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Pediatrics - University of Saskatchewan
Rotation Objectives Manual for
Pediatric Residents
[revised May 21, 2014]
2014
Revised May 21, 2014
Table of Contents
Community Pediatrics (General Pediatrics) Rotation for Pediatric Residents ...................................... 2
Gastroenterology Rotation for Pediatric Residents................................................................................ 7
Medical Genetics Rotation for Pediatric Residents ............................................................................... 9
Hematology-Oncology Rotation for Pediatric Residents .................................................................... 12
Rheumatology Rotation for Pediatric Residents .................................................................................. 16
Respirology Subspecialty Rotation for Pediatric Residents ................................................................ 25
Cardiology Rotation for Pediatric Residents ....................................................................................... 29
Ward (Purple and Orange Team) Rotations for Pediatric Residents ................................................... 32
Anesthesiology Rotation for Pediatric Residents ................................................................................ 39
Child Psychiatry Rotation for Pediatric Residents............................................................................... 41
Developmental Pediatrics Rotation (Kinsmen Children’s Centre) ...................................................... 44
Infectious Diseases Rotation ................................................................................................................ 47
Nephrology rotation for Pediatric Residents ........................................................................................ 51
Neonatology Rotation for Pediatric Residents ..................................................................................... 55
Emergency Room Rotation for Pediatric Residents ............................................................................ 59
PICU rotation for Pediatric Residents .................................................................................................. 62
Pediatric Neurology Rotation ............................................................................................................... 65
Pediatric Rotation - Prince Albert - for one month:............................................................................. 68
Educational Objectives for Social Paediatrics Rotation ...................................................................... 69
Pediatric Surgery Objectives for Pediatric Residents .......................................................................... 73
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Community Pediatrics (General Pediatrics) Rotation for Pediatric Residents
By working as much as possible one-on-one with a clinical preceptor, residents will provide consultative outpatient care to children
and youth referred from urban, rural and northern communities in a multidisciplinary setting. Common disorders include failure to
thrive, overweight/obesity, respiratory symptoms, headache, school problems, behavior problems, mental health concerns, eating
disorders, prematurity, developmental delay and genetic disorders. The resident will be assigned to a general pediatrician primary
preceptor for the 1 month block. The preceptor will complete the final evaluation for the resident.
The resident is responsible for organizing their schedule for pediatric clinics, multidisciplinary clinics and with other health
professionals. Allocation of time for discussion with your preceptor regarding personal learning objectives, midpoint and final
evaluation is recommended.
General Pediatric Clinics – usually ½ day clinics run daily/weekly:
Supervisors:
Saskatoon Pediatric Consultants – Dr. Carla Krochak, Dr. Erin Woods
Pediatric Outpatient Department, RUH – Dr. Krista Baerg, Dr. Janna Brusky, Dr. Heather Hodgson-Viden,
Dr. Ayisha Kurji, Dr. Susanna Martin, Dr. Morgan Hewitt, Dr. Megan Garner, Dr. Karen Leis
Goals:
1) Provide general pediatric consultative care
2) Provide primary care for children with complex needs
3) Participate in at least one multidisciplinary clinic per rotation (eg. cleft lip and palate team, CF, pain or obesity
clinic)
4) Shadow a minimum of 2 non-medical health professionals in a ½ day clinic per rotation
5) Optional - Observe circumcision procedure (Dr. Krochak); palliative care home visit (Dr. Hodgson-Viden)
Resources:
Nelsons or Rudolf’s pediatric texts; Goldbloom Clinical Skills
Gene Clinics, Smith’s Recognizable Patterns of Human Malformation
CPS website, Position Statements, publications, caringforkids.cps.ca
Canadian Practice Guidelines; CADDRA, CMAJ and Learning Disabilities websites
AAP Guidelines for Health Supervision, AAP Red Book, AAP website and Parenting Corner
Royal College of Physicians and Surgeons Objectives for Pediatrics and CanMeds Roles
(note: growth charts recommended for Canadian children are at: www.dietitians.ca/growthcharts)
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Professionals:
Charlotte Douglas (Audiologist); Carla Floggan (Dietitian); Shirley Wieler (SLP); Rupal Bonli (Clinical
Psychologist)
The areas that Pediatric residents are expected to focus on, and will be evaluated commensurate with level of training:
CanMEDS
Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
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Obtain comprehensive, accurate, concise
history from patient and family
Perform complete, accurate, age-appropriate
physical exam
Obtain and interpret appropriate
developmental history/exam
Formulate a rational diagnostic and
therapeutic strategy for the child with general
pediatric problems
Formulate a rational diagnostic and
therapeutic strategy for the child with school
failure
Demonstrate appropriate growth in clinical
and basic science knowledge
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Do one observed history & physical
Formulate prioritized patient problem list
Demonstrate Wood’s lamp exam
Demonstrate HEADSS assessment on adolescent
Demonstrate correct technique for weighing and
measuring infants, children and youth
Discuss normal values for parameters such as BP,
BMI, weight-stature index and %ideal weight
Describe developmental tasks and milestones
Look up indications, limitations and
complications of medications and treatments
Describe routine immunization schedule
Discuss considerations with immunization
schedules, contraindications, extra vaccines (CPS
Your Child’s Best Shot, Canadian Immunization
Guide)
Read CPS position statements and available
Canadian Guidelines for care for children (eg.
monitoring growth; management of asthma,
obesity, diabetes)
Discuss evidence-based well child care as
advised and outlined in Rourke and Greig
Records
Follow CADDRA guidelines for assessment and
management of ADHD
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Communicator
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Collaborator
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Communicate effectively with families,
family doctor and other health care
professionals
Explain the rationale and side effects for the
investigative and treatment plans
Demonstrate initiative in arranging continuity
of care
Work with patients, families and other health
care providers to provide optimal patient care
Demonstrate successful interaction with
nurses, physiotherapists, dietitians, social
workers, and other health team members to
promote optimal care of children
Recognize and understand roles and expertise
of other physicians and health professionals
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Interpret SNAP and Weiss Impairment Scale for
children with school problems
Adhere when appropriate to AAP Guidelines for
Health Supervision of children with genetic
disorders
Refer patients to sub specialists when
appropriate.
Read around cases on a daily basis
Introduce self and role to family and other
professionals
Demonstrate appropriate use of open-, closedand permissive questioning
Document well organized database
Inform MRP and family of lab results
Dictate consultation letters within 24 hours of
clinic visit and copy to appropriate individuals in
circle of care
Liaise with community based health
professionals to formulate comprehensive familycentered plan
Clarify roles and scope of practice of health
professionals
Review CMPA statement on collaborative care
Participate on at least one multidisciplinary team
experience per month (eg. CF. GT, cleft lip,
chronic pain or obesity teams) or special project
per month (eg. palliative care home visit)
Arrange to attend 2 non-medical ½ day clinics
(eg. SLP*, audiology*, dietitian, etc)
Observe audiology assessment and discuss red
flags for hearing loss and services available (C.
