1. health and fitness
2. disease

Assessment for subspecialty training in
Paediatric Intensive Care Medicine
The Intercollegiate Committee for Training in
Paediatric Intensive Care Medicine
January 2009
Contents
Introduction ............................................................................................................................................ 5
Schedule of Assessments for PICM training ........................................................................................... 6
Notes on assessment tools ............................................................................................................. 7
Annual National review .................................................................................................................. 8
The Syllabus ............................................................................................................................................ 9
1. RESUSCITATION AND INITIAL STABILISATION ................................................................................. 9
Knowledge....................................................................................................................................... 9
Skills................................................................................................................................................. 9
Attitudes and behaviour ............................................................................................................... 10
Workplace training objectives ...................................................................................................... 10
2. CLINICAL ASSESSMENT.................................................................................................................. 10
Knowledge..................................................................................................................................... 10
Skills............................................................................................................................................... 11
Attitudes & behaviour................................................................................................................... 11
Workplace training objectives ...................................................................................................... 11
3. INVESTIGATION, DATA INTERPRETATION AND DIAGNOSIS .......................................................... 11
Knowledge..................................................................................................................................... 11
Skills............................................................................................................................................... 12
Attitudes & behaviour................................................................................................................... 12
Workplace training objectives ...................................................................................................... 12
4. ORGAN SYSTEM SUPPORT AND RELATED PRACTICAL PROCEDURES ........................................... 13
Knowledge..................................................................................................................................... 13
Skills............................................................................................................................................... 14
Attitudes & behaviour................................................................................................................... 14
Workplace training objectives ...................................................................................................... 14
5. MONITORING AND CLINICAL MEASUREMENT ............................................................................. 15
Knowledge..................................................................................................................................... 15
Skills: Safe use of, and interpretation of data from: ..................................................................... 15
Attitudes & behaviour................................................................................................................... 16
Workplace training objectives ...................................................................................................... 16
6. SAFE USE OF EQUIPMENT ............................................................................................................. 17
Knowledge..................................................................................................................................... 17
Skills............................................................................................................................................... 17
2
Attitudes & behaviour................................................................................................................... 17
Workplace training objectives ...................................................................................................... 17
7. SPECIFIC CIRCUMSTANCES ............................................................................................................ 18
7a GENERAL PAEDIATRIC CONDITIONS............................................................................................. 18
Knowledge..................................................................................................................................... 18
Skills............................................................................................................................................... 20
Attitudes & behaviour................................................................................................................... 20
Workplace training objectives ...................................................................................................... 20
7b ANAESTHESIA, ANALGESIA AND AIRWAY MANAGEMENT .......................................................... 21
Knowledge..................................................................................................................................... 23
Skills............................................................................................................................................... 24
Attitudes & behaviour................................................................................................................... 24
Workplace training objectives ...................................................................................................... 24
7c CARE OF THE NEWBORN .............................................................................................................. 21
Knowledge..................................................................................................................................... 23
Skills............................................................................................................................................... 24
Attitudes & behaviour................................................................................................................... 24
Workplace training objectives ...................................................................................................... 24
7d PERIOPERATIVE CARE................................................................................................................... 21
Knowledge..................................................................................................................................... 23
Skills............................................................................................................................................... 24
Attitudes & behaviour................................................................................................................... 24
Workplace training objectives ...................................................................................................... 24
7e TRAUMA AND BURNS .................................................................................................................. 24
Knowledge..................................................................................................................................... 24
Skills............................................................................................................................................... 25
Attitudes & behaviour................................................................................................................... 25
Workplace training objectives ...................................................................................................... 25
7f TRANSPORT CARE ......................................................................................................................... 26
Knowledge..................................................................................................................................... 26
Skills............................................................................................................................................... 26
Attitudes & behaviour................................................................................................................... 26
Workplace training objectives ...................................................................................................... 26
7g CHILD PROTECTION ...................................................................................................................... 26
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Knowledge..................................................................................................................................... 26
Skills............................................................................................................................................... 26
Attitudes & behaviour................................................................................................................... 26
Workplace training objectives ...................................................................................................... 26
7h SEPSIS AND INFECTION CONTROL................................................................................................ 28
Knowledge..................................................................................................................................... 28
Skills............................................................................................................................................... 28
