Rotation Timeline

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Rotation Timeline

  1. 1. Timeline for PICU Resident Rotation 1984 A. I. duPont Institute, new Hospital Building Opens 1988 January A. I. duPont Institute PICU Opens with four beds Robert Kettrick MD, Chairman, Department of Pediatric Anesthesiology and Critical Care, Director PICU 1991 Steve Lawless MD, new Medical Director, PICU 1992 Thomas Jefferson Pediatric Residency Program moves to A. I. duPont Institute under the direction of Residency Director, Dr. Weiss 2nd-year pediatric residents start in the 16-bed PICU Medical Center of Delaware Emergency Medicine 2nd-year residents start in PICU 1993 Rob Walter, MD, named new Residency Director Thomas Jefferson Pediatric Residency Program Thomas Jefferson Emergency Medicine 2nd-year residents begin in PICU Abstract: 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: 700A 1994 March 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, MD September Formalized PICU Educational Program begins at A. I duPont Institute PICU PICU Resident Rotation Coordinator Edward J. Cullen, Jr., DO Multidisciplinary instructors involved in PICU Resident Education Maryann Cunningham, Nursing Bad News Sept. 1994 - June, 1996 Mary Jo Rose, RN - Mock Codes 1994 -1997 1995 June University of Pennsylvania Pediatric Critical Care Nurse Practitioner Student
  2. 2. July Mission, Vision, Values statement from Nemours August Second 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, MD Multidisciplinary 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 7/96 1996 January Dave Corddry, MD, new Chairman, Department of Pediatric Anesthesiology and Critical Care April Vinay Nadkarni, MD, new Medical Director, PICU May Abstract 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, 1996 June Our PICU Resident Program becomes involved with the SCCM Pediatric Resident Education Committee July PICU 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 rotation Multidisciplinary Instructors involved in PICU Resident Education
  3. 3. 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 - 6/97 1997 February Vinay Nadkarni, MD, presents information about our PICU Resident Rotation efforts to the SCCM Pediatric Resident Education Committee at its annual meeting, 2/9/97 March Dave Berger begins designing and creating our Access PICU Resident Education Data Base May Abstract 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 1997 July Monthly 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 experience Interactive PICU Teaching Rounds replace formal lectures by the Critical Care Physicians Residents given choice of PICU Rotation Exit Test: Oral Interview, Presentation or Essay Response to two pediatric critical care scenarios Multidisciplinary Instructors involved in PICU Resident Education Radiology - Daily PICU X-ray Reviews with
  4. 4. radiologist, 7/97 6/98 Donna Corddry, RN, Mock Codes 1997 - present Nancy Blackburn, RN, Mock Codes 1997 - present Intranet PICU Resident Education Web Page initial development with Karen Hartis and Dan Hart September Poster 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, Arkansas November Original 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: 1898-1903 Editorial Response Timothy S. Yeh. Give a little, take a little: Resident education in the evolving healthcare environment. Crit Care Med 1997; 25:1782 1998 July SCCM 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 situations Multidisciplinary instructors involved in PICU Resident Education
  5. 5. Julie Harrison, RT, and Dawn Selhorst, RT - Introduction to Ventilators, BiPAP Negative Pressure Ventilator July, 1998 ? present Converting 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 present Re-evaluating our available time / resources and clinical ? research - administration commitments and their impact on maintaining the one month PICU Resident Rotation Steve Selbst, MD, becomes new Residency Director for the Thomas Jefferson Pediatric Residency Program November Increased clinical load / night call due to loss of one critical care physician Increased 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 1999 January Abstract 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) A102 February Meeting 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
  6. 6. 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 April Abstracts 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 series Continuous Quality Improvement issues that require ongoing attention:
  7. 7. • 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? July Scott Penfil, MD, joins Pediatric Critical Care staff Weekly interactive teaching rounds and oral interviews re-introduced into PICU rotation August Jim Hertzog, MD, joins Pediatric Critical Care staff September Monthly Pediatric Chief Resident directed PICU Resident Evidence Based Medicine Clinical Practice Journal Club begins (ran through December 1999) October Begin 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 care Cerner computer system introduced 2000 February Jeanette Murphy, computer instructor, spends one hour during the first rotation week with new PICU residents on specific PICU Cerner computer ordering April Critical Care Journal Club resumes: Basic Science Article and Clinical Article with Evidence Based Clinical Practice review May David Corddry, MD, relinquishes Anesthesiology & Critical Care Chairman position Steve Lawless, MD, Interim Chairman, Department of Anesthesiology & Critical Care July Oral interviews discontinued August Nemours Education Innovation Program Application: Promoting PICU Evidence-Based Clinical Practice September Kathleen Bradford, MD, joins Pediatric Critical Care staff October PICU Resident Rotation Goals updated to meet Thomas Jefferson Pediatric Residency needs 2001 January PICU Resident Rotation information initiated through Nemours Intranet under
  8. 8. a developing Anesthesiology & Critical Care Web site February Edward 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, A146 March Nemours Education Innovative Program project entitled Promoting PICU Evidence based Clinical Practice begins March 1 for a one year period July Kathleen Bradford, MD, new Associate Director, Thomas Jefferson Pediatric Residency Program Andrew T. Costarino, Jr., new Chairman, Department of Anesthesiology and Critical Care August PICU Resident Rotation web site opens on the Nemours Foundation Internet site October December Vinay Nadkarni, MD, departs Alfred I. duPont Hospital for Children Clinical Research Project, Accidental Extubation in the PICU 2002 January University of Pennsylvania Pediatric Critical Care Nurse Practitioner Student March Begin second year grant from Nemours Education Innovation Project: Promoting PICU Evidence Based Clinical Practice June University of Pennsylvania Pediatric Critical Care Nurse Practitioner Student July Glenn 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.
  9. 9. August PICU Resident rotation post-test now on-line from the SCCM Pediatric ICU Resident Education Committee http://www.picucourse.org John Giamalis, Clinical Pharmacist, joins PICU rounds. September ACGME Outcome Project and general competencies discussed at meeting with Thomas Jefferson University GME Subcommittee. December Radiologist comes to PICU Monday through Friday morning in order to review patient radiographs with PICU team. 2003 January Begin 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. April All PICU bedside wireless computers have access to Nemours Users Guides Interactive Desktop June Division Teaching Award is presented to Critical Care Medicine by the Thomas Jefferson University Pediatric Residents July Edward 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 the leadership of Shamin Tejani, clinical pharmacist Alfred I duPont Hospital for Children Graduate Medical Education (GME) office begins its official oversight of local medical training Alfred I duPont Hospital for Children Graduate Medical Education (GME) office begins 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.
  10. 10. • 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 care 2004 January PICU 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. June Kathleen Bradford, MD departs PICU July Nicholas Slamon, MD begins Pediatric Critical Care Medicine Fellowship September John 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 2005 Jaunary Nemours Education Committee - Grant to Promote Evidence Based Clinical Practice throughout the Nemours Foundation, PICU Article Collection developed for the Nemours UGI Desktop June Tania Burns MD joins the pediatric critical care staff. Scott Penfil MD receives Teaching Award from Thomas Jefferson Emergency Medicine Residency Program. July New 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
  11. 11. Care Medicine Post-PICU Rotation Test will be sent to residents’ respective program directors. August Brian Binck MD joins the pediatric critical care staff. 2006 May Anesthesiology 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. June Nicholas Slamon, MD, Pediatric Critical Care Fellow, receives Teaching Award from Thomas Jefferson Pediatric Residents July Rahul 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 Cardiac Critical Care August Glenn Stryjewski, MD joins Pediatric Critical Care and as Associate Director Thomas Jefferson Pediatric Residency Clinical Research Project, BiS Monitor Use in Peds 2007 June Nick Slamon, MD graduates from Critical Care Medicine Fellowship Recipient of Thomas Jefferson University Pediatric Residency Program Fellow Teaching Award July Kevin Couloures DO begins Critical Care Fellowship program July Mentor program for residents during their PICU rotation discontinued Pediatric residents do 8 weeks in the PICU during their second residency year 2009 February Glenn 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. April Epic 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. June Faculty 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 Fellowship July New SCCM pre and post test as well as audio powerpoints for Residents during their PICU Rotation
  12. 12. 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. ECMO medical director.

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