Douglas)*
Observe feeding and/or speech assessments,
discuss red flags for speech delay and services
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Health
Advocate
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Provide consultative care to patients with
common, uncommon, multi-system or
undifferentiated problems
Show insight and clinical judgment in
management of problems
Use health care resources appropriately
Identify psychosocial, economic,
environmental and biological factors which
influence health
Identify and promote available resources with
in the broader community context
Describe current routine and catch-up
childhood immunization schedules.
provide anticipatory guidance
Attend and participate in clinic
Demonstrate motivation and interest in
reading around cases
Make clinical judgment based on evidence
Provide constructive feedback to others
Understand medico-legal issues and ethics in
pediatric practice (eg. child abuse, reportable
diseases)
Deliver care with integrity, honesty and
compassion
Demonstrate sensitivity to age, gender,
available (S. Wieler)*
*Mandatory one per rotation and both over 4 years
• Manage consultation to finish in one hour
including history, physical and dictation
• Use investigations (blood tests, radiograph,
nuclear scans, urine and stool work-up)
judiciously to manage patient and avoid
unnecessary painful procedures
• Triage new referrals appropriately
• Prevent, anticipate and manage pain in children
• Provide anticipatory care as per Rourke Baby and
Greig Records
• Promote CPS Healthy Active Living
• Access patient educational material for families
and community resources
• Inform parents and youth of availability of
appropriate non-publicly funded vaccines (eg.
Gardicil)
• Utilize the internet for Medline searches and the
Cochrane library to find evidence-based
information.
• Create problem management pathways
• Discuss current standards of care for medical
problems (eg. asthma, obesity, ADHD) and
common genetic disorders (Turner, Down,
Fragile X, etc)
• Prepare for and participate in additional
educational sessions with staff
• Meet patient needs in a timely fashion
• Interact with staff, health professionals, teachers,
patients and families appropriately
• Provide client and family centered care
• Respond to phone messages promptly
• Report possible child abuse and reportable
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cultural and societal issues
Demonstrate appropriate personal and
interpersonal behaviors
Adhere to the SHR policy
Adhere to legal and ethical codes of practice
Obtain appropriate informed consent for
procedures (eg. MRI under sedation)
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diseases to the appropriate authorities
(supervision required)
Document informed consent for procedures and
high risk medications (ADHD meds,
antidepressants, risks of discontinuation of
ADHD treatment)
Community Pediatrics Rotation Planning:
Rotation planning is the responsibility of the resident and must be approved by the preceptor. Most pediatricians have a set clinic
schedule, however ward rotations and other commitments will impact clinic availability. Final schedules must be based on the
availability of scheduled clinics. For planning RUH rotations, Kathy Nelson, RN has a detailed schedule with confirmed clinics
available 2-4 weeks before the rotation.
Pediatric residents should contact their primary preceptor (or locum) at 2-4 weeks ahead of time to plan their schedule (goal 6-8 halfday clinics per week). A blank template is available for the resident to make their schedule. The preceptor schedules will be posted in
Pediatric Outpatient Department (consult B).
For all rotations, the finalized schedule must be copied to the following individuals at least one week in advance of the start of the
rotation:
 Clinical preceptor (see schedule)
 Rotation coordinator (Dr. K. Baerg)
 Kathy Nelson, RN (for RUH rotations)
Rotation Evaluation: An evaluation of the rotation will be circulated on One-45 for participants to complete.
Back to Table of Contents
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Gastroenterology Rotation for Pediatric Residents
This rotation is for four to eight weeks, done during the R2, R3 or R4 years of Pediatric residency.
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The resident will be supervised by the Pediatric Gastroenterologist during the rotation.
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The resident will perform consults on in-patients (10-20% of the time) and out-patients (80-90% of the time).
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The resident is expected to read around cases seen, as well as to review the progress of any in-patients daily.
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The resident will be evaluated by his/her supervisor at the end of the rotation (with feedback given at the mid-point if the
resident’s performance is unsatisfactory) with respect to the areas indicated in the table below.
CanMEDS Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
The resident is expected to demonstrate knowledge of:
• the normal development of the gastrointestinal tract (and
related structures) and common congenital anomalies
(intestinal malrotation/atresia/duplication,
omphalocele/gastroschisis, pyloric stenosis, biliary
atresia/choledochal cyst, etc.)
• the functions of the gastrointestinal tract (alimentary
nutrition); the complications that arise from removal of a
length of the bowel (short gut syndrome and problems seen
with long-standing TPN use)
• the functions of the liver and biliary systems; understand the
pathophysiology of liver failure as well as the indications for,
and complications of liver transplantation
• chronic bowel diseases (such as inflammatory bowel disease,
peptic ulcer disease), Celiac disease
• Reading around cases, including
embryology texts for the normal
development of the gastrointestinal
tract
• Case discussions during clinic
• Review medical imaging
investigations
The resident should develop a clinical approach to the
following problems:
• vomiting/regurgitation
• abdominal pain (acute/chronic/recurrent)
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Collaborator
Manager
Health Advocate
Scholar
Professional
• abdominal distention
• constipation, diarrhea (acute/chronic), encopresis
• intestinal bleeding
• jaundice (hyperbilirubinemia), enlargement of liver and/or
spleen
• abdominal masses
• dysphagia
• failure to thrive, gastrenteritis
• Ability to communicate with families and fellow health care
professionals regarding gastrointestinal diseases
• Ability to work with pediatric surgeons, dietitians in
managing children with intestinal and liver diseases
• Understand the indications and limitations of common
radiologic procedures in gastroenterology, including plain
abdominal x-rays, upper GI series, Ba enema, abdominal
ultrasound and CT scan
• to educate families about appropriate feeding practices in
children with or without gastrointestinal diseases
• to obtain the appropriate resources for children who require
prolonged enteral or parenteral feeds in the home setting
• to be able to research the up-to-date aspects of care for
gastrointestinal and liver disorders
• Demonstrates responsibility in performing timely consults,
attending clinics and counseling sessions
• Understands medico-legal and ethical issues in dealing with
chronic bowel disease and/or liver disease/transplantation
• Observing staff counsel patients and
their families
• Attending team meetings; talking
with the relevant consultants, support
staff
• Reviewing investigations with staff
• Reading around cases.
