Critical Care Medicine (Pediatric)

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 2.1 Prioritize issues to address in the patient’s assessment and management PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □ME 1.4 Recognize urgent problems and one’s own limitations, and seek assistance as needed
• □ME 2.2 Develop an initial diagnosis relevant to the patient’s presentation

Communicator

• □COM 3.1 Communicate in a clear, compassionate, respectful, and accurate manner to the patient and family

Collaborator

• □COL 1.2 Seek and respond to input from other health care professionals
• □COL 1.3 Communicate clearly and directly to promote understanding in the health care team

Leader

• □L 2.1 Consider health care resources and costs when determining the investigation and management plan

Health Advocate

• □HA 1.1 Facilitate timely access to limited health care resources PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Observation

1. ●direct handover observation
2. ●chart review
3. ●handover paperwork
4. ●transfer/discharge note

Medical Expert

• □ME 1.5 Prioritize among patients based on clinical acuity
• □ME 4.1 Establish plans for ongoing care, including follow-up on investigations and response to treatment

Communicator

• □COM 5.1 Organize information systematically within an electronic or written medical record
• □COM 5.1 Maintain accurate and up-to-date problem lists
• □COM 5.1 Document information about patients and their medical conditions in a manner that enhances intra- and interprofessional care

Collaborator

• □COL 3.2 Describe specific information required for safe and effective handover during transitions in care
• □COL 3.1 Identify patients requiring handover to other physicians or health care professionals PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □COL 3.2 Summarize patient issues, including plans to deal with ongoing concerns
• □COL 3.2 Provide anticipatory guidance for issues that are likely to arise
• □COL 1.3 Communicate clearly and directly to promote understanding in the health care team PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Communicator

• □COM 1.1 Introduce oneself and explain one’s role in the interprofessional team
• □COM 1.1 Communicate using a patient-centered approach that facilitates patient trust and autonomy and that is characterized by empathy, respect, and compassion
• □COM 3.1 Convey information about medical course and management plan clearly and accurately
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 1.4 Identify, verify and validate non-verbal cues on the part of the patient and /or family PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family
• □COM 5.1 Document the clinical encounter to accurately reflect the discussion and decisions

Professional

• □P 1.2 Ensure that the patient and family are informed about the diagnosis and plan of care
• □P 1.1 Respect diversity and difference, including but not limited to the impact of socio-economic background, gender, religion and cultural beliefs on decision making PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.3 Apply knowledge of basic physiology to the management of common ICU conditions
• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 1.6 Develop a plan that considers the current complexity, uncertainty and ambiguity in a clinical situation
• □ME 2.2 Select and interpret the results of investigations and imaging
• □ME 2.3 Work with the patient and family to establish goals of care
• □ME 2.4 Develop and implement initial and/or ongoing management plans for patients with common ICU conditions
• □ME 2.4 Develop plans to monitor the evolution of the clinical course and/or the patient’s response to treatment PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □ME 3.1 Integrate planned procedures or therapies into the overall plan of care
• □ME 4.1 Determine the need and timing of consultation with other specialists
• □ME 5.2 Organize safe intrahospital transport of patient to and from ICU, using all necessary human and equipment resources, recognizing when it may be inappropriate to transport patient

Communicator

• □COM 1.6 Integrate the child’s and family’s beliefs, concerns, expectations and experiences relevant to the presenting problem

Collaborator

• □COL 1.2 Implement a multidisciplinary approach to the care of ICU patients
• □COL 1.3 Engage in respectful shared decision-making with physicians and colleagues in other health care professions

Professional

• □P 2.2 Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.3 Apply knowledge of respiratory physiology and cardiopulmonary interactions
• □ME 1.6 Develop a plan that considers the current complexity, uncertainty, and ambiguity in a clinical situation
• □ME 2.2 Interpret diagnostic imaging of the respiratory system
• □ME 2.4 Develop and implement an initial management plan for uncomplicated patients requiring non-invasive or invasive ventilation
• □ME 3.2 Ensure that the patient and family are informed about the risks and benefits of each treatment options in the context of best evidence and guidelines
• □ME 5.2 Use cognitive aids such as clinical care paths to enhance patient safety

Communicator

• □COM 3.1 Use strategies to verify and validate the understanding of the patient and family PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □COM 4.3 Answer questions from the patient and family about next steps

Collaborator

• □COL 1.2 Seek and respond to input from other health care professionals PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Teaching activity

1. ●teaching a procedure
2. ●telephone support
3. ●in-person case review
4. ●other (write in)

Setting

1. ●clinical
2. ●simulation

Collaborator

• □COL 1.2 Assign tasks and responsibilities to other team members, commensurate with their skills and patient complexity
• □COL 2.1 Delegate tasks and responsibilities in a respectful manner

Scholar

• □S 2.1 Use strategies for deliberate, positive role-modelling
• □S 2.2 Create a positive learning environment
• □S 2.4 Identify the learning needs and desired learning outcomes of others
• □S 2.3 Provide learners with opportunities for appropriate clinical responsibility
• □S 2.3 Supervise learners to ensure they work within their limitations, ensuring patient safety
• □S 2.5 Provide feedback to enhance learning and performance PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □S 2.3 Identify unsafe clinical situations involving learners and manage them appropriately PEDIATRIC CRITICAL CARE MEDICINE (2024)