Attitudes & behaviour................................................................................................................... 28
Workplace training objectives ...................................................................................................... 28
7i COMPASSIONATE AND FAMILY ORIENTATED CARE ..................................................................... 29
Knowledge..................................................................................................................................... 29
Skills............................................................................................................................................... 29
Attitudes & behaviour................................................................................................................... 29
Workplace training objectives ...................................................................................................... 29
8. PRE- AND POST-ICU CARE ............................................................................................................. 30
Knowledge..................................................................................................................................... 30
Skills............................................................................................................................................... 30
Attitudes & behaviour................................................................................................................... 30
Workplace training objectives ...................................................................................................... 30
9. END OF LIFE CARE ............................................................................................................................. 31
Knowledge..................................................................................................................................... 31
Skills............................................................................................................................................... 31
Attitudes & behaviour................................................................................................................... 31
Workplace training objectives ...................................................................................................... 31
10. PROFESSIONALISM ..................................................................................................................... 32
Knowledge..................................................................................................................................... 32
Skills............................................................................................................................................... 32
Attitudes & behaviour................................................................................................................... 32
Workplace training objectives ...................................................................................................... 32
4
Introduction
This document sets out the workplace based assessment requirements for Paediatric Intensive Care
Medicine (PICM). Training in PICM may be undertaken by a trainee from a background in
paediatrics, anaesthesia or surgery. This document does not address the assessment of the specialty
of primary appointment since this is properly the business of that specialty. For trainees from a
background of paediatrics the contents of this document should be considered alongside the RCPCH
document ‘A Framework of Competencies for Level 3 Training in Paediatric Intensive Care Medicine’.
The document comprises two sections:
1. The schedule of assessments
2. The syllabus, divided into ten parts, and related to the domains of good medical practice
(below), with an indication of the assessment modalities appropriate for the testing of each
item.
It is envisaged that the items listed under ‘workplace training objectives’ will be used to help the
trainee and trainer select appropriate competencies to be evaluated using CbD, mini-CEX, DOPS and
other relevant assessment tools.
Domains of Good Medical Practice
1. Good clinical care
2. Maintaining good medical practice
3. Teaching and training, appraising and assessing
4. Relationships with patients
5. Working with colleagues
6. Probity
7. Health
5
Schedule of Assessments for PICM training (RCPCH level 3)
Assessment year
Basic level
Advanced level
Year 3 (ST8)
Year 1 (ST6)
Year 2 (ST7)
- if required
Mini CeX
4
4*
(4)
CbD
4
4
(4)
1 – which can be
1 – which can be
undertaken at national
undertaken at national
review
review
MSF (eSPRAT)
1
1
DOPS
1 satisfactory assessment for each procedure
CbD
(external )
Letter writing (eg SAIL)
Parent assessment
(SHEFFPAT)
(1)
(1)
2 letters (eg PICU discharge,bereavement follow up, referral to
specialist or Coroner)
1 assessment
Logbook review
1
1
(1)
Portfolio review
1
1
(1)
Structured trainers report
1
1
(1)
Expanded case summaries
5
National Review
1
5 - to include one
clinical guideline
1
(1)
* to include assessments that assess competence to a) lead a PICU ward round and b) co-ordinate all
patient care in PICU (‘acting consultant’ but with Consultant support)
The above represents the minimum number of assessments to be undertaken.
Notes on assessment tools
6
CbD: Case-based Discussion - an instrument to review patient management based on a case.
To include: a range of cases to represent the PIC curriculum such as acute respiratory failure, septic
shock, congenital heart disease, trauma, metabolic disease, the immunosuppressed patient, coma,
neonatal surgery
DOPS: Directly Observed Practical Procedures - an instrument to assess competence in practical
procedures.
To include: Endotracheal intubation, arterial line insertion, central venous line insertion, chest drain
insertion, tracheostomy tube change, use of anaesthetic machine / inhalational anaesthetic, rapid
sequence induction of anaesthesia, use of ultrasound (eg for line insertion, assessment of pleural
effusion)
MiniCeX: Mini-Clinical Evaluation exercise - an instrument to assess a clinical encounter.
To include: clinical encounters on PICU, on the referring ward and Emergency Department, and on
retrieval. Senior trainees (year 2) should be specifically assessed a) leading a PICU ward round and b)
co-ordinating all patient care across the PICU (‘acting consultant’ but with consultant support).
Multi Source Feedback (MSF): A tool used to gather performance information about a single
individual from a number of sources. E-SPRAT is an example of a MSF tool.
SAIL: Sheffield Instrument for Letters - an instrument to review quality of letter writing.
To include: discharge letters, or referral letter to Coroner or another specialist, or clinic letters.
SHEFFPAT: Sheffield Parent Assessment Tool - an instrument giving feedback from parents on
doctors’ performance.
Structured trainer’s report: educational supervisor’s structured report commenting on trainee’s
performance with regards good medical practice, maintaining good medical practice, professional
and clinical relationships, communication, ethical and legal knowledge. Importantly this will include
an assessment of whether the trainee should progress from the Basic level (Year 1) to the Advanced
level (Year 2) of training, and whether the Advanced level trainee has acquired the necessary
competencies to be signed off as a Paediatric Intensivist.
Annual National Review Process
In addition to the local deanery annual review (at which the trainee’s ARCP is completed) there will
be a national Paediatric Intensive Care Medicine annual review towards the end of each training
year.
7
The annual review will be carried out by members of ICTPICM and the RCPCH PICM CSAC for the
specialty. The purpose of this is to allow the Colleges to ensure standards and monitor consistency
across the national centres that offer training in this sub-speciality. A calibration exercise will also be
undertaken to assess the level of agreement between the trainee assessment undertaken locally and
fed into their ARCP, and this independent assessment of all trainees. In future it is envisaged that the
outcome of the national review process could be fed back to inform the ARCP process if it is shown
to provide additional benefit.
The annual review will involve:
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Review of trainee’s portfolio, and expanded case summaries
Review of trainee logbook (procedures, retrievals)
Reflective summary by trainee on their subspecialty training in paediatric intensive care
medicine
Report from trainee’s supervisor
Trainee presentation of a topic with critical appraisal of the relevant literature (end of year
1) and presentation of a clinical guideline developed by the trainee (end of year 2)
Assessments outlined above (per year)
8
The Syllabus
Case Based Discussion
Multi-source
Feedback
GMP domain tested
sustaining, or at risk of, cardiopulmonary arrest or other life-threatening disturbances in acute physiology.
They would all be expected to have APLS provider certification.
Mini Clinical
Evaluation Exercise
Overview: All intensive care trainees must be able to recognise, resuscitate and stabilise patients
Direct Observation of
Procedural Skills
1. RESUSCITATION AND INITIAL STABILISATION
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1,6
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Knowledge
Identification of the patient at risk of critical illness including cardiopulmonary arrest
Immediate management of common emergencies (asthma, respiratory failure, DKA, septic shock,
ventricular failure, haemorrhage, trauma)
Understand common causes for admission to intensive and high dependency care
Triage and management of competing priorities
Methods of maintaining a clear airway
Indications for and methods of tracheal intubation
Appropriate use of drugs to facilitate airway control
Selection of tube type (oral, nasal, cuffed / uncuffed), diameter and length
Management of difficult intubation and failed intubation
Methods of confirming correct placement of the endotracheal tube
Insertion and use of oral airways, face masks and laryngeal mask airway
Causes of regurgitation and vomiting; prevention and management of pulmonary aspiration
Cricoid pressure
Airway management in special circumstances, (head injury, full stomach, upper airway obstruction, shock)
Indications for and methods of ventilatory support
Recognition and emergency treatment of life-threatening disorders of cardiac rhythm
External cardiac massage
Drugs: pharmacology and dosages of hypnotics, analgesics and relaxants