• Observing nutritional advice given by
the gastroenterologist and/or dietitian
• Utilizes the internet for Medline
searches in order to find and read the
relevant articles. Review the
pharmacology of medications used in
inflammatory bowel diseases
• Discussing issues with the supervisor
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Medical Genetics Rotation for Pediatric Residents
This rotation is for four to eight weeks, done during the R2, R3 or R4 years of Pediatric residency.
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The resident will be supervised by the medical geneticist during the rotation.
The resident will perform genetics consults on in-patients (15% of the time), observe the workings in the cytogenetics laboratory
(5% of the time) and participate in out-patient clinics (80% of the time).
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The resident is expected to read around the cases, as well as to review the progress of any in-patients daily.
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The resident will be expected to read relevant articles compiled in the resident binders.
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The resident is required to give 30 - 40-minute presentation on a genetics-related topic to members of the Division of Medical
Genetics prior
to the completion of their rotation.
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The resident will be evaluated by his/her supervisor at the end of the rotation (with feedback given at the mid-point of the
rotation) with respect to the areas indicated in the table below.
CanMEDS Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
The resident is expected to demonstrate knowledge of the
following principles
a) of genetics:
• basic human genetics terminology
• the basic principles of Mendelian and non-Mendelian
(chromosomal, mitochondrial, multifactorial, uniparental
disomy, etc.) inheritance
• the basic principles and applications of traditional and
molecular cytogenetics
• the indications, applications and limitations of prenatal
screening and diagnostic testing
• the indications, applications and limitations of genetic
screening programs
• the basic principles of a dysmorphology examination and its
applications for syndrome indentification
• the indications, applications and limitations of molecular
• Reading around cases
• Case discussions during clinic
• Reading articles from the resident
binder
• Resident presentation
• Informal teaching sessions
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Communicator
Collaborator
Manager
Health Advocate
genetic testing
• the ability to correctly interpret molecular and cytogenetic
test reports
b) of teratology:
• the embryological basis of malformation
• the environmental factors in fetal development, and to
recognize (and prevent further) exposure to possible
teratogens.
c) of metabolic disorders
• an understanding of the basis of inborn errors of metabolism
and the basic principles of management
• the indications and applications of newborn screening as it
relates to metabolic disorders
• the ability to obtain information from families to construct
and interpret a pedigree chart
• an ability to emphasize with, and to explain the basis of
genetic/teratogenic/metabolic diseases to families.
• the ability to provide basic genetic counselling (such as
counselling for the risk of recurrence of autosomal, X-linked
or multifactorial conditions), or to refer to medical genetics
when beyond their abilities.
• Ability to work with other pediatric specialists (including
developmental pediatricians), surgeons, dietitians,
physiotherapists, occupational therapists and social workers in
providing support for children with
genetic/teratogenic/metabolic diseases.
• Demonstrate the ability to correctly interpret basic
cytogenetic, metabolic and molecular test reports and to use
this information appropriately in a clinical situation
To advocate for children with genetic or metabolic disorders,
the resident should obtain all appropriate resources in meeting:
• the physical needs of children with genetic diseases
(including surgical repair of deformities and rehabilitation).
• the special dietary and medication (enzyme replacement
• Observing genetics staff counsel
patients and their families.
• Attending team meetings; talking
with the relevant consultants, support
staff
• Reviewing genetic tests with the
geneticist.
• Reading around cases.
• Experience at the Kinsmen Children’s
Center.
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Scholar
Professional
therapy, seizure medications, etc) needs of children with
metabolic diseases.
• any educational needs – special schools or developmental
programs to counter learning disabilities and developmental
delay.
• to be able to research the up-to-date aspects of care for
genetic/teratogenic/metabolic diseases.
• Demonstrates responsibility in performing consults,
attending clinics and counseling sessions.
• Understands medico-legal and ethical issues in genetics,
including explaining any role of prenatal testing for
genetic/metabolic conditions.
• Utilizes the internet for medline
searches in order to find and read the
relevant articles. Review the
pharmacology of relevant medications.
• Interacting with the supervisor when
dealing with genetic/metabolic cases.
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Hematology-Oncology Rotation for Pediatric Residents
This rotation is for four to eight weeks and is generally done in PGY 1. However, the resident may choose to spend further elective or
selective time in this field during the PGY 2 to PGY 4 years.
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The resident will be supervised by the Pediatric Hematologist-Oncologist during the rotation.
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The resident will follow both in-patients and out-patients (distribution of patients on the ward vs. clinic at any given time is not
predictable).
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The resident is expected to read around cases seen, as well as to review the progress of any in-patients daily.
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The resident will be evaluated by his/her supervisor at the end of the rotation (with feedback given at the mid-point if the
resident’s
performance is unsatisfactory) with respect to the areas indicated in the table below.
CanMEDS Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
The resident is expected to acquire knowledge of:
• Development, structure and function of the formed
elements of the blood and blood-forming organs including
the changes in normal values with age
• The pathophysiology, presenting features, investigations
and management of common hematological and
oncological diseases
• Approach to hemostasis and thrombosis including
indications for and interpretation of common
hematological tests and management of patients with
bleeding disorders
• Approach to cytopenias, hemoglobinopathies and red cell
disorders.
• Approach to lymphadenopathy
• Pathophysiology of neoplasms including acute leukemia’s
• Characteristics and principles of investigation of the acute
leukemia’s and common tumours of childhood
• Social, familial and personal effects of childhood cancer
and chronic diseases
Case discussions during clinic
Reading around cases – recommended
texts:
1) Hematology of Infancy and
Childhood (Nathan and Oski)
2) Blood Diseases of Infacny and
Childhood (Miller)
3) Principles and Practice of Pediatric
Oncology (Pizzo and Poplack)
4) Clinical Pediatric Oncology
(Fernbach and Vietti)
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Communicator
The modes of action, delivery, side effects and monitoring
for surgery, chemotherapy and radiotherapy in the
management of pediatric oncology patients
Management of immunocompromised patients
Late effects of cancer therapy
Supportive care of hematology oncology patients (e.g.
Central lines, G-CSF, antiemetics etc.)
Principles of palliative care
Practical aspects of transfusion of blood and blood
products
The indications, process, and complications of bone
marrow transplants
Skills the resident will develop include the ability to:
• Perform a complete and appropriate disease oriented
history and physical exam for childhood malignancies and
hematological disorders
• Demonstrate effective, appropriate, safe, and timely
performance of both diagnostic and therapeutic lumbar
punctures in pediatric oncology patients
The resident will gain experience in
• Observing staff and oncology team
members counsel patients and their
• Developing rapport, trust, and ethical therapeutic
relationships with children and adolescents of all ages, as
families
well as with their parents, legal guardians, or other
caregivers in order to obtain a meaningful history, conduct
a relevant physical examination and provide the best care
available for the disorder for which the consultation was
requested
• Counseling patients and families faced with life
threatening illnesses as well as chronic childhood illnesses
• Understand the psychological aspects of caring for children
with life threatening and/or chronic disorders, and their
families
• Maintain clear, accurate, and appropriate records (e.g.:
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Collaborator
Manager
Health Advocate
Scholar
written or verbal) of clinical encounters and plans
The resident is expected to
• Work with families and the multidisciplinary health care
team to create a shared plan of care
• Work across medical disciplines and other specialties
(intensivists, dieticians, social workers etc.) to support
children with hematological and oncologic disorders.
