Surgical Critical Care Rotations

The SCCF rotates on several surgical and critical care services during their 12-month training. A principal rotation, totaling three months, would be as a member of the Pediatric Surgery/Trauma team at UPMC Children’s Hospital of Pittsburgh (CHP). Additional electives and rotations include the CHP Anesthesia, CICU, NICU, and PICU; UPMC Magee Womans Hospital NICU; UPMC Mercy Hospital Burn Unit; UPMC Presbyterian University Hospital CITCU, Nephrology, and SICU/Trauma. The learning objectives for these rotations include:

Patient Care

The SCCF is responsible for providing administrative leadership and critical care service of the patients during the individual critical care rotations. They are also be responsible for the trauma service while on the Surgical/Trauma service at CHP, including conducting bedside rounds, assigning duties to fellows and physician extenders, coordinating care among multiple physician and ancillary providers. Specific patient care duties include:

1. Directing the care of patients admitted to the trauma surgery service and critically ill pediatric surgical patients.
2. Manage the care of the injured child from initial emergency department resuscitation to ultimate discharge including ICU care and post-discharge planning.
3. Interpret physiologic data in the context of the age of the child.
4. Develop the technical skills necessary to practice pediatric surgical critical care, including, but not limited to: endotracheal intubation, central venous access, arterial access, ECMO cannulation, tube thoracostomy. The fellow should demonstrate proficiency in these procedures across the age spectrum encompassed by the program.
5. The SCCF may participate in the operative management of patients while on the Pediatric Surgery/Trauma rotation.

Medical Knowledge

During the course of the fellowship, the SCCF must attain knowledge regarding critically ill pediatric surgical and trauma patients. This includes, but is not limited to:

1. Hemodynamic monitoring including the use of noninvasive and invasive monitoring devices.
2. Hemodynamic support including the appropriate use of fluids and pharmacologic agents, ventricular assist devices
3. Identify patients who are suffering from shock.
4. Apply the principles of nutritional support and becoming facile with the prescribing of total parenteral nutrition solutions and the various different enteral nutrition formula and delivery systems.
5. Demonstrate understanding of the indications for initiation and the management of renal replacement therapy and plasmaphoresis.
6. Describe the role of infection in critical illness as well as its diagnosis and management in both immunocompetent and immunoincompetent hosts.
7. Explain the role that endocrine and metabolic abnormalities have on the host response to illness, and effectively diagnosis and manage these disorders.
8. Develop an understanding of the indications for transfusion of blood, blood components, and use this knowledge to effectively treat patients with primary or secondary hematologic and coagulation disorders.
9. Describe the diagnostic and therapeutic interventions used to treat illness of multiple organ systems.
10. Discuss the ethical issues surrounding the care and treatment of critically ill neonates, infants, children and adults.

Practice-Based Learning

Practice-based learning is the basis for life-long learning habits. The SCCF must actively participate in the evaluation of their patient care skills, as well as appraise and assimilate the evidence from the surgical literature. They must also have an important role as teachers on the service.

Interpersonal and Communication Skills

It is imperative that the SCCF demonstrate competency in communication and in teamwork. The SCCF must work with members of the patient’s primary service to insure the smooth functioning of the patient care team. It is expected that the resident: effectively interact with colleagues in allied disciplines, demonstrate effective and compassionate communication skills with parents, and age appropriate methods of communicating with children, actively participate in the teaching and supervising of junior house staff, provide timely and accurate documentation of the plan of care through the medical record.

Professionalism

The surgical critical care fellow is a leader in care delivery to critically ill children with surgical disease. It is therefore imperative that the surgical critical care fellow develop strong skills in professionalism. These are manifested by a demonstration of a commitment to patient care, an adherence to the policies that regulate the medical environment, both from health care regulatory agencies and the ACGME, and sensitivity to issues of race, gender, and culture as they relate to medical practice. As the fellow progresses through the program, there is an increasing emphasis on administrative activities, such as team leadership and conference preparation.

Systems-Based Practice

Surgical critical care is a sub-specialty in both pediatric and adult health care systems. It is, therefore, required that the SCCF learn the tools required to effectively function in this environment. They need to be able to demonstrate effective coordination of patient care, considerations of cost-containment, risk-benefit analysis, patient advocacy, inter-professional teamwork, and develop administrative experience by participating in multi- disciplinary conferences such as Medical Advisory Committee, Trauma Conference, Tumor Board, ECMO Conference, and NICU Committee.

Rotations and Electives on other UPMC Services

The length of these rotations varies from two weeks to two months.

1. UPMC CHP Anesthesia allows the SCCF to gain increased familiarity with airway instrumentation in a controlled environment and to understand the basic principles of anesthesia management.
2. UPMC CHP CICU primary goal is to develop skills necessary for care of patients with congenital cardiac disease, and demonstrate competence in routine and specialized intubation/ventilation techniques and management of pediatric patients with congenital heart disease.
3. UPMC CHP NICU involves management of neonatal and pediatric patients who have undergone major surgery, including those involving general surgical, cardiac, thoracic, neurosurgical, head and neck, orthopedic, organ transplantation, and urologic procedures.
4. UPMC CHP PICU where the primary goal is to develop the skills necessary to care for the critically ill pediatric patient; and demonstrate appropriate evidence based, direct care to pediatric patients with critical illness and injury, including life threatening trauma and multisystem organ failure.
5. Magee of UPMC NICU rotation enables the SCCF to develop necessary skills to care for critically ill, premature infants, including the management of premature neonates.
6. UPMC Mercy Burn Unit will provide an overview of the principles of evaluating burn victims, and rapid diagnosis will be emphasized. Rapid interpretation of clinical findings, laboratory values, and radiologic results will be stressed as important aspects of management.
7. CTICU at UPMC Presbyterian the overall goal is to provide the SCCF with an in-depth understanding of pathophysiology of patients with severe cardiac disease and to develop skills necessary to appropriately diagnose and manage these disorders.
8. Nephrology UPMC Presbyterian rotation should provide the SCCF with the ability to identify, manage and prevent various types of acute kidney injury. The SCCF should be able to diagnose and treat various types and severities of acute kidney injury, and have an understanding of problems that occur with all types of renal replacement therapy.
9. SICU/Trauma at UPMC Presbyterian requires the SCCF to demonstrate evidenced based, direct care to patients with critical illness and injury, including life threatening trauma and multisystem organ failure.

For additional information, please visit www.chp.edu/our-services/surgery-pediatric