Side effects of drugs used and their interactions
Monitoring during sedation/induction of anaesthesia for endotracheal intubation
Recognition and management of anaphylactic and anaphylactoid reactions
Recognition and management of inadvertent intra-arterial injection of harmful substances
Problems of the obese or immobilised patient
Methods of securing adequate vascular access rapidly
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Skills
Life support skills to APLS provider level
Airway assessment and optimising the patient’s position for airway management
Airway management with mask and oral/nasal airways
Support of ventilation using bag and mask
Introduction and checking correct placement of laryngeal mask airway.
Appropriate choice and insertion of oral endotracheal tubes
Endotracheal intubation
Use of gum elastic bougie and stilette
Identifying correct/incorrect placement of tube (oesophagus, right main bronchus)
Interpretation of capnograph trace
Failed intubation drill
Rapid sequence induction/cricoid pressure
External cardiac massage
Percutaneous pericardial aspiration (emergency)
Obtaining vascular access sufficient to manage acute haemorrhage
Fluid resuscitation and initial management of shock, including use of drugs
Use of emergency monitoring equipment
Safety checking of resuscitation equipment (see equipment section)
Management and avoidance of cardiovascular and respiratory changes during and after intubation
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Case Based Discussion
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GMP domain tested
Mini Clinical
Evaluation Exercise
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Multi-source
Feedback
Direct Observation of
Procedural Skills
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1
5
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1
1
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Attitudes and behaviour
Safety first and knowing limitations
Always knowing the location of senior assistance
Being clear in explanations to patient, family and staff
Being reassuring to patients and relatives
Consideration of ethical issues: patient autonomy, appropriateness of ICU admission.
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Workplace training objectives
Possession of current APLS certification
Describe risk factors for, and methods of prevention of, cardiopulmonary arrest
Demonstrate control of airway with bag and mask
Demonstrate and confirm the correct placement of an orotracheal tube (Grade I-II)
Describe failed intubation drill
Demonstrate methods for preventing aspiration of gastric contents
Safe management of patient with difficult airway or shock
Identify need for surgical assessment of acute abdominal problems or occult bleeding
Initial management of common medical emergencies (see Medical Conditions)
Practical management of triage: competing priorities for admission
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Multi-source Feedback
Case Based Discussion
patients outside the PICU before admission or after discharge, and in the day-to-day review of the longer
stay PICU patient.
Direct Observation of
Procedural Skills
Overview: Clinical skills are important in managing critically ill patients, particularly when assessing
Mini Clinical Evaluation
Exercise
2. CLINICAL ASSESSMENT
Knowledge
Importance of clinical history in making diagnosis
Relevance of prior health status in determining risk of critical illness and outcomes
Understanding of the impact of drug therapy on organ-system function
Physical signs associated with critical illness
The inflammatory response in relation to organ-system dysfunction
Infection and its relation to the inflammatory response
Methods of obtaining clinical information
Relative importance and interpretation of clinical signs
Pathogenesis of multiple organ dysfunction
Principles of prevention of multiple organ failure
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1,4
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GMP domain tested
Multi-source Feedback
Case Based Discussion
Mini Clinical Evaluation
Exercise
Direct Observation of
Procedural Skills
Skills
Obtain an accurate history of the current condition, co-morbidities and previous health status using
appropriate sources of information
Elicit and interpret symptoms and signs on clinical examination
Examination and care of the unconscious or confused patient
Obtain and interpret information from case records, charts and ICU chart
Document information in the case record in a structured and accessible manner
Link clinical with laboratory information to form a diagnosis
Establish a management plan
Recognition of impending organ system dysfunction
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Attitudes & behaviour
Manage patient and family in a compassionate and considerate manner
Communicate effectively with other health care professionals to obtain accurate information and plan care
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4
1,5
Workplace training objectives
Demonstrate ability to elicit history and clinical signs
Identify key points in the care of the unconscious patient
Integrate information from the ward or ICU charts
Present clinical cases accurately and concisely
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3. INVESTIGATION, DATA INTERPRETATION AND DIAGNOSIS
GMP domain tested
Multi-source Feedback
Case Based Discussion
Mini Clinical Evaluation
Exercise
on technology and organ system support that it is easy to forget the fundamental importance of making
a diagnosis, and how difficult that can be. PICU trainees should be able to integrate clinical with
laboratory information in order to diagnose the more common conditions encountered in intensive care,
and to correct acute and life-threatening complications.
Direct Observation of
Procedural Skills
Overview: Diagnostic accuracy determines therapeutic specificity. Intensive care focuses so greatly
Knowledge
Appropriate use of laboratory tests to confirm or refute a clinical diagnosis
Advantages and disadvantages of laboratory tests
Indications for, and basic interpretation of:
Electrocardiographs of common congenital heart defects, dysrhythmias, ischaemia/ infarction,
pulmonary hypertension/embolism, pericarditis, LVH
Echocardiography
Ultrasound examination
Cardiovascular physiological variables
Fluid balance charts
Blood gas measurement
Respiratory function tests
Chest radiographs: collapse, consolidation, infiltrates (including ALI/ARDS), pneumothorax, pleural
effusion, pericardial effusion etc
X-rays of long bone, skull, vertebral and rib fractures
CT and MRI scans of head : fractures/ haemorrhage /oedema / infarction
Neck and thoracic inlet films
X-rays of abdomen: fluid levels / free air / intramural gas
Microbiology: types of organisms; colonisation vs infection; appropriate antibiotic use
Haematology: coagulation and sickle tests, blood group and X-matching
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GMP domain tested
Multi-source Feedback
Case Based Discussion
Mini Clinical Evaluation
Exercise
Direct Observation of
Procedural Skills
Knowledge (cont)
Urea, creatinine, electrolytes (Na, K, Ca, Mg)
Liver function tests
Drug levels in blood or plasma
Endocrine function: diabetes, thyroid disorders, adrenal failure
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Metabolic tests to investigate common inborn errors of metabolism
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Skills
Non-bronchoscopic broncho-alveolar lavage in an intubated patient
Diagnostic bronchoscopy in an intubated patient
Lumbar puncture and CSF sampling
Link clinical with laboratory information to form a diagnosis
Establish a management plan based on clinical and laboratory information
Document results of laboratory tests
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Attitudes & behaviour
Communicate and collaborate effectively with all laboratory staff
Avoid unnecessary tests
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Workplace training objectives
Justify use of particular laboratory tests
Interpret results of laboratory tests
Interpret microbiology laboratory results in relation to patient's condition and environment
Demonstrate ability to refine differential diagnoses using appropriate investigations
Non bronchoscopic broncho-alveolar lavage in an intubated patient
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4. ORGAN SYSTEM SUPPORT AND RELATED PRACTICAL PROCEDURES
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GMP domain tested
Case Based Discussion
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Multi-source Feedback
Mini Clinical Evaluation
Exercise
clinical practice. Organ system support is not just equipment: it also includes drugs and the coordinated provision of multidisciplinary care. PICU trainees must be able to provide emergency
resuscitation, and know the principles of management of commonly used modalities of organ
system support. No practitioner of whatever grade should undertake an elective practical
procedure without due consideration for patient safety.
Direct Observation of
Procedural Skills
Overview: Multiple organ failure and multiple organ system support are now a routine part of
Knowledge
Respiratory system
Indications for and methods of tracheal intubation
Appropriate use of drugs to facilitate airway control
Tube types (oral, nasal, tracheostomy etc.), cuffed / uncuffed, diameter and length
Management of difficult intubation and failed intubation
Methods of confirming correct placement of the endotracheal tube
Insertion and use of oral airways, face masks and laryngeal mask airway
Indications for tracheostomy
Management of and complications associated with tracheostomy tubes
Causes of regurgitation and vomiting; prevention and management of pulmonary aspiration
Cricoid pressure: indications and safe provision
Airway management in special circumstances, (head injury, full stomach, upper airway obstruction,
shock, cervical spine injury)
Indications for and methods of mechanical ventilation
Ventilatory modes: VC, PC,, PRVC, SIMV, PS, CPAP, BiPAP etc.; Non-invasive ventilation
Principles of extra-corporeal membrane oxygenation (ECMO)
Detection and management of complications of mechanical ventilation
Detection and management of pneumothorax (simple and tension)
Insertion and safe management of chest drains
Indications and methods of bronchoscopy via an endotracheal tube
Indications and methods of bronchoscopy in a conscious non-intubated patient
Principles of weaning from mechanical ventilation
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Cardiovascular system