• Participate effectively and appropriately in an
interprofessional health care team
The resident is expected to
• Understand the indications and interpretation of
investigations in children with hematological or malignant
disorders including
o Radiological investigations
o General Hematology laboratory tests (like CBCD
and peripheral blood film)
o Coagulation laboratory tests
o Bone marrow aspirates and biopsies
• Learn to allocate finite health care resources appropriately
for children with hematological and oncological disorders
The resident is expected to
• Identify opportunities for advocacy, health promotion and
disease prevention in patients like immunizations for
hyposplenic children, iron fortified formulas for children,
and avoidance of carcinogens like smoking in people at
risk of malignancies.
• Identify the health needs of an individual patients and
families
• Advocate for appropriate inpatient and outpatient health
care for pediatric hematology oncology patients with
chronic disease and those requiring symptom management
or palliative care.
The resident is expected to
• Recognize the importance of self-assessment of
• Attending team meetings; talking
with the relevant consultants, support
staff
• Reviewing investigations with staff,
discussing cost-benefit of the
investigations
• Reading and being aware of updated
guidelines on these preventive
measures
• Utilizes the internet for Medline
searches in order to find and read the
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Professional
professional competence and limits of abilities / training
relevant articles
• Evaluate medical information and its sources critically, and
apply this appropriately to practice decisions
• Integrate new learning into practice
The resident is expected to
• Discussing issues with the supervisor
and oncology teams
• Demonstrate responsibility in performing timely consults
attending clinics and family conferences
• Ensure appropriate informed consent is obtained for
therapies including blood transfusions and management
plans
• Demonstrate a commitment to patients, the profession, and
society through ethical practice
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Rheumatology Rotation for Pediatric Residents
This rotation is for four to twelve weeks, done during the R2, R3 or R4 years of Pediatric residency.
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The resident will be supervised by the Pediatric Rheumatologist(s) during the rotation.
The resident will engage with both outpatient and inpatients
The resident is expected to read around cases seen, as well as to review the progress of patients
To achieve the Rotation’s Objectives the resident is expected to regularly attend all clinics and participate in educational
programming (for example, rounds and seminars) during the rotation
The resident will be evaluated by his/her supervisor(s) at the end of the rotation (with feedback given at the mid-point if the
resident’s performance is unsatisfactory) with respect to the areas indicated in the table below.
CanMEDS Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
Apply knowledge of the clinical, socio-behavioral, and
fundamental biomedical sciences relevant to rheumatology.
For those training in pediatrics the pediatrician will
demonstrate basic knowledge of the following in the context of
pediatric rheumatology:
• Natural History of childhood rheumatic diseases including
expected outcomes
• Epidemiology of childhood rheumatic diseases
• Pathogenesis (including genetics, immunology, and
inflammation)
• Clinical presentations (typical and atypical) and approach
to diagnosis
• Classification criteria
• Complications
• Investigations: Laboratory, including immunologic
markers; Diagnostic imaging (radiography, ultrasound, MR
and CT, nuclear medicine including understanding of
growth-related features); Synovial fluid analysis;
Pathology
• Patient encounters (interacting with
patients in clinic/in-patient settings)
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Reading around cases
• Case discussions during clinic or
while reviewing in-patients
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Demonstrate ability to identify characteristics and outcome
measures (economic and social consequences, disability
assessment, disease activity) of the following conditions:
Pediatric inflammatory/autoimmune rheumatological
diseases
 Juvenile idiopathic arthritis (JIA)
 Systemic autoimmune conditions including
systemic lupus erythematosus, mixed
connective tissue disease/undifferentiated
connective tissue diseases/overalp syndromes
 Henoch-Schonlein Purpura
 Kawasaki Disease
 Systemic and localized forms of scleroderma
 Myositis (including childhood
dermatomyositis) /myopathies
 Raynaud’s disease
 Sjogren’s syndrome
 Other vasculitides (Granulomatosis with
polyangiitis, Goodpastures syndrome)
 Periodic fever syndromes
 Central Nervous System vasculitis
 Neonatal lupus syndrome
 Infectious/Post-infectious diseases (including
rheumatic fever)
 Autoinflammatory bone syndromes including
chronic recurrent multifocal osteomyelitis and
SAPHO syndrome
• Diffuse and localized pain syndromes
• Uveitis
• Osteoporosis/metabolic bone diseases
• Infections of bone presenting as a rheumatic disease
• Malignancy and neoplasms presenting as rheumatic
diseases
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Hypermobility syndromes including benign
hypermobility and Ehlers Danlos syndrome
Primary and secondary osteoarthritis
Other rheumatic/musculoskeletal manifestations of
systemic diseases
(including malignancies,
endocrine disorders, infections)
Use preventive and therapeutic interventions effectively
• Implement a management plan in collaboration with a
patient and their family
• Demonstrate appropriate and timely application of
preventive and therapeutic interventions relevant to the
physician’s practice
• Non pharmacological therapy
• Pharmacologic and biologic therapy
• Ensure appropriate informed consent is obtained for
therapies
Perform a complete and appropriate assessment of a patient
Clinical Competencies and Skill Requirements
Upon completion of training the resident will be able
to: Elicit a history that is relevant, concise accurate and
appropriate to the patient’s problem(s) and erform a
physical examination (with special attention to the
musculoskeletal system) that is relevant and
appropriate to the patient’s age and problems.
These skills should include the following:
• Ability to detect signs of active arthritis
• Recognize arthritic disease damage and deformity
• Detection of extra-articular symptoms and signs
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Functional assessment
Demonstrate knowledge of, indications for, and interpretation
of:
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Specialized immunological and serologic investigations
Diagnostic imaging of joint and skeletal diseases
Joint aspiration and injection
Tissue biopsies
Develop an appropriate management and therapeutic plan.
Demonstrate effective consultation skills in the provision of
timely, well-documented assessments and recommendations
Demonstrate the attitudes and skills necessary to collaborate
with other health care professionals necessary to the care of
your patient.
