ࡱ> 35012 :cbjbj 8:[ffq 4J} ( !!!IIIIIII$*LNI!!!!!I If(f(f(!v  If(!If(f(6EG @'EIJ04J FVO'pVO8GGVO_I@!!f(!!!!!IIf(!!!4J!!!!VO!!!!!!!!!f o: Timeline for PICU Resident Rotation 1984A. I. duPont Institute, new Hospital Building Opens1988JanuaryA. I. duPont Institute PICU Opens with four bedsRobert Kettrick MD, Chairman, Department of Pediatric Anesthesiology and Critical Care, Director PICU1991Steve Lawless MD, new Medical Director, PICU1992Thomas Jefferson Pediatric Residency Program moves to A. I. duPont Institute under the direction of Residency Director, Dr. Weiss2nd-year pediatric residents start in the 16-bed PICUMedical Center of Delaware Emergency Medicine 2nd-year residents start in PICU1993Rob Walter, MD, named new Residency Director Thomas Jefferson Pediatric Residency ProgramThomas Jefferson Emergency Medicine 2nd-year residents begin in PICUAbstract: Lawless S, Kettrick R, Donar-Reale M, David Corddry, John McCloskey: Utilizing a program of continuing quality improvement to evaluate residents impact on a pediatric ICU (PICU). Abstr.Pediatric Research 1993; 33: 700A1994March First Education Focus Group Meeting of Division of Critical Care Medicine, Alfred I. duPont Institute, Thomas Jefferson University and Medical Center of Delaware, chaired by Robert Kettrick, MDSeptemberFormalized PICU Educational Program begins at A. I duPont Institute PICUPICU Resident Rotation Coordinator Edward J. Cullen, Jr., DOMultidisciplinary instructors involved in PICU Resident Education Maryann Cunningham, Nursing Bad News Sept. 1994 - June, 1996 Mary Jo Rose, RN - Mock Codes 1994 -19971995JuneUniversity of Pennsylvania Pediatric Critical Care Nurse Practitioner StudentJulyMission, Vision, Values statement from NemoursAugustSecond Education Focus Group of Division of Critical Care Medicine, Alfred I. duPont Institute, Thomas Jefferson University and Medical Center of Delaware , Chaired by Robert Kettrick, MDMultidisciplinary instructors involved in PICU Resident Education Mary Donar-Reale, RN, MSN Care of Children with Chronic Trach / Vent Care Needs, 12/95 - present Shamin Tejani, PharmD Inotropes & Vasodilators; TPN in the PICU, 3/95 - present Radiologists - bimonthly X-ray Rounds, 4/95 7/961996January Dave Corddry, MD, new Chairman, Department of Pediatric Anesthesiology and Critical CareAprilVinay Nadkarni, MD, new Medical Director, PICUMayAbstract and Poster Presentation Cullen E, Lawless, ST, Nadkarni VM, McCloskey JJ, Corddry DH, Kettrick RG (sponsored by Alan Spitzer) Department of Anesthesia/Critical Care, A. I. duPont Institute, Wilmington, DE: Assessing Resident (RES) Education in the Pediatric ICU (PICU). Abstr. Pediatric Res 1996; 39: 777A American Pediatric Society, the Society for Pediatric Research, Washington, DC, May, 1996JuneOur PICU Resident Program becomes involved with the SCCM Pediatric Resident Education CommitteeJulyPICU Residents are asked by Pediatric Residency Program and Neonatology to cover SNICU on nights and weekends. Neonatologists provide weekly Interactive NICU Rounds and NICU Mock Codes during PICU rotationMultidisciplinary Instructors involved in PICU Resident Education Diane Necastro, Social Service Bad News / Loss, Grief, Mourning, 7/96 - 98 Radiology - Monthly PICU Radiology Rounds, Case Conferences, 7/96 7/97  Erin McCloskey, RN Mock Codes and Transport, 1996 -97 Cindy Harris, Computer Training - Jeffline Access in PICU Intro to residents, 7/96 - 6/971997FebruaryVinay Nadkarni, MD, presents information about our PICU Resident Rotation efforts to the SCCM Pediatric Resident Education Committee at its annual meeting, 2/9/97MarchDave Berger begins designing and creating our Access PICU Resident Education Data BaseMayAbstract and Poster Presentation Cullen E, Lawless ST, Corrdry DH (Spon. by John Stefano) Pediatric Anes/Critical Care, duPont Hospital for Children, Wilmington, DE: The Mismatch Between Attending (Attnd)and Resident (Res) Desired Education Delivery Styles in Pediatric Intensive Care (PICU). Abstr. Pediatr Res 1997; 41: 1774A American Pediatric Society/The Society for Pediatric Research, Washington, DC, May 1997JulyMonthly Individualized Resident Reports Pre- and Post-rotation block distributed to the Critical Care Physicians to help acquaint them with the new residents and give immediate resident feedback about the PICU rotation experienceInteractive PICU Teaching Rounds replace formal lectures by the Critical Care PhysiciansResidents given choice