Cardiopulmonary resuscitation to APLS provider level
Peripheral and central venous cannulation
Arterial catheterisation
Oesophageal Doppler, transoesophageal echo
Principles of thermodilution measurement of cardiac output
Principles of transvenous cardiac pacing
Use of inotropic, chronotropic, vasodilator and vasoconstrictor drugs
Use of intravenous fluids: crystalloids, colloids, blood and blood products
Principles of intra-aortic counterpulsation balloon pump
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Renal system
Safe urinary catheterisation
Methods of preventing renal failure
Investigation of impaired renal function
Knowledge of nephrotoxic drugs
Adjustment of drug doses in renal impairment/failure
Renal replacement therapies
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Gastrointestinal system and nutrition
Principles of adequate nutrition in the critically ill patient, including vitamins, trace elements,
immunonutrition
Assessment of nutritional status
Selection of enteral or parenteral routes for nutrition
Nasogastric cannulation
Nasojejunal tube insertion
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GMP domain tested
Multi-source Feedback
Case Based Discussion
Mini Clinical Evaluation
Exercise
Direct Observation of
Procedural Skills
Sengstaken, or similar, tube insertion
Principles of support for the failing liver
Prevention of stress ulceration
Techniques for preventing microbial translocation
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Nervous system
Principles of management of closed head injury
Principles of management of raised intracranial pressure
Principles of management of cerebral vasospasm
Indications for and use of information from intracranial pressure monitoring devices
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Musculoskeletal system
Prevention of pressure sores
Principles of management of fluid losses following burns
Short-term complications of fractures
Consequences of muscle wasting
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Sepsis and infection
Requirements for microbiological surveillance and clinical sampling
Relation between laboratory results and the patient's condition
Appropriate use of antibiotics
Proper handling of invasive medical devices
Importance of surveillance to monitor hospital acquired infection rates
Use of care bundles to prevent PICU acquired infections (VAP, CRBSI)
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Skills
Maintenance of a clear airway using bag and mask
Orotracheal intubation
Naso-tracheal intubation
Needle crico-thyoidotomy
Changing an endotracheal tube over a bougie
Changing a tracheostomy tube
Manual bagging and tracheal suction
Institution and maintenance of invasive ventilation in a critically ill patient
Confirmation of adequate oxygenation and control of PaCO2 and pH
Aseptic insertion of a pleural chest drain and connection to a one-way drainage system
Establish peripheral venous access sufficient to manage major haemorrhage
Aseptic insertion of central venous, and arterial catheters
Appropriate use of intravenous fluids
Appropriate use of infused vasoactive drugs
Measurement of cardiac output using thermodilution or oesophageal Doppler
Identification and avoidance of factors contributing to impaired renal function
Urinary catheterisation: male and female
Nasogastric tube placement
Management of cardiorespiratory physiology to minimise rises in intracranial pressure
Recognition and temporary stabilisation of unstable cervical spine
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√
√
1,5
1,5
1,5
1,2
1,5
1,2
1,5
1
1
1,4,5
1,2
1,5
1,2
1,2
1,2
1
1
1
1,2
1,2
√
√
Attitudes & behaviour
Understand importance of ensuring physiological safety as a primary aim
Understand difference between organ system support and specific treatment
Appreciation of importance of timely institution of organ-system support
Call for senior/more experienced help when experiencing difficulties
Consideration of patient comfort in performance of practical procedures
√
√
√
Workplace training objectives
Practical procedures as listed above
√
√
1,2,5
14
GMP domain tested
√
Multi-source Feedback
√
√
√
1,2
1,4,5
1,5
1
1
1
1,4,5
√
√
√
√
√
√
√
Multi-source Feedback
√
√
√
√
√
Case Based Discussion
Mini Clinical Evaluation Exercise
√
√
√
√
Case Based Discussion
Direct Observation of Procedural
Skills
Safe administration of intravenous drugs
Performance of practical procedures with attention to patient comfort
Safe endotracheal intubation
Setting up a ventilator for a new post-operative ICU admission
Setting a ventilator for a patient with ARDS
Constructing a weaning plan
Safe extubation
5. MONITORING AND CLINICAL MEASUREMENT
GMP domain tested
Mini Clinical Evaluation
Exercise
of clinical information. Routinely used methods for obtaining clinical information must be understood
by all trainees.
Direct Observation of
Procedural Skills
Overview: Intensive care is synonymous with close observation, documentation and interpretation
Knowledge
The role of clinical assessment in monitoring
Physical principles underlying use of monitoring devices (see physics and measurement)
Indications for and contraindications to the use of monitoring devices
Interpretation of information from monitoring devices, and identification of common causes of error
Principles of 'minimal monitoring'
Complications associated with monitoring and monitoring devices
Methods for measuring temperature
Methods for assessing pain and sedation
Methods for measuring severity of illness (severity scoring systems)
Methods for severity scoring or case mix adjustment for therapeutic intensity or costs
Glasgow Coma Scale
Drug levels monitoring
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√
√
√
√
√
√
√
√
√
√
√
√
√
√
1
1
1,2
1
1,2
1
1
1
1
1
1
1,5
√
√
√
√
√
√
√
√
√
√
√
√
1
1
1
1
1
1
1
1
1
1
1
1
Skills: Safe use of, and interpretation of data from:
Pulse oximetry
ECG
Non-invasive arterial blood pressure measurement
Invasive arterial blood pressure measurement
Central venous pressure measurement
Oesophageal Doppler
Jugular bulb catheters and SjO2 monitoring
Arterial blood gas sample handling
Inspired and expired gas monitoring for O2, CO2, and NO
Indirect calorimetry
Spirometry and peak flow measurement
Ventilator alarms
√
√
√
√
√
√
√
√
15
GMP domain tested
Multi-source Feedback
Case Based Discussion
Mini Clinical Evaluation
Exercise
Direct Observation of
Procedural Skills
Intracranial pressure monitoring
Nerve stimulator to measure therapeutic neuromuscular block
Clinical assessment of pain
Scoring or scaling systems to assess degree of sedation
Collection of data for severity scoring and case mix adjustment
√
√
√
√
√
√
√
1,2
1
1
1
1
√
√
√
√
√
√
√
√
√
√
√
1,2,3
1,4
1,5
1,2
√
√
√
√
√
√
√
√
√
Attitudes & behaviour
Ensure safe use of monitoring equipment in an appropriate environment
Minimise patient discomfort in relation to monitoring devices
Support other staff in the correct use of devices
Review regularly the need for continued monitoring
√
Workplace training objectives
Identify an appropriate level of monitoring in relation to a patient's condition
Demonstrate safe management of invasive monitoring devices
Set up flush system and transducer for intra-arterial pressure measurement
Correctly interpret data from clinical measurement in relation to the patient's condition
Resolve apparent contradictions between clinical information vs data from monitors
Correct documentation of Glasgow Coma Scale.
Demonstrate understanding of case mix adjustment methods
√
√
1
1,3
1,3,5
1,3
1,3
1
1,2,3
√
√
√
√
√
16
6. SAFE USE OF EQUIPMENT
Case Based Discussion
√
√
√
1
√
√
√
√
1
1
√
√
√
√
√
√
√
1
1
1
1
1
1
1
1
1
1
1
1
GMP domain tested
Multi-source Feedback
Mini Clinical Evaluation
Exercise
care. Trainees should know the indications, contraindications and safe use of those items of
equipment that they are expected to use, particularly those required for organ system support.
They should also understand some of the physical principles underlying their operation.
Direct Observation of
Procedural Skills
Overview: Proper use of equipment is an essential component in the safe delivery of effective
Knowledge
Airways, tracheal tubes, tracheostomy tubes, emergency airways, laryngeal masks, fixed and
variable performance oxygen therapy equipment and self-inflating bags
Humidification and nebulising devices
Modes of ventilation and method of operation of at least one positive pressure ventilator, one
non-invasive ventilator, and a constant positive airway pressure (CPAP) device
Principles of use of pressure regulators, flowmeters, vaporizers, breathing systems.
Principles of disconnection monitors.
Manufacture, storage and safe use of oxygen, nitric oxide, compressed air and helium.
Pipeline and suction systems, gas cylinders
Non-invasive monitoring devices
Methods for checking ventilator, breathing systems and monitoring apparatus
Environmental control of temperature, humidity, air changes and scavenging systems for waste
gases and vapours
Sterilisation and cleaning of equipment.
Electrical safety
Characteristics and safe use of vascular access cannulae, spinal needles, epidural catheters, chest
drains
Function and use of defibrillator and other resuscitation equipment
Function and use of continuous haemodiafiltration devices
√
√
√
√
√
√
√
√
√
√
√
√
Skills
Checking and setting the ventilator
Checking pipelines, checking and changing cylinders
Connecting and checking breathing systems
Setting alarm limits for monitoring equipment
Identifying and correcting ventilator mis-assembly and disconnections
Collecting data from monitors
Record keeping
Checking, assembling resuscitation equipment
Safe defibrillation
Preparing equipment for:
difficult and failed intubation
paediatric intubation set
aseptic vascular access
intravascular pressure monitoring
Choosing appropriate fluid balances using renal replacement therapies
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√
√
√
√
√
√
√
√
1
1
1
1
1
1
1
1
1
√
√
√
√
1
1
1
1
1
√
Attitudes & behaviour
Shared responsibility for equipment with nursing and technical staff
Determination to maximise safety
Rapid response to acute changes in monitored variables
√
√
√
1,5
1,6
1
Workplace training objectives
Set up a ventilator for a new post-operative ICU admission
Set a ventilator for a patient with ARDS
Assemble and check breathing systems
Decide when additional monitoring (e.g. CVP, arterial line) is needed
Set up and check monitoring equipment and alarm limits
Check resuscitation equipment
Document equipment settings
√
√
√
√
√
√
√
1
1
1
1
1
1
1
17
7. SPECIFIC CIRCUMSTANCES
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
GMP domain tested
Case-based discussion