Demonstrate medical expertise in situations other than those
involving direct patient care including communication with
mentors, peers and students and seminar/small group
presentations
Demonstrate insight into his/her own limitations of expertise
by self-assessment.
Communicator
Develop rapport, trust, and ethical therapeutic relationships
with patients and families
• Observing staff counsel patients and
their families, and other health care
professionals
Accurately elicit and synthesize relevant formation and
perspectives of patients and families, colleagues, and other
professionals
Convey relevant information and explanations accurately to
patients and families, colleagues and other professionals
Develop a common understanding on issues, problems and
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plans with patients, families, and other professionals to
develop a shared plan of care
General Requirements:
• Establish therapeutic relationships with patients/families
and gain skills in interacting appropriately with children
and adolescents.
• Obtain and synthesize relevant history from
patients/families/communities.
• Listen effectively.
Specific Requirements:
• Establish therapeutic relationships with patients and their
families, and other caregivers that are characterized by
understanding, trust, respect, empathy and confidentiality.
• Listen effectively to patients, families, and members of the
health care team.
• Present clinical problems clearly, concisely and correctly
in verbal reports or written letters.
• Demonstrate ability to provide appropriate support and
counsel to a patient and family with chronic
rheumatologic, connective tissue or musculoskeletal
disorders.
• Demonstrate an appreciation of the patients’ perception of
health, concerns and expectations as well as the impact of
the rheumatological disease on the patient and the family
while considering factors such as the patient’s age, gender,
cultural and socioeconomic background and spiritual
values.
• Demonstrate open-mindedness to consideration of
alternative health care practices in the treatment of
rheumatologic diseases.
• Demonstrate an understanding of the importance of
communication among health care professionals involved
in the care of individual patients such that the roles of these
20 | P a g e
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professionals are delineated and consistent messages are
delivered to patients and their families.
Collaborator
Seek appropriate consultation from other health professionals • Attending team meetings; talking
recognizing
the
important
contributions
of
the with the relevant consultants, support
multidisciplinary team members in the care of patients with staff
arthritis related conditions (Registered Nurse, Physiotherapist,
Occupational Therapist, Psychologist, Social Work, Dietician,
Pharmacist)
General Requirements:
• Effective and timely consultation with other physicians and
health care professionals.
Specific Requirements:
• Recognize how to appropriately consult effectively with
other physicians, particularly those most often associated
with Rheumatology such as: orthopedics, ophthalmology,
plastic surgery, general internal medicine, general
pediatrics, medical imaging, neurology and neurosurgery,
dermatology, pain management and obstetrics.
Manager
Health Advocate
General Requirements:
• Utilize resources effectively to balance patient care,
learning needs, and outside activities.
• Allocate finite health care resources wisely
• Work effectively and efficiently in a health care
organization.
• Utilize information technology to optimize patient care,
lifelong learning and other activities.
Identify the determinants of health for the populations that
they serve particularly as it relates to patients with chronic
musculoskeletal and connective tissue disorders
• Reviewing the need for
rheumatological investigations with
staff
• Discussing management issues with
the supervisor and associated health
professionals
• Review the need for and organize
Promote the health of individual patients, communities, and preventive measures in patients on
21 | P a g e
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populations
General Requirements:
• Identify the important determinants of health affecting
patients.
• Contribute effectively to improved health of patients and
communities.
• Recognize and respond to those issues where advocacy is
appropriate.
specific therapies
•
Become aware of
community resources aimed at
supporting rheumatic disease care,
education, research and advocacy
Specific Requirements:
• Identify the important determinants of health affecting
patients, particularly those contributing to the burden of
illness and disability from chronic arthritis and connective
tissue disorders, chronic musculoskeletal pain disorders
and chronic metabolic bone disorders such as osteoporosis.
• Advocate on behalf of patients for improved and timely
access to specialist and allied health care, necessary
surgery, beneficial medications and therapies, and
community based support services.
Scholar
Maintain and enhance professional activities through ongoing • Utilize the library and the internet for
learning
searches in order to find and read
relevant articles.
Critically evaluate medical information and its sources, and •
Be familiar with
apply this appropriately to practice decisions
diagnostic and treatment guidelines
•
Review the
Contribute to the development, dissemination, and translation
pharmacology of medications used in
of new knowledge and practices
rheumatic diseases
•
Present and participate
General Requirements:
in seminars/rounds
• Develop, implement and monitor a personal continuing
education strategy.
• Critically appraise sources of medical information
• Utilize information technology to optimize patient care,
22 | P a g e
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•
life-long learning and other activities.
Facilitate learning of patients, housestaff/students and
other health professionals.
Specific Requirements:
• Critically appraise sources of medical information,
particularly as it pertains to the rheumatologic and
connective tissue disorders.
• Educate patients, housestaff, students, and other health
professionals in formal and informal educational settings
regarding rheumatology, connective tissue disease, and the
burden of chronic musculoskeletal disorders.
Professional
Demonstrate a commitment to their patients, profession, and • Regular attendance at clinics and
society through ethical practice
educational programs, punctuality in
clinics, preview of patients records
Demonstrate a commitment to their patients, profession and prior to the clinics, doing timely
society through participation in profession-led regulation
consults on in-patients, discussing
ethical issues with the supervisor
Demonstrate a commitment to physician health and sustainable
practice.
General Requirements:
• Deliver highest quality care with integrity, honesty and
compassion.
• Exhibit appropriate personal and interpersonal professional
behaviors.
• Practice medicine ethically, consistent with obligations of a
physician.
Specific Requirements:
• Demonstrate knowledge of the principles of medical ethics
as they relate to patient care and clinical research,
including autonomy, beneficence/nonmalificence,
confidentiality, truth telling, justice, respect for persons,
conflict of interest and resource allocation.
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•
Demonstrate a willingness to accept peer and supervisor
reviews of professional competence.
• Demonstrate recognition of personal limitations of
professional competence and demonstrates a willingness to
call upon others with special expertise.
Demonstrate flexibility and willingness to adjust to changing
circumstances
Back to Table of Contents
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Respirology Subspecialty Rotation for Pediatric Residents
This rotation is for four to eight weeks, done during the R2, R3, or R4 years of Pediatric residency.
•
•
•
•
The resident will be supervised by a Pediatric Respirologist during the rotation.
The resident will perform respirology consults on in-patients (20-30% of the time) and out-patients (70-80% of the time).
The resident is expected to read around cases seen on the wards and in the outpatient department, as well as to review the
progress of in-patients daily.
The resident will be evaluation by his/her supervisors at the end of the rotation (with feedback given at the mid-point if the
resident’s performance is unsatisfactory) with respect to the areas indicated in the table below.
