Program Requirements for Residency Education in Pediatric ...


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Program Requirements for Residency Education in Pediatric ...

  1. 1. Program Requirements for Residency Education in Pediatric Critical Care Medicine 1 Programs must comply with the Program Requirements for Residency Education in the Subspecialties of Pediatrics and with the following requirements. These specialty requirements may exceed the common requirements. If there is more than one ACGME program in critical care medicine in the institution, there should be an institutional policy governing the educational resources committed to these programs and ensuring cooperation of all involved disciplines. I. Scope of Training The purpose of an accredited program in pediatric critical care medicine is to provide subspecialty residents with an understanding of the pathophysiology of acute, life-threatening disease and injury. To achieve this, the program must emphasize the fundamentals of clinical diagnosis, patient assessment, and clinical management. The program must provide the subspecialty residents with the opportunity to augment their knowledge of advanced multisystem life support as well as their leadership skills in patient care, teaching, and research in the subspecialty. These programs must be organized and conducted in a manner that ensures optimum patient care while providing residents with the opportunity to become skilled clinicians, competent teachers, and knowledgeable investigators familiar with and capable of administering a critical care unit. II. Faculty A. Pediatric Critical Care Medicine Specialists To ensure the educational and research quality of the program, and to provide adequate supervision of residents, there must be at least four members of the teaching staff who have knowledge of and experience in the care of acute pediatric illness and injuries. Two of these must be certified in pediatric critical care medicine or have equivalent qualifications in pediatric critical care medicine. B. Other Physician Teaching and Consultant Faculty An accredited program also is required to have consultants in each of the following: 1. Pediatric cardiology 2. Pediatric pulmonology 3. Neonatology 4. Pediatric gastroenterology
  2. 2. Program Requirements for Residency Education in Pediatric Critical Care Medicine 2 5. Pediatric infectious diseases 6. Pediatric nephrology 7. Pediatric neurology 8. Pediatric hematology/oncology 9. Pediatric surgery 10. Pediatric cardiovascular surgery C. Other Professional Personnel The following other personnel are essential contributors to a program in that they enhance the subspecialty resident's understanding of the multidisciplinary nature of pediatric intensive care: respiratory therapy staff, critical care nursing staff, social workers and support staff, pediatric nutritionist, pediatric pharmacist, physical and occupational therapist, child life therapist, and speech therapist. The presence of a bioengineer, statistician and/or epidemiologist, and an ethicist is highly desirable. III. Facilities/Resources At the primary teaching site there must be a specially designed pediatric critical care unit in which the program is based. Facilities and equipment in and related to that unit must meet the generally accepted standards of modern intensive care units and must be available on a 24-hour-a-day basis. These must include but are not limited to the following: • Microchemistry laboratory • Blood gas laboratory • Hematology laboratory • Diagnostic bacteriology and virology laboratories • Blood bank • Facilities for special radiographic imaging including computerized axial tomography, radionuclide scanning, angiography, magnetic resonance imaging, and ultrasonography • Cardiac catheterization facility
  3. 3. Program Requirements for Residency Education in Pediatric Critical Care Medicine 3 • Pulmonary function testing laboratory • Capabilities for portable use, including radiology and echocardiography • Screening laboratory for inborn errors of metabolism In addition, access to the following should be available within a reasonable period of time at the primary teaching site or nearby: • Clinical toxicology laboratory • Nuclear medicine facilities IV. Educational Program A. Clinical Experience The subspecialty residents must have the opportunity to acquire the knowledge and skills required to diagnose and manage patients with acute life-threatening problems. This must include but not be limited to the development of special competence in such areas as cardiopulmonary resuscitation; stabilization for transport; trauma; triage; ventilatory, circulatory, and neurologic support; management of renal and hepatic failure, poisoning, and complicated hematological, infectious, and immune problems; continuous monitoring; and nutritional support. Though clinical training in pediatric critical care medicine must include direct patient care responsibilities, a graduated experience also must enable the subspecialty resident to assume supervisory and teaching roles. B. Patient Population An adequate number and variety of pediatric ICU patients must be available to enable the subspecialty resident to develop competence in the management of such patients, including those requiring preoperative and postoperative care. In the case of a patient on the surgical service, the pediatric critical care resident should collaborate with the surgeon managing the care of the patient. To meet the educational objectives of an accredited program, the average daily census in the ICU should be at least six patients per pediatric critical care resident assigned to the service. The pediatric patients available to the residents should include patients with solid organ transplantations, at least 50 cases per year of patients who have sustained severe trauma, at least 100 cases per year of patients
  4. 4. Program Requirements for Residency Education in Pediatric Critical Care Medicine 4 who have undergone cardiovascular surgery, at least 150 cases per year of patients who have major neurologic or neurosurgical problems. The number of patients requiring mechanical ventilation must be sufficient to provide each resident with adequate opportunity to become skilled in their management. C. Procedural Experience The patients must be sufficiently ill and the cases sufficiently complex that adequate opportunities exist for residents to become proficient in critical care procedures. These include but are not limited to peripheral arterial and venous catheterization, central venous catheterization, endotracheal intubation, thoracostomy tube placement, and sedation of conscious patients. Furthermore, there should be sufficient exposure to the use of pulmonary artery catheters and intracranial monitoring to ensure understanding of their uses and limitations. The program director must monitor and document the development of clinical competence in the performance of necessary procedural skills. D. Curriculum: The curriculum should include instruction in collation and critical interpretation of patient care data. Interpretation of laboratory studies essential to the care of the critically ill pediatric patient also must be included. The program must teach pharmacologic principles and provide opportunity for the subspecialty residents to apply them to the critically ill patient. Instruction in biomedical instrumentation must be offered to familiarize the resident with current and developing technology. Subspecialty residents must participate in regularly scheduled multi- disciplinary conferences such as morbidity and mortality review and case conferences. E. Other Critical Care Unit Experiences Some of the residents’ clinical experience may take place in other critical care settings, for example, with anesthesiologists, in a medical intensive care unit (ICU), in a burn unit, in a neonatal ICU, and/or in a surgical ICU. Electives in these units may be included in the clinical experience, but they should not replace time in the pediatric intensive care unit. The time spent in these other critical care settings should be no more than 4 months. ACGME: September, 1999 Effective: July, 2000