OVERALL EDUCATIONAL GOAL:
The PICU rotation will teach students to care for children with serious medical and surgical problems and to learn the principles to identify and manage children with a critical illness. Students will acquire an understanding of the pathophysiologic basis of common disease processes in the PICU, participate in the resuscitation and care for critically ill children, and understand end of life care for children and their families.
This rotation should allow the student to accomplish most of the following objectives:
Core Competency codes:
PC = Patient Care; MK = Medical Knowledge; PBL = Practice-Based Learning; SBP = System-Based Practice; P = Professionalism; I&CS = Interpersonal and Communication Skills
- Recognize and appropriately respond to acute life threatening events. The student should observe and be able to describe the necessary skills to resuscitate and describe the initial stabilization of the critically ill child. (PC)
- Demonstrate competence in basic airway skills (appropriate implementation of oxygen delivery devices and demonstration of bag-mask ventilation) and placement of peripheral intraosseous and intravenous catheters. Advanced airway skills (intubation) and advanced intravenous access skills (central venous catheter placement and arterial line placement) may be performed if mastery of basic skills achieved. (PC)
- Understand the pathophysiology and treatment of common medical disorders in the PICU: respiratory failure (apnea, bronchiolitis, asthma, ARDS), shock (septic, cardiogenic, hypovolemic), neurologic critical care (status epilepticus, altered mental status, traumatic brain injury, brain death), renal failure, and liver failure (PC, MK)
- Understand the indications, perioperative management and complications of common surgical admissions to the PICU: congenital heart disease, trauma, ENT, orthopedic, neurosurgical and solid organ transplant. (PC, PBL)
- Understand the different monitoring techniques in pediatric critical care: vascular hemodynamics, intracranial devices, blood pressure, arterial saturations, end-tidal CO2, and a variety of common laboratory tests. (PC, PBL)
- Understand pediatric critical care pharmacology: inotropes and vasoactive agents, basic antibiotic therapy, common sedatives and analgesics, drug pharmacokinetics and monitoring of side effects. (MK, PBL)
- Understand techniques for enteral and parenteral nutritional supplementation in the PICU patient. (MK)
- Understand the ethical and legal issues which emerge during the care of critically ill and/or dying children (do not resuscitate orders, withholding and withdrawing life support, right of patients). (MK, SBP)
- Understand the importance of psychosocial issues related to the care of critically ill or dying children. Learn to provide support and deliver difficult information to the family of a critically ill child. (MK, PBL)
- Succinctly present an ICU patient on rounds, formulate a coherent assessment of a patient’s problems and present an appropriate therapeutic/diagnostic plan. Further, effectively communicate this plan to nurses, respiratory therapists, and sub-specialists/ consultants. (PC)
Student performance is observed daily in the PICU and is assessed by the PICU attendings on service. A final online evaluation of the student is based on the goals and objectives outlined above. A mid-rotational verbal assessment should be given to each student by an attending of the division.
LEARNING ACTIVITIES OF THE ROTATION:
Daily work rounds with attendings on service and the PICU team composed of fellows from the divisions of pediatric critical care and pediatric anesthesiology; residents from pediatrics, anesthesiology, and emergency medicine; nurses; respiratory therapists; pharmacists; and social workers.
Weekly lectures given by the attendings and fellows of the division covering essential learning objectives for the rotation. Active participation in conferences pertaining to the patients; parent and family, sub-specialists, social worker, etc.