CanMEDS Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
The resident will be expected to demonstrate knowledge
concerning:
• normal embryology and anatomy of the upper and lower
airways, diaphragm and chest wall; recognition of congenital
anomalies of these (i.e. choanal atresia, TEF, tracheomalacia,
cystic malformations, vascular ring, diaphragmatic hernia, etc).
• the control of respiration and normal pulmonary
physiology, including the use of invasive and non-invasive
methods of measuring airflow, lung volumes, gas exchange,
ventilation/perfusion ratio, dead space and alveolar ventilation
and oxygenation; recognizing variations with age
• respiratory failure and the management including
principles of mechanical ventilation
• normal immune and non-immune respiratory defense
mechanisms and the implications of their failure including
infectious or allergic disorders
• the pharmacology and indications of drugs commonly used
in Respirology
• pathophysiology of diseases of the respiratory system,
including infectious disorders (laryngotracheitis, bronchiolitis
• reading around cases
• case discussions during rounds and
case conferences
• review of tests done in the work-up of
patients with respiratory disorders
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and pneumonia), allergic disorders such as asthma; genetic
disorders such as cystic fibrosis; prematurity/developmental
disorders such as bronchopulmonary dysplasia; and sequelae
of congenital anomalies of the lung, pulmonary aspiration.
• role of: chest X-ray, bronchoscopy, lung biopsy, lung
scintigraphy, sleep studies, apnea monitors, pulmonary
function studies, sweat test, and CT scan of the chest
• understanding the importance of cardiopulmonary
interactions in health and disease
Specific skills that residents are expected to master in this
rotation:
• ability to obtain the medical history relevant to respiratory
disorders, and to examine the respiratory system in a thorough,
organized and logical manner
• ability to dictate referral letters to colleagues about the workup and interpretation of results, plus management plans for
patients referred to the respirologist
• ability to read a chest x-ray, interpret basic pulmonary
function test and blood gas results
The respiratory problems encountered that residents should be
able to recognize, diagnose and manage include:
• acute and chronic cough
• stridor
• dyspnea
• chest pain
• wheezing
• snoring
• hemoptysis
• apnea/sleep disordered breathing
• pulmonary edema
• mediastinal mass and intrathoracic neoplasms
• respiratory failure/ acute respiratory distress syndrome
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Communicator
Collaborator
Manager
Health Advocate
• pleural diseases/pneumothorax
• recurrent/chronic upper and lower respiratory tract infections
• upper airway obstruction
• excessive gastroesophageal reflux as a cause of airway
disease
• chronic lower respiratory tract diseases including Cystic
fibrosis, bronchiectasis, asthma, acute and chronic pulmonary
aspiration
• An ability to communicate with patients, parents and fellow
health care professionals about respiratory diseases in children;
for genetic disorders, the ability to explain the inheritance
nature of these diseases and provide basic counseling
• ability to work with intensivists, physiotherapists, dietiticians
and other allied health professionals in the management of
respiratory diseases
• understanding the role of, and soliciting the help of infection
control in preventing infection transmission, e.g., bacterial
pathogens between patients with cystic fibrosis
Demonstrate an understanding of the indications, benefits,
limitations/hazards, and costs of investigations involved in a
respiratory work-up, namely:
• cultures of sputa or nasopharyngeal aspirates
(bacterial/viral/Chlamydia studies), blood gases, rigid and
flexible bronchoscopy, lung biopsy, lung scintigrapgy, sleep
studies, use of apnea monitors, pulmonary function studies,
esophageal pH probe studies, sweat test, tuberculin tests,
fluoroscopy, chest x-ray, CT scan, ultrasound of the chest
• understanding when surgical measures are needed, such as a
tracheostomy, lung resection and lung transplants,
thoracostomy
The resident should:
• encourage the measures available to prevent respiratory
diseases – such as avoidance of cigarette smoking,
immunization with pneumococcal, Hib and influenza vaccines
• observing staff, counsel patients and
their families
• attending team meetings; talking with
the relevant consultants, support staff
• Review CXRs and PFT results with
staff; attend bronchoscopy sessions
• Reading about preventive pediatrics
27 | P a g e
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Scholar
Professional
to prevent infections, compliance with recommended therapies
• organize the appropriate resources at home for patients with
chronic lung disease, especially those with long-standing
tracheostomies and those requiring oxygen
• ability to review and assess the relevant studies on the
management of respiratory disorders; residents are expected to
specifically review pre-assigned topics and discuss these with
the respirologist during the rotation
• demonstrates responsibility in carrying out timely respiratory
consultations, and appropriate follow-up of patients
• understands ethics in pediatric respirology, especially the
dilemmas faced by children and young adults with cystic
fibrosis
• utilizes the internet for Medline
searches in order to find and read the
relevant articles
• interacting with the supervisor when
dealing with problem cases
Back to Table of Contents
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Cardiology Rotation for Pediatric Residents
This rotation is for four to eight weeks, done during the R2, R3 or R4 years of pediatric residency.
•
•
•
•
The resident will be supervised by a Pediatric Cardiologist during the rotation.
The resident will perform pediatric cardiology consults on in-patients (30-40% of the time) and out-patients (50-70% of the
time).
The resident is expected to read around cases seen on the wards and in the outpatient department, as well as to review the
progress of in-patients daily.
The resident will be evaluated by his/her supervisors at the end of the rotation (with feedback given at the mid-point if the
resident’s performance is unsatisfactory) with respect to the areas indicated in the table below.
CanMEDS Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
The resident will be expected to demonstrate knowledge
concerning:
• the anatomy, hemodynamics and electrophysiology of the
normal heart
• the disturbance of anatomy and haemodynamics associated
with the more common congenital heart defects, and acquired
inflammatory and infectious cardiac diseases
• the fetal circulation and post-natal circulatory changes
• the basic mechanisms of heart failure and the principles of
management of heart failure in the pediatric patient
• reading around cases
• case discussions during rounds and
case conferences
• review of ECGs, CXRs,
Echocardiograms, Cardiac
catheterizations
Specific skills that residents are expected to master in this
rotation:
• to obtain an accurate blood pressure reading in infants and
children, to recognize the range of normal readings at different
ages and the importance of cuff size; be aware of the
difference between arm and leg in blood pressure readings
29 | P a g e
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• to assess from a PA and lateral chest x-ray the abnormalities
in heart size, increases and decreases in pulmonary vascularity
and chamber enlargement
• to recognize and interpret disturbances in rhythm, evidence
of right or left ventricular hypertrophy, and patterns of various
arrhythmias on an ECG
• to recognize functional heart murmurs, and typical
auscultatory findings in common congenital heart
malformations
Communicator
Collaborator
Manager
The medical problems encountered in Cardiology that
residents should be able to recognize, diagnose and manage
include:
• high blood pressure
• cardiac murmurs – innocent or pathologic
• congenital heart disease, cyanotic and acyanotic forms
• cardiac arrest, cardiac arrhythmia
• cardiomegaly
• chest pain
• carditis
• congestive heart failure
• cardiogenic shock
• An ability to communicate with patients, parents and fellow
health care professionals about congenital and acquired heart
disease in children.