of PICU Rotation Exit Test: Oral Interview, Presentation or Essay Response to two pediatric critical care scenariosMultidisciplinary Instructors involved in PICU Resident Education Radiology - Daily PICU X-ray Reviews with radiologist, 7/97 6/98 Donna Corddry, RN, Mock Codes 1997 - present Nancy Blackburn, RN, Mock Codes 1997 - presentIntranet PICU Resident Education Web Page initial development with Karen Hartis and Dan HartSeptemberPoster Presentation Cullen E, Lawless ST, Corrdry DH, Pediatric Anes/Critical Care, duPont Hospital for Children, Wilmington, DE: The Mismatch Between Attending and Resident Desired Education Delivery Styles in Pediatric Intensive Care Tenth Annual Pediatric Critical Care Colloquium, Sept 19, 1997, Hot Springs, ArkansasNovemberOriginal Article Edward J. Cullen, DO; Stephen T. Lawless, MD, MBA, FCCM; Vinay M. Nadkarni, MD; John J. McCloskey, MD; David H. Corddry, MD; Robert G. Kettrick, MD. Evaluation of a pediatric intensive care residency curriculum. Crit Care Med 1997; 25: 1898-1903Editorial Response Timothy S. Yeh. Give a little, take a little: Resident education in the evolving healthcare environment. Crit Care Med 1997; 25:17821998JulySCCM Pediatric Resident Education Committee distributes first national Pre- and Post-tests for PICU rotation residents. This replaces our optional PICU Exit Tests and compliments our PICU pre-test (Edward J. Cullen, Jr., DO, a contributor to test)Residents have time in the operating room with John McCloskey, MD, in order to practice pediatric intubations under controlled situationsMultidisciplinary instructors involved in PICU Resident Education Julie Harrison, RT, and Dawn Selhorst, RT - Introduction to Ventilators, BiPAP Negative Pressure Ventilator July, 1998 ? presentConverting monthly PICU resident individualized files to a monthly updated menu page that critical care attendings can access in order to learn about new residents and get immediate feedback about the previous months rotation (menu page developed by Dave Berger)Dave Berger designing menu page for our Intranet Web page that will allow access to PICU Resident Education facts from 1994 to presentRe-evaluating our available time / resources and clinical ? research - administration commitments and their impact on maintaining the one month PICU Resident RotationSteve Selbst, MD, becomes new Residency Director for the Thomas Jefferson Pediatric Residency ProgramNovemberIncreased clinical load / night call due to loss of one critical care physicianIncreased clinical load for critical care physicians leads to:Interactive rounds changed to occur during clinical rounds Initially oral interviews continued at end of month as a teaching tool to compensate for less formal interactive rounds; dropped soon thereafter due to lack of time with increased clinical needs OR time less consistent for residents Weekly resident status updates initiated but becomes harder to accomplish on routine basis 1999JanuaryAbstract Vinay Nadkarni, Edward Cullen, Stephen Lawless, John McCloskey, David Corddry. Jefferson Medical College, AI duPont Hospital for Children, Wilmington, DE. Resident Pediatric Specific Cardiopulmonary Resuscitation Experience Prior To Entering A Second Year PICU Rotation. Abstr. Crit Care Med 1999 Vol 27, No 1 (Supple) A102FebruaryMeeting with Pediatric Residency Program to discuss concerns about PICU Rotation:Autonomy issues: residents are not enough of a part of decision making process Very few "dedicated" teaching rounds Few or no didactic lectures Residents not allowed to do procedures even when they are available SCCM, Pediatric Resident Education Committee meeting Informal consensus that what we are actually teaching during the PICU rotation is acute care pediatrics. Nuances (modes of ventilation, NO, ECMO, etc) should be left to fellow level training. It was felt that we need to train pediatric residents to recognize and stabilize critically ill children. We need to teach the "basics"Critical Care Attendings from Wilmington and Florida sites PICUs met and discussed ways to interact between sites including resident education AprilAbstracts Edward J Cullen, Stephen T Lawless, Vinay M Nadkarni, John J McCloskey, David Corddry. Pediatric Anesthesia and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, DE (Sponsored By: John L Stefano). Adjusting to Resident Learner (RL) Needs During Pediatric (PICU) Rotation. Abstr. Pediatr Res 1999; 45: 76A Edward J