Resident Evaluations of PICU Resident Rotation



Resident Evaluations of PICU Resident Rotation

July 2007 – June 2008

Thomas Jefferson Univ Pediatric Residents

Average Rotation Quality: Balance of Service and Education = 4.0 (Scale 1 – 5 )

Christiana Care Medicine-Pediatric Residents

Average Rotation Quality: Balance of Service and Education = 4.01 (Scale 1 – 5)

Christiana Care Emergency Medicne Residents

Rotation met your expectations

Superior 2 /Satisfactory 11/ Unsatisfactory 1

Thomas Jefferson Univ Emergency Medicine Residents

Average Overall Evaluation = 6.5 (Scale 1 – 8)

Society of Critical Care Medicine

National Post – PICU Resident Rotation Test

| |Pediatrics |MedPeds |Christiana ER |TJU ER |Medical Students |Total |

|Number per Program|293 |50 |209 |174 |62 |788 |

|Number Taking Test|72 |12 |52 |42 |21 |199 |

|% Taking Test |25% |24% |25% |24% |34% |25.2% |

| | | | | | | |

|Average score % |72% |76% |79% |71% |65% |73% |

During Academic Year 2007-2008, only 4 of 61 (7%) PICU residents took the Society of Critical Care Medicine National Post – PICU Resident Rotation Test. Two Pediatric residents took the test with scores of 71% and 74%, one TJU ER resident with a score of 66% and one medical student with a score of 61%.

The Society of Critical Care Medicine Education Committee will soon provide a Pre and Post updated National Post – PICU Resident Rotation Test and programs will be able to compare their PICU Resident scores with that of other PICU Resident Rotation programs.

PICU Resident Rotation

Strengths

Useful rotation to learn how to handle critically ill children

PICU Orientation for new residents

Great teaching

Pharmacist on patient care rounds

Care provided to the children in the PICU

Development of daily individual plan of care for the children in the PICU

Integration between nursing, respiratory and physicians in the PICU

Nursing, respiratory therapy and unit clerks exceptional

Drs Penfil, Stryjewski are especially great teachers

Weaknesses

Cumbersome computer order entry

When on night call, tied to computer and thus less time with patients

Difficult weekend call schedule

Pediatric critical care fellows take priority for procedures

PICU Residents do not routinely participate in the SCCM National PICU Resident Test

Opportunities

Encourage resident independence

More emphasis on bedside teaching

More access to procedures

Updated SCCM Pre and Post National PICU Resident Test will be comparable from one PICU Resident Rotation Program to another..

Threats

Some residents feel they are treated as interns

Assimilating into Alfred I duPont Hospital system difficult

Resistance from charge nurse and unit clerks to facilitate transfers out of PICU

Potential for work hours to be exceeded when more than one resident is off- service.

Less time for bedside teaching may decrease as patient volume and acuity increase.

|Name______________________ Pediatric Resident PICU Core Curriculum |

|Dates |

|PICU Resident Rotation Web Site: ( Username = picu Password = resident) |

|Monday |Tuesday |Wednesday |Thursday |Friday |

| 0630 | 0730 |0730 |0730 | 0730 |

|Introduction To PICU |PICU Clinical Rounds - |PICU Clinical Rounds - |PICU Clinical Rounds - |PICU Clinical Rounds – |

| | | | | |

|0730 |1030 | |1030 | |

|PICU Clinical Rounds - |Radiology Rounds | |Radiology Rounds |1400 |

| | |Respiratory Failure 1 | |Mock Code – |

|Complete Pre-Rotation Questionnaire | |ARDS1 |Shock States1 | |

| |Airway1 |Blood Gas Analysis 1 |Shock & Sepsis1 |DIC1 |

|Computer order entry training for |Mechanical Ventilation 1 | |Cardiogenic Shock1 |Vasoactive Drugs1 |

|visiting residents |HFOV1 | | |Arrythmias1 |

| | | | | |

| | | | | |

|Monday |Tuesday |Wednesday |Thursday |Friday |

| 0730 |0730 |0730 |0730 | 0730 |

|PICU Clinical Rounds - |PICU Clinical Rounds – |PICU Clinical Rounds – |PICU Clinical Rounds - |PICU Clinical Rounds – |

| |0830 | | | |

| | | |1030 |1400 |

| |PICU Resident Case Presentation at |Guidelines for Medical Management |Radiology Rounds |Difficult Airway Mock Code – |

|Fluid & Electrolyte Emergencies1 |Morning Report |Traumatic Brain Injury1 | | |

|Sedation/Analgesia & Neuromuscular | |Spinal Cord Injury1 |Asthma1 |DKA1 |

|Blockade1 |1030 |Renal Failure1 |Status Epilepticus1 |Toxicology1 |

|Enteral & Parenetral Nutrition1 |Radiology Rounds |Hepatic Failure1 |Thromboembolic Disorders1 | |

|Hyponatremia1 | | | | |

| |Head Injury1 | | | |

| |Coma1 | | | |

|Monday |Tuesday |Wednesday |Thursday |Friday |

| 0730 |0730 |0730 |0730 |0730 |

|PICU Clinical Rounds – |PICU Clinical Rounds – |PICU Clinical Rounds – |PICU Clinical Rounds – |PICU Clinical Rounds – |

| | | | | |

|Strokes in Children1 |1030 | | | |

|Oncologic Emergencies1 |Radiology Rounds | |1030 |1400 |

|Sickle Cell –critical care1 | |Extracorporeal Life Support1 |Radiology Rounds |Mock Code - |