• Ability to work with intensivists, physiotherapists and
dietitians in the management and rehabilitation of children
with complex heart disease.
• Demonstrate an understanding of the indications, benefits,
limitations/hazards, and costs of various cardiac investigations,
namely:
• echocardiography, cardiac catheterization,
angiocardiography, scalar electrocardiogram, chest x-ray,
exercise ECG, Holter monitor, and radionuclide cardiac scans
• Observing staff, counsel patients and
their families
• Attending team meetings; talking
with the relevant consultants, support
staff
• Read ECGs and CXRs before
discussing with staff; attend echo
and/or cath sessions.
• Read about the work-ups for
congenital heart disease in
texts/journals
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Health Advocate
Scholar
Professional
To advocate for children with heart disease, the resident should
know:
• the indications for, and anticipated results from, modern
cardiac surgical therapy;
• the pre- and post-operative needs of the pediatric heart
patient
• the indications for and the antibiotics used for bacterial
endocarditis prophylaxis
• the epidemiology of adult-onset cardiac disease and means
for possible prevention in children (e.g. obesity,
hyperlipidemia disorders, lack of physical exercise, etc.)
• residents are expected to learn the pharmacology of
commonly used cardiac drugs, such as digoxin, beta-blockers,
antiarrythmics, diuretics, calcium channel blockers and
captopril
• ability to review and assess the relevant studies on the
management of cardiac disorders
• Demonstrates responsibility in carrying out timely cardiac
consultations, and appropriate follow-up of patients
• Understands medico-legal issues and ethics in Pediatric
Cardiology, including the difficulties encountered when
deciding whether heart surgery and/or heart transplantation is
indicated
• Reading around cases
• Read handbooks/texts re the
pharmacology of meds
• Utilizes the internet for Medline
searches in order to find and read the
relevant articles
• Interacting with the supervisor when
dealing with problem cases in a timely
manner
Back to Table of Contents
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Ward (Purple and Orange Team) Rotations for Pediatric Residents
Residents acquire professional skills by system of graduated responsibility under the direction of General Pediatricians and Pediatric
Sub-Specialists on two multidisciplinary clinical teaching units (purple and orange). Rotations are scheduled during the R1 to R4
years of Pediatric residency (see Ward structure guidelines).
Purple Subspecialties: Cardiology, Genetics, Developmental, Neurology, Respirology
Orange Subspecialties: Endocrinology, Gastroenterology, Heme-Oncology, Rheumatology
•
•
•
•
•
The patient is viewed as a ‘point of practice’ learning opportunity. Residents provide the majority of in-patient care from
admission to discharge for pediatric patients on the clinical teaching unit. Residents assess their patients daily before rounds and
present a prioritized problem list and management plan. Throughout the day they perform procedures, follow-up investigations,
review clinical status and participate in case conferences and teaching sessions as arranged.
Residents establish continuity of care in evenings and on weekends by signing over appropriate transfer of clinical information
to peers.
Residents develop a discharge plan, access community resources and promote continuity of care by communicating within the
circle of care.
Through a system of graduated responsibility, senior residents follow minimal to no patients directly, but oversee team
functioning. Senior residents assign and monitor patient load of junior trainees and provide ongoing feedback to junior staff and
discuss concerns with staff.
Residents are evaluated on one-45 at the end of rotation and feedback is provided at mid-point.
Supervisors:
General Pediatricians: Dr. Krista Baerg, Dr. Janna Brusky, Dr. Carla Krochak, Dr. Ayisha Kurji, Dr. Susanna Martin
and Dr. Heather Hodgson-Viden, Dr. Erin Woods, Dr. Morgan Hewitt, Dr. Megan Garner, Dr. Karen Leis and
locums as assigned
Goals:
1) Acquire professional skills by provision of in-patient care to hospitalized children
2) Acquire clinical knowledge of diseases of children
3) Acquire and practice skills in communication and collaboration
4) Acquire management skills to provide optimal, efficient and timely patient care
Resources:
Department of Pediatrics CTU Handbook for Residents and Staff
College of Physicians and Surgeons of Canadian Objectives for Pediatrics, CanMeds Roles
Nelson’s or Rudolph’s Textbook of Pediatrics
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Canadian Pediatric Society Position Statements and website for professionals
American Academy of Pediatrics Red Book and website for professionals
InfoLetters on CMPA website (delegation and supervision, collaboration)
Medline Search, Gene Clinics for genetic disorders
SHR Policy Manual
The areas that Pediatric residents are expected to focus on, and will be evaluated commensurate with level of training:
CanMEDS
Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
•
•
•
•
•
•
•
•
Obtain comprehensive, accurate, concise history
from patient and family on admission
Perform complete, accurate, age-appropriate
physical exam
Formulate a rational diagnostic and therapeutic
strategy
Perform investigative and diagnostic procedures
such as intravenous access, lumbar puncture,
urethral catheterization, nasogastric tube
placement with appropriate technique
Discuss indications, limitations and complications
of procedures and interventions.
Identify and respond to the child who is acutely ill
with urgent medical need and modify medical
management appropriately.
Demonstrate appropriate growth in clinical and
basic science knowledge
•
•
•
•
•
•
•
•
•
Obtain complete age-appropriate history and
physical on admission
Demonstrate reproducible physical findings
Practice aseptic technique/isolation
procedures
Develop succinct prioritized problem list and
management plan for active issues
Participate in all case discussions during
rounds.
Read around cases on a daily basis to
broaden clinical and basic science
knowledge bases
Read indications / complications of
medications and treatments (eg. transfusion,
GA)
Read about procedural technique,
indications, and complications of procedures
Demonstrate correct procedural technique
(must be observed by senior resident or staff
physician first three times they do any
procedure)
Discuss Guidelines for management of
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•
•
Communicator
•
•
•
•
Communicate effectively with families, family
doctor and other health care professionals. Also
explain the rationale for the investigative and
treatment plans
Maintain clear, accurate written records
Establish and maintain rapport and trust
Demonstrate empathy and sensitivity
•
•
•
•
•
•
•
•
•
•
•
•
common disorders (eg. Jaundice, asthma,
reduction of immunization distress)
Broaden knowledge base by reading around
cases for which consultation or concurrent
care is provided
Refer patients to sub specialists when
appropriate, discussing reason for
consultation
Lead case discussion at admission rounds
Document well organized complete database
Communicate accurate concise summary of
hospital course on rounds
Listen attentively when MRP leads
discussion with family and transition to lead
discussion on rounds as ward senior
Listen to and respond to concerns from
families and professionals
Keep family informed regarding results and
clinical status of patient as appropriate
Use systems approach for progress notes and
identify key issues clearly in notes
Update notes when management plan
changed or called by RN to assess patient
(eg. SOAP note)
Document procedure notes and informed
consent
Ensure concise and accurate sign-in in the
morning and sign-out at the end of the day
Document physical exam, follow-up plan,
medical advice and final diagnoses at
discharge
Draft a ‘Dear Doctor’ letter for family to
provide to the physician when ward followup advised
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•
Collaborator
•
•
Demonstrate successful interaction with nurses,
physiotherapists, dietitians, social workers, and
other health team members to promote optimal
care of children.