Cullen, Stephen T Lawless, Vinay M Nadkarni, John J McCloskey, David Corddry, Pediatric Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE. (Sponsored By: John L Stefano). Does Pediatric ICU (PICU) Residency Curriculum Match General Pediatric Practice (GP) Needs? Abstr. Pediatr Res 1999; 45: 76A  Edward J Cullen, Stephen T Lawless, Vinay M Nadkarni, John J McCloskey, David Corddry. Pediatric Anesthesiology and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, DE. (Sponsored By: John L Stefano). PICU Resident Learner (RL), Resident Educator (RE) and Utility Scores. Abstr. Pediatr Res 1999; 45: 76A Our Web page will interact with other sites that are already involved in resident educational activities including the PedsCCM Web site which is developing a pediatric critical care medicine on-line lecture seriesContinuous Quality Improvement issues that require ongoing attention:How Do We Know That Information We are Teaching Is Correct and Updated? How Best to Present the Above Info During a PICU Rotation? Do Residents Who Come Through Our PICU Need the PICU Experience for Their Future Practice Settings? How Do We Evaluate if the PICU Rotation Provides Residents With the Skills to Recognize and Stabilize a Critically Ill Child/ Adolescent? JulyScott Penfil, MD, joins Pediatric Critical Care staffWeekly interactive teaching rounds and oral interviews re-introduced into PICU rotationAugustJim Hertzog, MD, joins Pediatric Critical Care staffSeptemberMonthly Pediatric Chief Resident directed PICU Resident Evidence Based Medicine Clinical Practice Journal Club begins (ran through December 1999)OctoberBegin introduction of evidence based clinical practice principles during PICU rounds through the educational prescription technique. Residents will be introduced to the EBCP principles for asking focused clinical questions on patient problems, searching for information, evaluating the validity / results / and applicability to patient careCerner computer system introduced2000FebruaryJeanette Murphy, computer instructor, spends one hour during the first rotation week with new PICU residents on specific PICU Cerner computer orderingAprilCritical Care Journal Club resumes: Basic Science Article and Clinical Article with Evidence Based Clinical Practice reviewMayDavid Corddry, MD, relinquishes Anesthesiology & Critical Care Chairman positionSteve Lawless, MD, Interim Chairman, Department of Anesthesiology & Critical CareJulyOral interviews discontinuedAugustNemours Education Innovation Program Application: Promoting PICU Evidence-Based Clinical PracticeSeptemberKathleen Bradford, MD, joins Pediatric Critical Care staffOctoberPICU Resident Rotation Goals updated to meet Thomas Jefferson Pediatric Residency needs2001JanuaryPICU Resident Rotation information initiated through Nemours Intranet under a developing Anesthesiology & Critical Care Web siteFebruaryEdward J Cullen, Stephen T Lawless, Vinay M Nadkarni, Scott Penfil, James H Hertzog David E Corddry. GME Reimbursement for PICU Resident Training, Is It Enough?Crit Care Med 2000; 28 (12) Suppl 424/T11, A146MarchNemours Education Innovative Program project entitled Promoting PICU Evidence based Clinical Practice begins March 1 for a one year periodJulyKathleen Bradford, MD, new Associate Director, Thomas Jefferson Pediatric Residency ProgramAndrew T. Costarino, Jr., new Chairman, Department of Anesthesiology and Critical CareAugust HYPERLINK "http://webcmt1.nemours.org/internet?url=no/aidhc/picu/internet?url=no/aidhc/picu/index.html" PICU Resident Rotation web site opens on the Nemours Foundation Internet site October DecemberVinay Nadkarni, MD, departs Alfred I. duPont Hospital for Children Clinical Research Project, Accidental Extubation in the PICU 2002JanuaryUniversity of Pennsylvania Pediatric Critical Care Nurse Practitioner StudentMarchBegin second year grant from Nemours Education Innovation Project: Promoting PICU Evidence Based Clinical PracticeJuneUniversity of Pennsylvania Pediatric Critical Care Nurse Practitioner StudentJulyGlenn Stryjewski, MD and John McCloskey, MD join Critical Care. PICU residents receive an hour introduction to Evidence Based Clinical Practice. They use these skills to address a focused clinical question during two interactive sessions on ARDS and Sepsis. A Critical Care attending mentor is assigned to each PICU resident for the month rotation. Mock Codes at Christiana Care are briefly reduced to once a month then to