Multi-source feedback
Mini clinical evaluation
exercise
Direct observation of
procedural skills
7a GENERAL PAEDIATRIC CONDITIONS


1
1
1
1
Knowledge
Respiratory
Clinical features associated with respiratory compromise and specific conditions
Investigations commonly used to diagnose and quantify disease severity
Management of the unprotected airway
Common acute respiratory conditions: pneumonia, collapse or consolidation, asthma,
bronchiolitis, pulmonary oedema, pulmonary infiltrates including acute lung injury and the acute
respiratory distress syndrome and causative factors; pleural effusion, pneumothorax upper and
lower airway obstruction - recognition and management


Cardiovascular

Clinical features of cardiovascular compromise and specific conditions
Investigations commonly used to diagnose and quantify disease severity
Hypotension and hypertension- mechanisms of shock (cardiogenic, hypovolaemic, distributive,
obstructive); malignant hypertension
Congenital heart defects- types and management
1
1

Multi-source feedback
GMP domain tested

1
1
Case-based discussion
Mini clinical evaluation
exercise

Direct observation of
procedural skills
Heart failure- left ventricular failure; right ventricular failure; cor pulmonale; cardiomyopathies;
myocarditis, cardiac tamponade
Arrhythmias- atrial tachycardias, ventricular tachycardias, conduction disturbances, atrial and
ventricular fibrillation, pacing box failure
Pulmonary conditions- pulmonary hypertension; pulmonary embolus
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1

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1
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1
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1
1
1
1
Renal and genito-urinary
Acute renal failure- causes and clinical features of; treatment of
Causes of chronic renal failure
Renal manifestations of systemic disease- e.g vasculitides, nephrotoxic drugs
Urosepsis
Gastrointestinal
Causes of abdominal pain and distension;
Upper and lower GI haemorrhage- peptic ulceration/erosion, varices;




1
1
18



Diarrhoea and vomiting- causes, investigation and management of
Pancreatitis- diagnosis and scoring systems, management of, complications.
Causes of jaundice- causes of cholestasis, hepatitis, fulminant hepatic failure; paracetamol
(acetaminophen)-induced liver injury
1
1
1
Neurological
Causes of confusion and coma- post-anoxic brain damage; drugs and metabolites, electrolyte,
metabolic and endocrine abnormalities
Intracranial lesions and infection- Intracranial haemorrhage and infarction; meningitis and
encephalitis; medical causes of raised intracranial pressure
Convulsions and status epilepticus- Causes and management of
Raised intracranial pressure- medical and surgical causes of; monitoring and management of
Neuro-myopathies- e.g.: Guillain-Barre, myasthenia gravis, malignant hyperpyrexia causing
respiratory difficulty; critical illness polyneuropathy, motor neuropathy, and myopathy
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
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1
1
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1
1
1
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1
1
1

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1
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1
Sepsis and Infection
Pyrexia and hypothermia; patients at risk of infection
Hospital acquired infections and infection control methods
Organ-specific signs of infection including haematogenous (venous catheter-related,
endocarditis, meningococcal disease), urological, pulmonary, abdominal (peritonitis, diarrhoea),
skeletal (septic arthritis) and neurological
Organisms causing specific infections: Gram positive and Gram negative bacteria, fungi, protozoa
(e.g. malaria), viruses (e.g. influenza, RSV, Hepatitis A, B and C, HIV, CMV)
Use of antibiotics, drug monitoring and specific complications and side effects
Haematology and Oncology
The immunosuppressed or immunoincompetent patient; agranulocytosis and bone marrow
transplant patients; cytotoxic therapy
Severe anaemia; major blood transfusion; coagulation disorders; haemoglobinopathies


1

1
19
Case-based discussion
Multi-source feedback
GMP domain tested
Mini clinical evaluation
exercise
Direct observation of
procedural skills



1
1
Metabolic, hormonal and toxicology
Diabetes; over- and under-activity of thyroid, adrenal and pituitary glands; electrolyte disorders.
General principles of the treatment of poisoning, and the specific management of poisoning with
aspirin, paracetamol/acetaminophen, paraquat, carbon monoxide, alcohol, tricyclic and other
antidepressants
Common metabolic disorders: organic acidaemias, fatty acid oxidation defects, urea cycle
disorders, glycogen storage diseases

1
Skills
Develop a limited differential diagnosis based on presenting clinical features
Develop a differential diagnosis to include less common or rare conditions
Recognise that diverse diseases share limited forms of acute physiological expression
Identify and integrate co-morbid diseases with the acute condition
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1, 2
1
1
1

1,2,5


1
1
1,6
1,5,6
Attitudes & behaviour
Communicate effectively to establish care plan with admitting clinicians, nursing staff and other
professionals, and with relatives and patient where appropriate

Workplace training objectives
Learn treatment algorithms for treatment of common medical emergencies
Integrate long-term and chronic treatment with the acute care process
Able to recognise when senior / more experienced advice and help is required
Recognise and manage medical emergencies until senior or more experienced assistance is
available
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
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20
Case-based discussion
Multi-source feedback
GMP domain tested
Mini clinical evaluation
exercise
Overview: By the end of training PICU trainees must be proficient in the use
of a number of different anaesthetic agents, sedatives, muscle relaxants and
analgesia, and have acquired expert airway skills. This will require a formal
period of training in anaesthesia for those from backgrounds in paediatrics or
surgery.
Direct observation of
procedural skills
7b ANAESTHESIA, ANALGESIA AND AIRWAY MANAGEMENT
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1
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1
1
1
1
1
1
1
1
1
1
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1
1
1
1
1
1
1
1
1
1
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1
1
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1
1,5

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1
1
1
1,6

1
1
1
Knowledge
The pharmacology of commonly used anaesthetic agents, sedatives, analgesics and muscle
relaxants
Know the indications for their use and side effect profiles
Know the principles of inhalational anaesthesia
Know the AAGBI minimum standards for monitoring
Know the indications for a rapid sequence induction
Know the patient factors that increase risk of anaesthesia
Understand the effect of different anaesthetic agents on intracranial pressure
Understands the importance of the pre-operative assessment
Understands the ASA classification
Knowledge of fasting periods in relation to the urgency of surgery / intervention
Knowledge of regional analgesia (e.g.epidurals) and anticipated side-effects/complications
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
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

Skills
Recognise the child who requires airway intervention and ventilation
Be able to perform a rapid sequence induction
Be able to perform an inhalational anaesthetic
Be able to check an anaesthetic machine and adjunct equipment
Be able to manage the airway expertly
Be able to monitor a child for level of anaesthesia and degree of muscle relaxation
Be able to plan for a difficult or failed intubation
Be able to safely anaesthetise an ASA I or II patient independently
Recognise the child with cardiovascular compromise and tailor the anaesthetic accordingly
Be able to employ appropriate airway techniques, including laryngeal mask airway (LMA),
bag/mask and endotracheal intubation
Be able to undertake a pre-operative assessment, including ASA status
Keep an appropriate and legible anaesthetic record
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
Attitudes & behaviour
Recognise when expert assistance is needed
Recognise the importance of the others members of the team in administering a safe
anaesthetic
Workplace training objectives
Be able to undertake a pre-operative assessment, including ASA status
Be able to check an anaesthetic machine and adjunct equipment
Be able to safely anaesthetise an ASA I or II patient independently
Be able to employ appropriate airway techniques, including laryngeal mask airway (LMA),
bag/mask and endotracheal intubation
Be able to perform a rapid sequence induction
Be able to perform an inhalational anaesthetic
Be able to plan for a difficult or failed intubation
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21
GMP domain tested
Multi-source feedback
Case-based discussion
Mini clinical evaluation
exercise
Overview: A significant proportion of PIC activity relates to care of the
neonate. It is essential that PIC trainees acquire competence to look after
this patient group, including care of the pre-term and low birth weight baby.
For trainees from anaesthesia and surgical backgrounds this is likely to
require a formal period of training in NICU.
Direct observation of
procedural skills
7c CARE OF THE NEWBORN
Knowledge


