTasks:Advocate for health care delivery issues that pertain to critically ill and injured children Educate the public about pediatric critical illness and injuries using evidence-based knowledgeContribute to pediatric critical care medicine’s shared vision for system change through collaboration and implementation of national action plans and practice guidelinesMentor the next generation of pediatric intensivistsKnowledge/Skills:Knowledge of:Factors that impact the delivery of health care to critically ill children (Task 2)Different types of direct child health advocacy (Task 1,3)Different strategies for population-level child health advocacy (Task 1,3)The factors associated with effective mentoring (Task 4)Local and national guidelines in the care of critically ill children (Task 3)Skill in:Understanding and applying the principles of evidence-based knowledge (Task 2)Identifying opportunities to contribute to the pediatric critical care medicine community (Tasks 1,2,3,4)Advocating for issues pertaining to injury and disease prevention (Task 1)Disseminating evidence-based knowledge regarding strategies to reduce morbidity and mortality from critical illness and injuries, including appropriate use of social media (Task 2)Developing collaborative and multidisciplinary approaches to injury prevention, management, and rehabilitation (Task 1,2,3)Mentoring pediatric critical care medicine trainees and junior faculty (Task 4)Performance Domain 10: Education of medical trainees, allied health professionals, patients, and families/caregiversGeneral description: Pediatric intensivists need to educate learners with variable backgrounds and needs.Tasks:Apply principles of adult learning to teachingDemonstrate an ability to create safe learning environments Teach core topics of pediatric critical care medicine in a manner that considers the level of the learnerDemonstrate evidence of lifelong learning and continuing education in one’s personal practiceEducate other health care team members about the evaluation and treatment of critically ill children and systems-based issues key to providing high-quality careEducate families and caregivers about the child’s illness, steps in management, and implications for long-term functionKnowledge/Skills:Knowledge of:Key principles of adult learning theory, with an understanding of inherent assumptions (Task 1) The characteristics of learners at various levels of clinical learning (Task 1,2)Mechanisms to maintain professional certification through ongoing learning activities (eg, CME, MOC, etc) (Task 4)Current guidelines and clinical recommendations that underpin accepted best practices (Task 3)Alternative sources of information that families may access, including potential threats to validity Skill in: Constructing learning experiences/activities that harness principles of adult learning theory (Task 1)Demonstrating content relevance and respect for learner(s) when engaged in teaching (Task 1,2)Asking questions at all levels of understanding when teaching (Task 2) Teaching effectively to all levels of learners on the multidisciplinary PICU team (Task 2,3,5)Assessing where learners on the PICU team are in their cognitive and technical skills using local assessment and evaluation methods (Task 3, 5)Participating in lifelong learning through critical appraisal and assimilation of the literature (Task 4)Disseminating knowledge to learners and peers and application to patient care and scholarship areas (Task 3)Recognizing and acknowledging one’s own gaps in knowledge (Task 4)Encouraging learners, and practicing self-reflection in learning opportunities and needs (Task 2,4)Teaching effectively to all levels of understanding when educating families, caregivers, and other non-medical persons ................
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