Professional

• □P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

ARDS

1. ●yes
2. ●no

Setting

1. ●clinical
2. ●simulation

Medical Expert

• □ME 1.3 Apply knowledge of respiratory physiology and cardiopulmonary interactions
• □ME 1.6 Adapt care to address complexity in the patient situation
• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 2.2 Integrate information from the clinical assessment to formulate an understanding of the patient’s condition PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □ME 2.2 Interpret diagnostic imaging of the respiratory system
• □ME 2.4 Develop and implement management plans for patients requiring non-invasive or invasive ventilation, including weaning from prolonged and/or complicated mechanical ventilation
• □ME 3.1 Determine the need for and timing of tracheostomy

Collaborator

• □COL 1.3 Communicate effectively with other physicians and health professionals

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision-making PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Etiology of organ dysfunction

1. ●shock
2. ●multi-system trauma
3. ●sepsis
4. ●polypharmacy overdose
5. ●other (write in)

Medical Expert

• □ME 2.1 Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed
• □ME 2.2 Prescribe and adjust medications in the setting of organ dysfunction
• □ME 4.1 Implement a patient-centred plan that supports ongoing monitoring of clinical status and response to treatment
• □ME 4.1 Ensure detailed and complete follow-up and handover of all patients under the resident’s care
• □ME 4.1 Determine the need and timing of referral to other specialists
• □ME 2.1 Identify patients for whom the patient perceived burden of disease modifying therapy or investigations is greater than the clinical benefit PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 2.2 Provide assessment and initial stabilization of ABCs
• □ME 2.4 Provide concurrent treatment and ongoing assessment of the patient’s clinical condition
• □ME 2.4 Reassess, re-evaluate and adjust resuscitative and diagnostic efforts as appropriate
• □ME 5.2 Demonstrate situational awareness, avoid fixation error
• □ME 4.1 Ask for additional assistance and/or other services when indicated
• □ME 1.4 Act decisively and maintain control of crisis situations
• □ME 2.2 Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □ME 2.4 Manage hemodynamic support and monitoring
• □ME 2.4 Manage non-invasive and/or invasive ventilation
• □ME 3.1 Integrate planned procedures or therapies into resuscitative efforts
• □ME 3.3 Triage a procedure or therapy, taking into account clinical urgency, potential for deterioration, and available resources

Collaborator

• □COL 1.2 Delegate tasks and direct team members to aid in resuscitation
• □COL 1.3 Use closed loop communication
• □COL 1.2 Seek and respond to input from other health care professionals PEDIATRIC CRITICAL CARE MEDICINE (2024)

Leader

• □L 4.2 Establish clear leadership in resuscitative efforts

Professional

• □P 4.1 Maintain capacity for professional clinical performance in stressful situations

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Procedure

1. ●airway management
2. ●intubation
3. ●arterial line
4. ●cardioversion
5. ●central venous line
6. ●Seldinger technique chest drain
7. ●dialysis line insertion
8. ●procedural sedation
9. ●testing of epicardial pacer

Complexity

1. ●complicated/urgent
2. ●uncomplicated

Ultrasound guidance

1. ●yes
2. ●no

Setting

1. ●clinical
2. ●simulation

Site

1. ●not applicable
2. ●femoral
3. ●jugular
4. ●radial
5. ●subclavian
6. ●other (write in)

Medical Expert

• □ME 3.1 Preprocedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required PEDIATRIC CRITICAL CARE MEDICINE (2024)
• □ME 3.4 Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications
• □ME 1.3 Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them
• □ME 3.4 Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues
• □ME 3.4 Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended
• □ME 3.4 Efficiency and flow: Obvious planned course of procedure with economy of movement and flow
• □ME 3.4 Postprocedure plan: Appropriate complete post procedure plan

Collaborator

• □COL 1.3 Professional and effective communication/utilization of staff PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.6 Adapt care as the complexity, uncertainty, and ambiguity of the patient’s clinical situation evolves
• □ME 2.1 Identify patients for whom the patient perceived burden of disease modifying therapy or investigations is greater than the clinical benefit
• □ME 2.3 Recognize and respond to signs that it is time to transition care away from a disease modifying approach
• □ME 2.3 Address the impact of the medical condition on the patients’ ability to pursue life goals and purposes
• □ME 2.3 Work with the patient and family to establish goals of care
• □ME 2.2 Select investigations and therapies appropriate to the patient’s goals of care
• □ME 2.4 Develop and implement management plans that support achievement of the patient’s goals of care
• □ME 4.1 Coordinate ongoing care when multiple physicians and health care professionals are involved

Communicator

• □COM 4.1 Communicate in a manner that is respectful, non-judgmental, and culturally aware
• □COM 3.1 Provide information on diagnosis and prognosis in a clear, compassionate, and respectful manner
• □COM 4.3 Use communication skills and strategies that help the patient and family make informed decisions PEDIATRIC CRITICAL CARE MEDICINE (2024)