Understand the effects of antenatal and perinatal events on outcome
Know about the complications of prematurity, including the long-term sequelae
Know about retinopathy of prematurity and its prevention and treatment
Know about NEC – risk factors, diagnosis and management
Know about intraventricular haemorrhage, periventricular leucomalacia and post-haemorrhagic
hydrocephalus
Know about infant respiratory distess syndrome
Know the guidelines for surfactant administration
Understand the importance of nutrition and the feeding options in the pre-term
Understand the principles of mechanical ventilation of the pre-term infant
Know about chronic lung disease and its management
Know the safe positions for the placement of umbilical arterial and venous lines
Know about pre- and post-natal genetic testing
Know about maternal risk factors that can effect the infant
Know about neonatal jaundice – causes, monitoring and treatment
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
1
1
1
1
1
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1
1
1
1
1
1
1
1
1
Skills
Be able to safely prescribe for newborn, including pre-term infants
Be able to interpret radiological investigations including cranial ultrasound
Be able to resuscitate the pre-term infant
Be able to intubate the pre-term infant
Be able to insert a percutaneous long line
Be able to recognise serious congenital abnormalities
Be able to manage a newborn baby with jaundice, including the use of phototherapy and
exchange transfusion
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
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
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




1
1
1
1
1
1
1
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1,4
1,4,5
1,4,5
1,4



1
1
1
1
1
Attitudes & behaviour
Be able to communicate honestly and sympathetically with families
Be able to describe the ethical issues relating to care of the pre-term infant
Understand the role of antenatal diagnosis and the role of fetal medicine
Understand the impact on parents of a baby with congenital abnormalities
Workplace training objectives
Be able to resuscitate the pre-term infant
Be able to intubate the pre-term infant
Be able to insert a percutaneous long line
Know about the complications of prematurity
Be able to manage the neonate with jaundice
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22
GMP domain tested
Multi-source feedback
Case-based discussion
admissions, or have surgical problems. Trainees should have a working knowledge of the
problems encountered by surgical patients, and must have experience of the main surgical
specialities such as neonatal, cardiothoracic and neurosurgery.
Direct observation of
procedural skills
Overview: substantial proportions of patients admitted to intensive care are postoperative
Mini clinical evaluation
exercise
7d PERIOPERATIVE CARE
Knowledge
General Considerations
Importance of preoperative health status on postoperative outcomes
Patient factors determining perioperative risk, and methods of optimising high-risk patients
Implications for postoperative care of type of surgery
Implications for postoperative care of type of anaesthesia. Anaesthetic risk factors complicating
recovery: suxamethonium apnoea, anaphylaxis, malignant hyperpyrexia, difficult airway
Dangers of emergency anaesthesia
The interpretation of relevant preoperative investigations
Effect of gastric contents, smoking, and dehydration on perioperative risk
Implications of current drug therapy
Assessment of post-operative analgesic needs
Management of cyanosis, hypo- and hypertension, shivering and stridor
Assessment of pain and methods of pain management
Methods of treating postoperative nausea and vomiting
Causes and management of post-operative confusion
Assessment of appropriate level of postoperative care: ICU, HDU, post-anaesthesia recovery
The importance of consent and the issues surrounding it
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1
1
1
1
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
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
1
1
1
1
1
1
1
1
1
1
1,6




Respiratory
Interpretation of symptoms and signs of respiratory insufficiency in the surgical patient
Common respiratory conditions (see general medical conditions)
Factors affecting patients following thoracotomy, lung resection, cardiac surgery




1,2
1
1




1,2
1
1
Cardiovascular
Interpretation of symptoms and signs of cardiovascular insufficiency in the surgical patient
Operative risk factors in patients with congenital heart disease
Management of patients following cardiac surgery

Renal


Causes of perioperative oliguria and anuria; prevention and management of acute renal failure
Consequences of nephrectomy, renal transplantation

1
1
Gastrointestinal

Interpretation of symptoms and signs of abdominal pathology
Causes of GI haemorrhage; diarrhoea, vomiting, ileus, peritonitis in the surgical patient
Management of patients with intestinal ischaemia; NEC, abdominal tamponade; pancreatitis;
post-liver transplant patient
Perioperative nutrition



1
1
1

1

1
GMP domain tested
Multi-source feedback
Mini clinical evaluation
exercise
Direct observation of
procedural skills
Surgical causes of confusion, coma and raised intracranial pressure. Determinants of cerebral
perfusion and oxygenation; prevention of secondary brain injury
Case-based discussion
Neurological
23
Perioperative management of patients with neuromuscular disease
Intracranial pressure monitoring

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
1
1


1
1
Sepsis and Infection
Wound infections; necrotising fasciitis
Use of prophylactic antibiotics; risk of infection in patients with indwelling medical devices
including intravascular and urethral catheters and heart valves
Haematology and oncology
Care of the immunosuppressed or immunoincompetent patient
Perioperative management of Jehovah’s Witness patients


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
1
1,2


1
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1
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1
1
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1
1
1
Metabolic and hormonal
Perioperative management of patients with known metabolic or endocrine disease
Musculo-skeletal
Trauma patients; pressure area care; compartment syndromes and paralysed patients
Skills
Obtain information from sources other than the patient
Identify airway or intubation difficulties, preoperative health status and intercurrent disease,
medications, allergies, nature of anaesthetic and surgery
Assess conscious level, status of airway and cervical spine, and conduct careful systems review
Determine adequacy and route of administration of analgesia
Document, monitor and manage fluid balance, circulating volume, drains, systemic oxygen
supply
Identify life-threatening cardiorespiratory complications, and manage hypovolaemia
Manage tension pneumothorax, cardiac tamponade


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





1

1
Attitudes & behaviour


Establish a plan for postoperative management
Ensure the necessary resources are available for safe postoperative care
Communicate effectively to establish care plan with anaesthetist, surgeon, nursing staff and
other professionals, and with relatives and patient where appropriate


1
1
1,5





1
1
1
1



1,5,6
1,5,6

1
Workplace training objectives

Background reading on surgical conditions as they present clinically
Gain practical experience of intraoperative management
Accurately assess the airway for potential difficulties with airway management
Interpret pre-operative investigations, intra-operative findings and events, and respond to them
appropriately
Recognise when senior advice or assistance is required
Recognise and manage perioperative emergencies until senior or more experienced assistance is
available
Consider impact of long-term and chronic treatment on acute surgical care


Multi-source feedback



GMP domain tested
Case-based discussion
Direct observation of
procedural skills
Overview: Co-ordinated team care is essential for managing the multiple trauma patient.
Mini clinical evaluation
exercise
7e TRAUMA AND BURNS
Knowledge
Performance and interpretation of the primary and secondary survey
Emergency airway management
Establishing IV access including intraosseous infusion
Immediate specific treatment of life-threatening illness or injury, with special reference to
thoracic and abdominal trauma