twice a month. Journal Club reinstituted. PICU residents requested to present a PICU patient to hospital resident morning report on 2nd Tuesday and 3rd Thursday of rotation block. Neonatology interactive rounds discontinued. Transport/OR-Intubation/Sedation Elective for residents - coordinated by Jim Hertzog, MD. Shamin Tejani, Clinical Pharmacist, offers monthly lecture on Immunosuppressive Medications for Patients with Organ Transplants. Alfred I duPont Hospital for Children GME office discussion about resident restricted duty work hours due to take effect in July 2003. All desktop computers in the PICU have access to PICU Vividesk, an Internet resource for Evidence Based Clinical Practice and Search engines.AugustPICU Resident rotation post-test now on-line from the SCCM Pediatric ICU Resident Education Committee  HYPERLINK "http://www.picucourse.org" \t "_blank" http://www.picucourse.org John Giamalis, Clinical Pharmacist, joins PICU rounds.SeptemberACGME Outcome Project and general competencies discussed at meeting with Thomas Jefferson University GME Subcommittee.DecemberRadiologist comes to PICU Monday through Friday morning in order to review patient radiographs with PICU team.2003JanuaryBegin third year Nemours Education Innovation Grant: Promoting PICU Evidence Based Clinical Practice. Closer interaction with Centre for Health Evidence and upgrade of PICU Vividesk to Nemours Users Guides Interactive Desktop Jim Hertzog, MD, continues his Nemours Education Innovation Grant studying a Mechanial Ventilator Laboratory for Residents.AprilAll PICU bedside wireless computers have access to Nemours Users Guides Interactive DesktopJuneDivision Teaching Award is presented to Critical Care Medicine by the Thomas Jefferson University Pediatric ResidentsJulyEdward Cullen, Stephen Lawless, James Hertzog, Scott Penfil, Kathleen Bradford, Vinay Nadkarni, David Corddry, Andrew Costarino, A Model of Determining a Fair Market Value for Teaching Residents. Who Profits? Pediatrics 2003; 112(1):40-48 Pediatric Critical Care Medicine Fellowship begins under direction of Scott Penfil, MD Caroline Boyd MD begins Pediatric Critical Care Medicine Fellowship PICU Residents can now fill out on-line the pre and post rotation questionnaires and tests as well as Nemours Education Innovation Grant questionnaires and tests. Pharmacy Residency Program begins rotating through the PICU under theleadership of Shamin Tejani, clinical pharmacist Alfred I duPont Hospital for Children Graduate Medical Education (GME) officebegins its official oversight of local medical training Alfred I duPont Hospital for Children Graduate Medical Education (GME) officebegins its official oversight of local medical training New ACGME Resident Duty Hours Take Effect Duty Hours 80 hours per week, averaged over 4 weeks. May increase by 10% in some circumstances. One day off out of seven, averaged over 4 weeks. No in-house call more than once every three nights, averaged over 4 weeks. 24 hours on call, maximum, with up to six additional hours to hand off patients and attend educational activities. 10 hours off between duty periods and after in-house call. High Quality Education and Safe and Effective Patient Care Priority of clinical and didactic education in the allotment of residents? time and energies. Schedules of teaching staff structured to provide ready supervision and faculty support/consultation to residents on duty. Duty hour assignments that recognize that faculty and residents collectively have responsibility for patient safety and welfare. Monitor residents for the effects of sleep and fatigue by Program director and faculty with appropriate action when it is determined that fatigue might affect safe patient care or learning. Education of faculty and residents in recognizing the signs of fatigue and in applying preventive and operational countermeasures. Appropriate backup support when patient care responsibilities are difficult and prolonged, and if unexpected needs create resident fatigue sufficient to jeopardize patient care2004JanuaryPICU continues to participate in the fourth Nemours Education Innovation Grant: Promoting Evidence Based Clinical Practice Society of Critical Care Medicine now houses the Pediatric Critical Care Resident powerpoint presentations and post-PICU test. Our PICU continues to participate.JuneKathleen Bradford, MD departs PICUJulyNicholas Slamon, MD begins Pediatric Critical Care Medicine