| | |Renal Replacement Therapy1 | | |

| |Pharmokinetics/Pharmacodynamics1 | |Post-Op Cardiac Management1 |Pulmonary Artery Cathereization1 |

| |Endocrine Emergenices1 | |Single Ventricle Physiology1 | |

|Monday |Tuesday |Wednesday |Thursday |Friday |

|730 |0730 |0730 |0730 |0730 |

|PICU Clinical Rounds – |PICU Clinical Rounds – |PICU Clinical Rounds - |PICU Clinical Rounds - |PICU Clinical Rounds - |

| | | | | |

|Stabilization & Transport1 |1030 | |1030 | |

|Pediatric Disaster and Terrorism |Radiology Rounds |1200 |Radiology Rounds |1400 |

|preparedness1 | |Journal Club – 3D 298 | |Mock Code – |

| |0830 | |1400 | |

|Medical Errors – The PCIU Perspective1 |PICU Resident Case Presentation at |Ethics in PICU1 |Critical Care Fellow Presentation |Hand in PICU, Procedure Log, Primary |

| |Morning Report |Pediatric Office Emergencies1 | |Patient Log , parking permit, proxy card |

| | | |Complete on-line post Rotation test |and beeper to Ilene Sivikoff (ext 5159) |

| |1400 | |Password____________________ | |

| |Critical Care Fellow Presentation | | | |

| | | | | |

• Saturday/Sunday/Holiday PICU Clinical Morning PICU Clinical Rounds 8:00 AM. Daily Afternoon Clinical Check Out Rounds between 2:30 PM and 5 PM.

• Chest XRAYS, CT Scans, etc can be viewed in hospital with Novell password at . Radiologists can be contacted to review individual films as needed.

• #1 refers to SCCM powerpoint presentations for residents in a PICU:

• Your PICU rotation goal should include being able to recognize and initially stabilize a critically ill child or adolescent with: Acute Respiratory Failure, Hemodynamic Instability, Cardiopulmonary arrest, Sepsis, Acute Neurologic insults, Acute electrolyte and endocrine disorders, Acute renal failure, Coagulation disorders, Overdoses & Poisonings.

• The PICU educational process focuses on interactive case-based bedside teaching and addressing focused clinical questions using evidence based principles.

• Nemours Infolink is available on bedside wireless computers, WYSE terminals and Citrix. Your username and password are the same as your Nemours username and password.

• Various textbooks are available in the PICU. The medical library is on the ground floor and requires a proxy card to enter during the night and weekends.

• Critical care physicians complete individual resident specific residency program evaluations forms on-line. Residents are evaluated on the six ACGME competencies.

• Questions? Contact Edward Cullen DO, Pediatric Critical Care (Beeper 302-426-4965).

PICU resident education is aligned with our goal to provide compassionate, specialized care for critically ill and injured children.

You are an important part of the PICU multidisciplinary team. Please interact professionally with the nurses, respiratory therapists, unit clerks, consultants, children and their families.

Please wash your hands before and after every patient encounter. Patient safety is a high priority.

Be prepared for and fully participate in patient care rounds using our PICU Resident and Critical Care Attending Progress Note.Examine your primary patient before morning and afternoon patient care rounds and frequently throughout the day and night if the child is unstable. Review patient charts for new entries from consults, collaborating physicians and nurses. GI usually writes for TPN but during patient care rounds we need to know the details (calories/kg/day, grams of protein, fat and carbohydrates/kg/day, etc)

On Sat/Sun and Holidays, the on-coming resident and the resident from night call are responsible for examining and collecting data on all PICU patients before rounds and completing the daily patient notes.

Know the general clinical course and plan for all PICU patients. Utilize patient care rounds to keep updated.

Keep the critical care physician updated with any changes in your primary patient’s condition.

Review PICU Written Order Entry Algorithm. No verbal orders. Be sure to date and time all written physician orders and notes. Print your name and beeper number below your signature on notes and written orders.

Review PICU Transfer Algorithm. Please do not pre-date transfer summaries

Complete and document H&Ps on patients admitted to the PICU from the ER, Transport Team, home. Accept Notes for children transferred from OR, PACU or general hospital area.

Review indications, landmarks, procedure and complication risk for all procedures before they undertake procedures under the supervised of critical care physicians. Procedures are infrequent. Critical care fellows have first priority if procedures present themselves. Occasionally, the technical or emergent nature of the child’s condition may preclude the resident from participating in the procedure. Assist with completion of procedure note.

Assist with discharge of patients to other facilities or home. A short -stay discharge summary can be done on-line for children discharge from the PICU if they are in the hospital for 3 or less calendar days. Dictated discharge summaries are required for children who are discharged home or to other facilities from the PICU after being in the hospital for greater than 3 calendar days.

PICU on-call resident carries a code beeper and is the procedure resident for codes. Review hospital Code Blue responsibilities and review PALS algorithms for pulseless arrest, bradycardia, tachycardia with poor & adequate perfusion.

Be acquainted with the PICU Difficult Airway Cart.

Please put your name on the PICU room board for those primary patients that you are following.

In the interest of patient continuity of care, before leaving for clinic, seminar or home, you must check out in detail (START: Situation, Therapies, Anticipated Course, Reconciliation, Transfer) to the resident who is designated on-call and the critical care attending.

ER residents are expected to return to the PICU after their weekly morning seminars.

Night call residents must leave the PICU no later than 30 hours after arriving in the PICU. (Night call residents are not to take new patients after 24 hours of continuous call).

On the first day of your rotation, please introduce yourself to the Unit Clerks and give them your beeper numbers

When you page someone please let the PICU clerks know that you are expecting a call.

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