The program in Paediatric Critical Care is designed to provide training in the comprehensive care of critically ill children. To fulfill this objective the program provides training and guidance in the following areas: clinical skills, research, academic, teaching, ethics and administration.

Clinical Training At least 12 months of the two year fellowship are spent working in the Pediatric Critical Care Unit (PCCU). The initial months are spent primarily in the role of a resident with direct responsibility for patient care and are used to further develop the skills of history taking, physical examination and development of differential diagnoses and care plans for the critically ill child. This is done in the context of direct supervision by the attending physicians. In addition the first few months are spent learning to perform the various technical procedures and dealing with the complexities of giving bad news to and discussing difficult issues with families. The second half of the first year is spent performing the above tasks more independently and the second year is spent primarily teaching and supervising more junior house staff in the performance of the above duties. Since the last review the care of post-op cardiac surgery cases is mastered at the Hospital for Sick Children or other cardiac surgery centre such as Montreal Children's Hospital.

The resident receives further clinical expertise in Pediatric Critical Care through their role as the Physician on the Critical Care Transport Team. As such they provide advice to referring physicians on the care of critically ill children in the periphery and also supervise an extended role ( RN and RRT ) Transport Team when a physician does not accompany the team. Finally the resident also accompanies the team on occasions when a physician is deemed necessary and as such gets experience in the management of critically ill children in smaller centres.

All residents are required to spend a month doing Pediatric Anesthesia in order to master vascular and airway skills such as bag and mask ventilation, intubations, intravenous and central lines. In addition this provides a chance for the resident to familiarize themselves with the various pharmacologic agents used in PCCU and the physiology of the anesthetized patient.

Elective rotations depend on the resident's background and career goals. Trainees may do up to 6 months of clinical electives which may include Neonatology, Cardiology, Neurology, ENT or Adult Critical Care. Finally, residents are expected to obtain their ATLS certificate in their first year if not previously completed. This is paid for by the Program.

Research

Research is an expectation of all trainees. Trainees spend a minimum of 6 months and a maximum of 12 months doing research. At the end of their two years all trainees are expected to have completed at least one project and presented it at a national meeting and/or submitted it for publication. The research project may be either clinically or laboratory based and may be carried out at the Children's Hospital or the laboratories of the London Health Sciences Centre depending on the interests of the resident. Residents are expected to attend the monthly Paediatric Critical Care Medicine Research Meetings.

Academic

During the two years the resident is expected to attend the weekly academic seminar series which occurs on Thursdays and , over the two years, covers a virtually complete curriculum of the basic and clinical science as they pertain to Pediatric Critical Care Medicine. In addition, there are monthly journal clubs which the resident is responsible to present a review of the current literature on a given topic. In addition there are PCCU rounds for the residents which are centred among a case and are organized (and often presented) by the resident. The PCCU attending staff are present at these rounds in order to participate in discussions and to provide feedback to the residents.

PICU Administration

Residents are expected to acquire an understanding of PICU administration and management in preparation for their ultimate roles as critical care physicians. They attend the monthly PCCU Operations Committee and the monthly Care Review Committee Meetings. In both of these forums, quality assurance, budget, and administrative issues are routinely discussed. In addition, the Academic Seminar Series addresses many administrative issues in a more theoretical forum. Residents sit as members of the Pediatric Critical Care Postgraduate Committee. To further develop their administrative and organizational skills the residents are put in charge of the monthly PCCU rounds and journal clubs.

Teaching

The residents are responsible for the supervision and teaching of the junior house staff when they are on rotation in the PCCU. As second year fellows they are responsible for independently running the morning multidisciplinary rounds in the Unit twice per week. In addition they are responsible for organizing, directing and sometimes presenting the monthly PCCU rounds.

Ethics

The residents are exposed to ethics on both a formal and informal basis. The informal teaching occurs regularly at the bedside as well in family meetings and in discussion with various consulting services. The formal teaching occurs in quarterly Ethics Rounds presented by a trained Ethicist and in the Academic Seminar Series and is focused on ethical issues as they pertain to PCCU. Also residents are invited to attend the ethics sessions in the General Paediatric Academic Half-Day.

University of Western Ontario, Department of Paediatrics
800 Commissioners Road East, Rm E6-103
London, Ontario, Canada N6A 5W9
Tel: (519) 685-8129  Fax: (519) 685-8156