Welcome Note

Welcome to the PICU! We are excited to work with you! Below are some general tidbits about the rotation.

Schedule:
Rounds start at 0730 in the PICU during the week and 0800 on Saturday and Sunday. You may want to get there a few minutes early (0700 or 0715) on the first day just to get settled in and meet the group. They generally congregate outside of room 2C10 and 2C11 in front of 'the board' - a whiteboard in the middle of the unit with patient names and room numbers. You will work out your call schedule with the residents when you arrive. In general, you should take a q4 call schedule (don't take call the first night). You should ensure that you have a Saturday and Sunday call during the rotation and that you have one weekend free of clinical obligations. This should work out to be 7 calls in a 28 day period. Due to personal commitments, you may need to adjust your call schedule but do not take call any more frequently than every 3rd day/night. You will be taking call with a pediatric, anesthesia, or emergency medicine resident during the rotation (as these are the residents that rotate through the unit).

The School of Medicine has an attendance policy that outlines procedures for absences (expected/unexpected or excused/unexcused). You can find that policy here.

Expectations:
Please review the orientation slideshow under PICU Resources.  You, as MS4s, are not to carry more than 2-3 patients at any one time and you should refrain from carrying any one patient for more than a week (at the most). There are several reasons for this, 1) your primary goal should be exposure to as many disease processes as possible-not carrying patients for more than 1 week at a time allows for this and 2) the reason for the limitation is that your other goal is a thorough understanding of the pathophysiology of disease in the patients you are caring for. While a thorough understanding should be what residents achieve for as well, the reality is that if you carry too many patients you will be too focused on 'getting work done' and not learning. You will be following patients in cooperation with a resident. That is, you will likely pre-round, examine and cull through labs and vitals and develop plans on your patients. However, each patient you are following should also have been discussed with the resident following the patient with you (they should have also examined the patient as well). You can also feel free to discuss the plan or labs with the fellow or attending if a resident is unavailable. In addition, while you can follow and write notes on the preoperative congenital heart disease patients, in general, you do not write notes or 'follow' the post-operative congenital heart disease patients (that is not to say you are excluded from the care of these patients, quite the opposite, you are encouraged to follow along without the burden of having to write notes).

Notes:
As for the notes, what has worked in the past is that you can write a generic note and send them to the attendings as correspondence, that way they can review your notes and discuss your thought processes directly. You can follow up with the attending of the week when you arrive next week to discuss this in detail. For legal reasons, medical residents or attendings are the only progress notes that count. Hence the reason for a resident that needs to follow a patient along with you.

Other items:
Use the resident datasheet to collect your information (under PICU Resources). That is, in general, how many of the attendings like to hear the information. You can clarify/discuss with the attending on service for specific guidance and feedback. Please read over what we expect of our pediatric residents rotating through the unit. To be clear, while it would be wonderful for you as a student to achieve these goals and meet these objectives, our main objective for students in the PICU is to get an understanding of the complex pathophysiology impacting pediatric patients and to get a sense of how they are managed. Honestly, come in with a good attitude, a willingness to ‘get your hands dirty’ and demonstrate that you know the ins and outs of your patients, you should be fine. To be clear, to achieve a grade of Honors in this rotation, you must demonstrate mastery (as assessed by your on-service attending) in the following areas: 1) presenting patients in a clear, concise, organized manner 2) formation of an appropriate and thorough differential diagnosis 3) understanding of the pathophysiology of the patients for which you are caring and 4) formulating a thoughtful and appropriate treatment plan for the patients for which you are caring. One of the most important ways that we as attendings can get an assessment of your understanding of the patient and pathophysiology is by assessing your presentations so, please ask for feedback early and often on this! It will serve you well.

Please review the list of books/readings under the PICU resource tab.  They will serve as excellent resources for you during the rotation. The list is not exhaustive by any means. The Marino book is geared toward adult critical care but some of the physiological principles (blood gas analysis, etc) still apply. If you encounter others during your rotation, please let me know so that I can pass this information on to future students.

Best of luck and, again, welcome to the PICU we are glad to have you as part of the team. Please, if there are questions, don't hesitate to ask the attending or fellow on service or email me.

Sincerely,

Katherine C. Clement, MD
Assistant Professor, Pediatric Critical Care Medicine
The University of North Carolina at Chapel Hill
214 MacNider Hall