Health Advocate

• □HA 1.1 Facilitate timely patient access to services and resources PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Transport context

1. ●in-hospital
2. ●interhospital

Setting

1. ●clinical
2. ●simulation

Complexity

1. ●simple
2. ●complex

Medical Expert

• □ME 2.2 Interpret clinical information gathered by another health professional, along with the results of investigations, for the purposes of diagnosis and management
• □ME 2.4 Determine the setting of care appropriate for the patient’s health needs
• □ME 2.4 Plan the logistics of transfer including stabilization and procedures prior to transfer, equipment and personnel requirements, methods of monitoring and assessment during transport

Communicator

• □COM 5.1 Document telephone advice provided and the care provided during transport PEDIATRIC CRITICAL CARE MEDICINE (2024)

Collaborator

• □COL 3.2 Demonstrate safe handover of care, using both verbal and written communication, during a patient transition to a different health care professional, setting, or stage of care

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Activity observed

1. ●family discussion/meeting
2. ●note written after meeting
3. ●simulated activity
4. ●other (write in)

Medical Expert

• □ME 2.3 Work with the patient and family to establish goals of care
• □ME 2.4 Develop and implement palliative care management plans (including withdrawal of life sustaining therapy) that align with patient and family goals of care PEDIATRIC CRITICAL CARE MEDICINE (2024)

Communicator

• □COM 1.1 Develop trusting and supportive relationships with families in distress
• □COM 4.1 Ask about and integrate rituals and end-of-life practices in keeping with the family’s cultural, spiritual and religious beliefs
• □COM 3.1 Use strategies to verify and validate the understanding of the patient and/or family.
• □COM 1.5 Manage emotionally charged conversations including breaking bad news and end of life conversations

Professional

• □P 1.3 Recognize and respond to the moral and ethical challenges in end-of- life care PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Scholar

• □S 2.5 Identify learner behaviors to support / continue as well as those for improvement
• □S 2.5 Provide specific suggestions for improvement of performance
• □S 2.5 Provide narrative comments that support coaching / assessment PEDIATRIC CRITICAL CARE MEDICINE (2024)

Professional

• □P 1.1 Complete learner assessments in a timely fashion

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Scenario

1. ●patient/family
2. ●other health care professional(s)

Communicator

• □COM 1.5 Recognize when strong emotions (such as anger, fear, anxiety, or sadness) are impacting an interaction and respond appropriately
• □COM 1.4 Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication
• □COM 3.1 Share information and explanations that are clear and accurate while checking for understanding
• □COM 1.5 Establish boundaries as needed in emotional situations
• □COM 4.1 Communicate in a manner that is respectful, non-judgmental and culturally aware
• □COM 4.3 Answer questions regarding care delivery, treatment decisions and/or prognosis in a respectful manner PEDIATRIC CRITICAL CARE MEDICINE (2024)

Collaborator

• □COL 2.2 Listen to understand and find common ground
• □COL 2.2 Manage differences and resolve conflicts

Professional

• □P 1.1 Intervene when behaviours toward colleagues and/or learners undermine a respectful environment PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Collaborator

• □COL 1.3 Convey the purpose of debriefing an event to the health care team
• □COL 1.3 Facilitate discussions within the health care team, ensuring everyone has the opportunity to participate

Leader

• □L 1.2 Establish a safe environment for debriefing critical events
• □L 1.2 Encourage all members of the team to identify opportunities to improve patient care
• □L 1.1 Summarize debriefing discussions, identifying potential improvements in health care delivery

Scholar

• □S 2.5 Role model self-assessment and feedback seeking behaviour

Professional

• □P 4.3 Recognize, support and respond effectively to colleagues in need PEDIATRIC CRITICAL CARE MEDICINE (2024)

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.3 Apply a broad base and depth of knowledge in clinical and biomedical sciences to manage the breadth of patient presentations in the ICU
• □ME 1.4 Perform focused clinical assessments that address all relevant issues
• □ME 1.5 Prioritize among patients based on clinical acuity
• □ME 1.5 Carry out professional duties in the face of multiple, competing demands
• □ME 1.6 Recognize and respond to the complexity, uncertainty, and ambiguity inherent in medical practice
• □ME 2.4 Establish patient centered management plans

Collaborator

• □COL 2.1 Delegate tasks and responsibilities in a respectful manner PEDIATRIC CRITICAL CARE MEDICINE (2024)

Leader

• □L 4.1 Integrate supervisory and teaching responsibilities into the overall management of the clinical service
• □L 2.1 Allocate health care resources for optimal patient care
• □L 4.1 Manage time and prioritize tasks

Scholar

• □S 2.4 Demonstrate basic skills in teaching others
• □S 3.4 Integrate best evidence and clinical expertise into decision-making

Professional

• □P 4.1 Manage the mental and physical challenges that impact physician wellness and/or performance in demanding or stressful clinical settings

Case description

Feedback provided

Next steps