1
1
1
1
24
Fat embolism
Recognition and management of hypovolaemic shock
Effects of trauma on gastric emptying
Central venous access: anatomy and techniques
Vascular pressure monitoring
Chest drain insertion
Principles of the management of head injury
Mechanisms and effects of raised intracranial pressure: coup and contra-coup injuries
Methods of preventing the 'secondary insult' to the brain
Management of cervical spine injuries
Soft tissue injury related to fractures
Crush injury and compartment syndromes
Calculation of area burned
Prevention of infection in the burned patient
Detection and management of smoke inhalation or airway compromise
Fluid resuscitation in the burned patient
Consideration of potential child protection issues
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1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Skills
Assessment and immediate stabilisation of the trauma patient: primary survey
Assessment and immediate stabilisation of the trauma patient: secondary survey
Calculation and documentation of Glasgow Coma Scale
Recognition of need for appropriate investigations (Hb, cross-match, chest X-ray, CT scan etc)
Assessment, prediction and management of circulatory shock
Emergency airway management, oxygen therapy and ventilation
Chest drain insertion and management: relief of tension pneumothorax
Cannulation of major vessels for resuscitation and monitoring
Care and immobilisation of cervical spine
Analgesia for the trauma patient
Urinary catheterisation in pelvic trauma
Differentiate and manage tension pneumothorax, cardiac tamponade,
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
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1
1
1
1
1
1
1
1
1
1
1
1
Attitudes & behaviour
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






1
1
1,5
1,5,6
1
1





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1
1
1,6
1
Rapid response and resuscitation
Focus on the ‘golden hour’
Communication with appropriate specialists
Ability to take control when either appropriate or necessary
Insist on stabilisation before transfer
Early planning for rehabilitation
Workplace training objectives
Perform assessment and immediate stabilisation of the traumatised patient
Stabilise a patient’s condition until senior / more experienced help arrives
Know when to get senior or more experienced help
Perform secondary survey and investigation of the traumatised patient
25
7f TRANSPORT CARE
Multi-source feedback
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1
1
1
1
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
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1
1
1
1
1
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1,5
1
1
1,5
1,5
1,5,6
1
1


1


1
GMP domain tested
Case-based discussion

Direct observation of
procedural skills
bedspace, or within hospital for diagnostic radiology or for surgical procedures, or between
hospitals. The principles of safe transfer are the same, regardless of the distance travelled. All
trainees should gain experience in safe transfer. Interhospital transfer in particular requires a
high level of expertise because additional help cannot be obtained if problems occur.
Mini clinical evaluation
exercise
Overview: Critically ill patients are frequently moved, either within the PICU to a different
Knowledge
Principles of safe transfer of patients
Understanding portable monitoring systems
Understand the importance of temperature control in infants
Principles involved with air transport
Skills
Organise a retrieval from referral call to return to PICU
Undertake interhospital transfer of patients requiring ventilatory support alone
Undertake interhospital transfer of patients with single or multiple organ failure
Be able to troubleshoot equipment problems in transit
Minimise the potential risks involved in patient transfer
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
Attitudes & behaviour
Insistence on stabilisation before transfer
Pretransfer checking of kit and personnel
Planning for and prevention of problems during transfer
Communication with referring and receiving institutions and teams
Communication with patient and family
Recognise the need of support from senior / more experienced colleagues
Take on a leadership role in the retrieval team
Understand the need for clear documentation
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Workplace training objectives
Intrahospital transfers of ventilated patients to theatre of for diagnostic procedures (e.g. CT,
MRI)
Interhospital transfers of ventilated patients with or without support of other organ-systems
26
Case-based discussion
Multi-source feedback
GMP domain tested
Mini clinical evaluation
exercise
Overview: all professionals working in PICU must be alert to the
possibility that critical illness or injury can be the result of child abuse.
They must know of local arrangements for child protection issues and
be able to initiate the necessary referrals.
Direct observation of
procedural skills
7g CHILD PROTECTION
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1,5
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1
1,2
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1,4
1
1
1
1
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1
1,4
1,5
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
1
1
Knowledge
Have an understanding of how different disciplines and agencies collaborate over child
protection issues
Be familiar with the different categories of abuse and recognise that they may occur together
Know of local and national guidelines
Skills
Understand the emotional impact of abuse on the child and the family
Keep accurate records of all findings and communications
Record clearly the results of any examination
Recognise features in the presentation where child protection may be an issue
Be able to write, under supervision, police statements and medical reports
Attitudes & behaviour
Understand the need to initiate a safe response where abuse is suspected
Continue to treat the family with respect and courtesy at all times
Communicate effectively with agencies involved in child protection
Workplace training objectives
Have attended a training course in child protection
27
Mini clinical evaluation
exercise
Case-based discussion
Multi-source feedback
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

GMP domain tested
Direct observation of
procedural skills
7h SEPSIS AND INFECTION CONTROL
Overview: The immunoinflammatory response is a fundamental mechanism in disease
processes. Critical illness is frequently attended by excessive activation of the
immunoinflammatory cascade combined with immunoincompetence. Patients are susceptible
to, and are a source of, resistant organisms, and the most common vector between patients is a
member of staff’s hand or clothing. Meticulous hand disinfection is the best method of
preventing cross infection.
Knowledge
Universal precautions and good working practices (hand washing, gloves etc)
Proper handling of medical devices including intravascular devices
Cross infection: modes of transfer and common agents
Autogenous infection: routes and methods of prevention
Emergence of resistant strains
Antibiotic policies in a hospital
Activity of commonly used antibiotics
Common surgical infections: antibiotic choice and prophylaxis
Infections from contaminated blood
Hepatitis and HIV infections: modes of infection: natural history: at risk groups
Immunisation policy
Sterilisation of equipment
Strategy if contaminated
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1,3
1
1
1
1
1,3
1
1
1
1
1,3
1
1,3
Skills
Recognition of at risk groups including the immunocompromised patient
Administration of IV antibiotics: risk of allergy and anaphylaxis
Aseptic techniques
Use of disposable filters and breathing systems
Use of protective clothing/gloves/masks etc
Application of methods for preventing autogenous infection (e.g. body positioning and mouth
hygiene)
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1
1
1
1
1
1
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1,6
1
1,3,6

1,2,3,6
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1
1
Attitudes & behaviour