FellowshipSeptemberJohn McCloskey MD and Glenn Stryjewski MD depart PICU. Computer difficulties with powerpoint presentations and SCCM test page as well as removal of Interactive Teaching Rounds due to reduced critical care physician staff decreased efectiveness of PICU resident educational process. Ilene Sivikoff takes over data entry responsibilities for PICU Resident Data Base. Clinical Research Project, SIRS in Pediatrics 2005JaunaryNemours Education Committee - Grant to Promote Evidence Based Clinical Practice throughout the Nemours Foundation, PICU Article Collection developed for the Nemours UGI Desktop JuneTania Burns MD joins the pediatric critical care staff. Scott Penfil MD receives Teaching Award from Thomas Jefferson Emergency Medicine Residency Program. JulyNew combined PICU Resident and Critical Care Attending daily progress note instituted. PICU Residents are asked to hand in a critically appraised topic on a pediatric critical care patient problem. A copy will be forwarded to their respective program directors at the completion of the PICU rotation. Additionally, PICU Resident test scores on the national Society of Critical Care Medicine Post-PICU Rotation Test will be sent to residents respective program directors.AugustBrian Binck MD joins the pediatric critical care staff.2006MayAnesthesiology and Critical Care Medicine and Sedation develop Team Projects: Patient Care; Learning Environment; Organization Support and Leadership; Respectful Workplace and Family Centered Care. PICU Resident and Fellowship activity included in Learning Environment Team.JuneNicholas Slamon, MD, Pediatric Critical Care Fellow, receives Teaching Award from ThomasJefferson Pediatric ResidentsJulyRahul Bhattia, MD and Meg Fizzola, MD begin Pediatric Critical Care Medicine Fellowship. Alfred I duPont Hospital for Children designated as Levell III Trauma Center Caroline Boyd MD begins joint appointment with Pediatric Critical Care and Pediatric CardiacCritical CareAugust Glenn Stryjewski, MD joins Pediatric Critical Care and as Associate Director Thomas Jefferson Pediatric Residency Clinical Research Project, BiS Monitor Use in Peds2007JuneNick Slamon, MD graduates from Critical Care Medicine Fellowship Recipient of Thomas Jefferson University Pediatric Residency Program Fellow Teaching AwardJulyKevin Couloures DO begins Critical Care Fellowship programJulyMentor program for residents during their PICU rotation discontinued Pediatric residents do 8 weeks in the PICU during their second residency year2009 FebruaryGlenn Stryjewski MD initiates PICU Systems Based Project: Quality Improvement Case Analysis.Eaxch resident is asked to identify a PICU problem and suggest ways to make improvements.AprilEpic Medical Record goes live. Cerner ordering system discontinued. Visiting PICU residents need to take a 4 hour on-line computer training session before starting their PICU rotation and then complete 4 hours of instructor led training when they arrive for their PICU rotation.JuneFaculty Teacher of the Year Award. For outstanding Teaching and Dedication to the Education of the Pediatric Residents. Selected by the Pediatric Residents Scott Penfil MD Glen Stryjewski MD Rahul Bhatia, MD - completes Pediatric Critical Care FellowshipJulyNew SCCM pre and post test as well as audio powerpoints for Residents during their PICU Rotation Yosef Lowenbrown DO begins Pediatric Critical Care Fellowship  August Brian Binck MD departs PICU staff. RESTORE clinical study begins September Heather Sobolewski RN, Simulation Lab Coordinator,brings simulation manikin and equipment to the PICU for our weekly Friday 2PM PICU Mock Code. Each PICU resident receives a copy of Rogers' Handbook of Pediatric Intensive Care (Fourth Edition) for their personal use during their PICU rotation. PICU Radiology Review with Staff Radiologists Monday-Friday changed to 1130 in PICU. Visiting PICU residents do all their EPIC Medical Record training online prior to their PICU rotation October Daily PICU Resident Progress switched from paper note to part of computerized EPIC medical record. November Meg Frizolla DO completes Pediatric Critical Care fellowship December Meg Frizolla DO joins Pediatric Critical Care attending staff Several pediatric critical care department secretary staff changes 2010 January Caroline Boyd MD departs PICU and begins full time in pediatric cardiac intensive care unit. 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