ࡱ> #` 5bjbjmm 7-7777LD8xEl99999]::, ;DDDDDDD$fGhIEr<]:]:r<r<E992E>>>r<99D>r<D>>/A{A9`9 i5@7l=GAA4HE0xEOA,J=J{AJ{AH#;0S;">u;;#;#;#;EE>"#;#;#;xEr<r<r<r<$1772E  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 PediatricsMedPedsChristiana ERTJU ERMedical StudentsTotalNumber per Program2935020917462788Number Taking Test7212524221199% Taking Test25%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: http://www.nemours.org/healthpro/education/de/residency/picu.html ( Username = picu Password = resident)Monday Tuesday Wednesday Thursday Friday  0630 Introduction To PICU 0730 PICU Clinical Rounds - Complete Pre-Rotation Questionnaire Computer order entry training for visiting residents 0730 PICU Clinical Rounds - 1030 Radiology Rounds Airway1 Mechanical Ventilation 1 HFOV1 0730 PICU Clinical Rounds - Respiratory Failure 1 ARDS1 Blood Gas Analysis 10730 PICU Clinical Rounds - 1030 Radiology Rounds Shock States1 Shock & Sepsis1 Cardiogenic Shock1  0730 PICU Clinical Rounds 1400 Mock Code DIC1 Vasoactive Drugs1 Arrythmias1Monday Tuesday Wednesday Thursday Friday  0730 PICU Clinical Rounds - Fluid & Electrolyte Emergencies1 Sedation/Analgesia & Neuromuscular Blockade1 Enteral & Parenetral Nutrition1 Hyponatremia10730 PICU Clinical Rounds 0830 PICU Resident Case Presentation at Morning Report 1030 Radiology Rounds Head Injury1 Coma10730 PICU Clinical Rounds Guidelines for Medical Management Traumatic Brain Injury1 Spinal Cord Injury1 Renal Failure1 Hepatic Failure1 0730 PICU Clinical Rounds - 1030 Radiology Rounds Asthma1 Status Epilepticus1 Thromboembolic Disorders1  0730 PICU Clinical Rounds 1400 Difficult Airway Mock Code DKA1 Toxicology1Monday Tuesday Wednesday Thursday Friday  0730 PICU Clinical Rounds Strokes in Children1 Oncologic Emergencies1 Sickle Cell critical care1 0730 PICU Clinical Rounds 1030 Radiology Rounds Pharmokinetics/Pharmacodynamics1 Endocrine Emergenices10730 PICU Clinical Rounds Extracorporeal Life Support1 Renal Replacement Therapy1 0730 PICU Clinical Rounds 1030 Radiology Rounds Post-Op Cardiac Management1 Single Ventricle Physiology1 0730 PICU Clinical Rounds 1400 Mock Code - Pulmonary Artery Cathereization1 Monday Tuesday Wednesday Thursday Friday 730 PICU Clinical Rounds Stabilization & Transport1 Pediatric Disaster and Terrorism preparedness1 Medical Errors The PCIU Perspective1 0730 PICU Clinical Rounds 1030 Radiology Rounds 0830 PICU Resident Case Presentation at Morning Report 1400 Critical Care Fellow Presentation 0730 PICU Clinical Rounds - 1200 Journal Club 3D 298 Ethics in PICU1 Pediatric Office Emergencies10730 PICU Clinical Rounds - 1030 Radiology Rounds 1400 Critical Care Fellow Presentation Complete on-line post Rotation test Password____________________0730 PICU Clinical Rounds - 1400 Mock Code Hand in PICU, Procedure Log, Primary Patient Log , parking permit, proxy card and beeper to Ilene Sivikoff (ext 5159) 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 http://Stentor. Radiologists can be contacted to review individual films as needed. #1 refers to SCCM powerpoint presentations for residents in a PICU: HYPERLINK http://www.learnicu.org/Clinical_Practice/Fundamentals/PICU/Pages/Course_Presentations.aspx http://www.learnicu.org/Clinical_Practice/Fundamentals/PICU/Pages/Course_Presentations.aspx 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 patients 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 childs 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). 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