Every patient entitled to the best care available
Prevention of self-infection
Prevention of cross infection is my responsibility
Workplace training objectives
Demonstrate routine application of skills and attitudes listed above to all patients, particularly
hand washing between patient contacts
Discussion of factors which may limit autogenous infection
Safe use of therapies which modify the inflammatory response
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28
Multi-source feedback
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GMP domain tested
Case-based discussion
Mini clinical evaluation
exercise
Direct observation of
procedural skills
7i COMPASSIONATE AND FAMILY ORIENTATED CARE
Overview: For patients and relatives the ICU is an intimidating environment. Critical illness is
often attended by discomfort and pain, and sometimes by the most extreme distress.
Minimising unpleasant symptoms and delivering care with compassion is an essential duty of all
staff, as is supporting each other during difficult periods.
Knowledge
Causes of, and methods of minimising, distress to patients
Bereavement: anticipating and responding to grief
Methods of measuring depth of sedation
Stress responses
Causes and management of acute delirium
Sleep deprivation and its consequences
Acute pain management, patient-controlled and nurse-controlled analgesia
Indications, contra-indications and complications of commonly used analgesic, hypnotic and
neuromuscular blocking drugs
Pharmacokinetics and dynamics of commonly used analgesic and hypnotic agents, and
neuromuscular blocking drugs in-patients with normal and abnormal organ system function
Indications, contra-indications, methods and complications of regional analgesia in critical illness
Epidural anaesthesia and analgesia
Importance of mouth care
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1
1,2
1
1
1
1
1
1
1
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1
1
1
Skills
Identify and treat causes of distress
Safe use of analgesic, hypnotic and neuromuscular blocking drugs
Management of established epidural analgesia
Minimise complications associated with opioid and non-opioid analgesics
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1,2
1
1
1
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1,6
1,2,5,6
1,2
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1,2
1
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Attitudes & behaviour
Desire to minimise patient distress
Work with nurses and relatives to minimise patient distress
Effective communication with and support of the patient’s family
Workplace training objectives
Demonstrate compassionate care of patients and relatives
Safe use of a range of analgesic, hypnotic and neuromuscular blocking drugs
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29
GMP domain tested
Multi-source feedback
Case-based discussion
Mini clinical evaluation
exercise
Direct observation of
procedural skills
8. PRE- AND POST-ICU CARE
Overview: ‘Outreach’ care is now recognised as an important component of the ‘ICU service
without walls’. It is the responsibility of the ICU staff to help provide safe care to all patients
regardless of environment, within the constraints of available service provision. Early
intervention may reduce cardiopulmonary arrest rates and hence risk of critical illness.
Knowledge
Factors which predispose patients to critical illness, including poor nutrition
Early warning signs of impending critical illness
Knowledge of existing early warning or trigger scoring systems
Methods of optimising high risk surgical patients
Criteria for admission to and discharge from intensive and high dependency (HDU) care units
Risk factors for ICU readmission following discharge to the ward
Tracheostomy care outside the ICU or HDU
Post-ICU mortality rate, and common reasons for death following discharge
Common symptomatology following critical illness
Rehabilitation: physical and psychological
Long-term or home ventilation
Persistent vegetative state
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√
√
√
√
√
√
√
√
√
1
1
1
1
1
1
1
1
1
1
1,4
1,4
Skills
Resuscitation and initial stabilisation (see domain 1)
Recognition and management of risk factors associated with critical illness
Optimisation of high-risk surgical patients before surgery: site of care, management,
communication
Liaison with ward staff to ensure optimal communication and continuing care after ICU
discharge
Timely discussion of ‘do not resuscitate’ orders and treatment limitation decisions
Identification of complications associated with critical illness (e.g. polyneuropathy) and
appropriate referral
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√
√
1
1
1,5
√
√
√
1,5
√
√
√
1,4.5
1
√
√
√
√
1,7
1
1,5
Attitudes & behaviour
Determination to provide best care possible regardless of environment
Follow-up of patients following discharge to the ward
Good communication and relationships with ward staff
Workplace training objectives
Case record analysis of pre-ICU standards of care
Exposure to perioperative management, including intra-operative management (see Domain 7b)
Discussion of criteria for admission to and discharge from ICU & HDU
Taking decisions to admit or discharge patients
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√
√
√
1,2
1
1
1,5
30
Multi-source feedback
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√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
GMP domain tested
Case-based discussion
Mini clinical evaluation
exercise
Direct observation of
procedural skills
9. END-OF-LIFE CARE
Overview: Death is a common event in intensive care. When death is inevitable, a dignified death
is a good outcome. Sustained organ system support of patients who are certain to die is unkind,
unethical, and inappropriate. Withdrawal of support does not mean withdrawal of care, and a well
managed death does much to resolve guilt and unhappiness persisting for years in the surviving
family. Brain death and organ donation must be handled with sensitivity and according to national
guidelines. Post-mortem examination often provides important opportunities for learning.
Knowledge
Basic ethical principles: autonomy, beneficence, non-maleficence, justice
Ethical and legal issues in decision-making for the incompetent patient
Surrogate decision making
Legal and ethical framework for withdrawal of care in children
Advance directives
Difference between consent and assent for treatment and research
Methods for assessing or measuring quality of life
Confidentiality
With-holding and withdrawing treatment: omission and commission
Difference between euthanasia and allowing death to occur
Procedure for withdrawing treatment and support
Attitude of major religions to brain death and organ donation
Preconditions, exclusions and tests for the diagnosis of brain death
Responsibilities and activities of transplant co-ordinators
Management of the organ donor
Completion of death certification
Responsibilities of coroner (procurator fiscal or equivalent), and reasons for referral
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√
√
√
√
1,4,5,6
1,4,5,6
1,4,5,6
1
1,4,5,6
1,4,5,6
1,4,5,6
1,4,5,6
1,4,5,6
1,4,5,6
1,4,5,6
1,4,5,6
1,6
1,5
1
1,4,6
1
Skills
Communicating with relatives
Discussing treatment options with patient and/or family before ICU admission
Communicating with the Coroner
Obtaining consent for treatment, research or post-mortem
Obtaining information on which to make assessments of quality of life
Relieving distress in the dying patient
Implementation of procedure for withdrawing treatment and support
Performance of tests of brain stem function, including preconditions and exclusions
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√
√
√
√
√
√
√
√
√
√
4
4
4
1,4
4
1,4
1,4,5,6
1
Attitudes & behaviour
Respect for the truth
Respect for the expressed wishes of competent patients
Respect for the views and wishes of the patient’s family
Liaison with religious representative
Liaison with transplant co-ordinators
Desire to support patient, family, and other staff members appropriately during treatment withdrawal
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√
√
√
√
√
√
√
√
6
6
6
4
5
6
√
√
√
√
√
√
4
4
1,4,5,6
4
1
1
Workplace training objectives
Attendance at discussions with family about treatment limitation or withdrawal
Involvement in discussions with family about treatment limitation or withdrawal
Management of procedure for withdrawing treatment and support
Obtaining consent/assent for treatment, research or autopsy
Performance of tests of brain stem function, including preconditions and exclusions
Completion of a Coroner referral
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31
Mini clinical evaluation
exercise
Case-based discussion
Multi-source feedback
GMP domain tested
Direct observation of
procedural skills
10. PROFESSIONALISM
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√
√
√
√
√
√
√
1,2
1,2
1,2
1,2,5
1,2
√
√
√
√
√
√
√
√
√
√
2
2
2,5
2,5
2,5
Knowledge
Published standards of care at local, regional and national level
Requirements for training
Local policies and procedures
Methods of audit and translating findings into sustained change in practice
Recent advances in medical research relevant to intensive care
√
Skills
Self-directed learning
Enquiring mind, self-prompted search for knowledge
Proper use of learning aids where available
Contribution to departmental activities
Participation in audit
Participation in educational activities and teaching other groups appropriate to level of
knowledge
Maintenance of education and training record
Understands research methodology
Actively participating in research
√
√
√
2
2
2
Communication
Able to achieve appropriate information transfer
Understands that communication is a two-way process
Calls for senior/more experienced help in difficult situations
Effective multidisciplinary communication and collaborative practice
√
√
√
4,5
4,5
1,5
5
√
√
√
√
√
√
√
1
1,2,3,4,5
5
5
5
1,5
5
5
√
√
√
√
√
√
√
√
4
4,6
6,7
5
5
1,5
4,5
4,5
√
Organisation and management
Structured approach to developing individual patient care plans
Effective member of the ICU team
Effective leadership of ICU team
Organise multidisciplinary care for patients in the ICU
Organise long-term multidisciplinary care
Strategic planning of the ICU service within the wider environment
Principles of workforce planning
Practical application of equal opportunities legislation
√
√
√
Attitudes & behaviour
Caring and compassionate with patients and relatives
Ethical behaviour
Functioning within competence
Accepts appropriate advice from other health care professionals
Supportive of colleagues
Demonstrates initiative in analysing problems and critically evaluating current practice
Professional and reassuring approach
Attentive to detail, punctual, clean, tidy, polite and helpful
√
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32
GMP domain tested
Multi-source feedback
Case-based discussion
Mini clinical evaluation
exercise
Direct observation of
procedural skills
Workplace training objectives
Maintain education and training record
Present topics at staff educational meetings
Present topics at regional or national meetings where possible
Active participation in research projects
Lead ICU ward round with consultant supervision
Lead ICU ward round without direct supervision
Arrange ICU educational meetings
Attend management meetings as appropriate
Discuss cost-effective care in the ICU
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√
√
√
√
√
√
√
√
√
√
2
2
2
2
1,5
1,5
2,5
5
1
33