Recognize and understand roles and expertise of
other physicians and health professionals
•
•
•
•
•
•
Manager
•
•
•
•
Manage patients with common, uncommon, multisystem or undifferentiated problems
Manage time in order to take care of in-patients
effectively
Show insight and clinical judgment in
management of problems
Use health care resources appropriately
•
•
•
•
•
•
•
Dictate discharge summaries within 24 hours
of discharge and copy appropriate
individuals in circle of care (eg. MRP,
referring doc, FMD, consultants)
Engage professionals involved in patient
care, family and when appropriate, the
affected child, to develop a family centered
plan
Clarify roles and responsibilities of other
health professionals
Respond promptly to requests by RNs
Provide consultative services or concurrent
care to patients admitted under other
services, communicating with the team
Participate in case conferences for complex
patients
Review CMPA statement on collaborative
care
Examine assigned patients and review
clinical information prior to rounds
Complete history and physical in one-hour
Use investigations judiciously to manage
patient and avoid unnecessary painful
procedures
Follow-up on recommendations from
consultants and lab results the same day
Triage admissions and transfers to ensure
timely assessment and admission
Manage time to complete morning
assessments, notes and paper rounds by 10
a.m.
Delegate tasks if necessary during post-call
or academic day, but act to manage the
majority of care to assigned patients
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•
Health
Advocate
•
•
•
•
Identify psychosocial, economic, environmental
and biological factors which influence health
Identify and promote available resources with in
the hospital and broader community context
Describe current routine and catch-up childhood
immunization schedules
Adhere to SHR infection control practices within
the hospital in order to prevent the spread of
infectious diseases
•
•
•
•
•
•
•
•
Scholar
•
•
•
Discuss the psychosocial impact of diseases and
hospitalization on children and their families
Discuss current standards of care for disorder that
precipitated hospitalization
Access appropriate academic resources to provide
evidence based care
•
•
•
•
•
•
•
•
Senior residents to keep track of discharges
and assign discharge summaries in
physician’s orders
Prevent, anticipate and manage pain in
children
Promote patient and family-centered care
Access patient educational material for
families
Access community resources to develop
appropriate discharge plan
Read CPS Your Child’s Best Shot and the
Canadian Immunization Guide
Refer to the hospital infection control
manual
Complete incident reports when appropriate
and inform MRP
Discharge patients when medically safe,
discharge plan is clear and parents prepared
Coordinate weekly educational sessions with
staff and prepare topics as assigned
Access internet to search for relevant clinical
information and practice guidelines
Do bedside teaching on rounds and on-call
Document admission and progress note on
patients followed by a JURSI
Supervise JURSI’s as they demonstrate
skills to meet their evaluation requirements
Supervise JURSI’s for ALL procedures
Senior residents supervise junior residents
until they fulfilled minimum number of
observed procedures per task (3) and
resident comfortable
Senior residents take a leadership role on
rounds and with bedside teaching
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•
•
•
Professional
•
•
•
•
•
•
•
•
•
Deliver care with integrity, honesty and
compassion
Demonstrate sensitivity to age, gender, cultural
and societal issues
Demonstrate appropriate personal and
interpersonal behaviors including adherence to the
SHR policy
Demonstrate initiative in arranging continuity of
care
Attend and fully participate in rounds and case
conferences
Understand and adhere to legal and ethical codes
of practice
Obtain appropriate informed consent for
procedures
Discuss medico-legal issues and ethics in cases of
potential child abuse, reportable diseases, genetic
testing and infectious diseases (keeping
confidentiality as it relates to HIV, etc.)
Adhere to SHR privacy policy and the CMA Code
of Ethics
•
•
•
•
•
•
•
•
•
•
•
•
•
Senior residents review admissions with
junior staff and document ward senior note
prior to calling staff
Senior residents ensure appropriate patient
assignments and monitor workload of
juniors
Senior residents facilitate educational
sessions with staff and assign topics to
juniors as appropriate
Inform patients, parents and staff of your
name, role and level of training
Acknowledge family on rounds and develop
client and family-centered care plan.
Remain patient-focused on rounds and avoid
personal or off-task discussion
Guard patient privacy and confidentiality
Be up to date on all patients on the team
Participate appropriately in bedside
discussions and case conferences for all
team patients
Ensure patients are assessed and orders
written in a timely fashion (within 1 hour of
arrival on ward)
Use verbal or telephone orders only when
delay would result in detriment to patient
Complete tasks prior to going home
Be readily available to junior residents and
JURSI’s while on-service or on-call
Answer pages and ward requests promptly
Sign out pager at switchboard and patients to
pediatric resident or staff if unavailable
Notify supervisor, senior resident and the
Program Administrator if unable to attend to
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•
•
•
•
•
•
•
duties
Participate in quality initiatives by
completing incident reports and participating
in critical incident and/or morbidity and
mortality review
Keep staff informed of your actions
Recognize your limits. Notify staff or senior
resident of your level of knowledge, skill
and experience with tasks and procedures
Inform MRP of possible child abuse and
reportable diseases
Obtain and document informed consent for
procedures and document discussion
Inform staff if you feel they need to
personally attend a patient or if support is
required to meet demands
Notify the supervisor of concerns regarding
junior staff in a timely manner
Back to Table of Contents
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Anesthesiology Rotation for Pediatric Residents
Pediatric residents on the one month Anesthesiology rotation should report to Krys Schornagel in the Department of Anesthesiology
for their schedules. They will be scheduled in various O.R. locations throughout the Saskatoon Health Region with at least one week
of SPEC Anesthesiology and the other three weeks distributed predominantly between St. Paul’s and Royal University Hospital (with
no more than one week at City Hospital). The resident is to report to the identified location each day at 7:30 a.m. with the O.R. and
the supervisor having been assigned the day before.
Site Coordinators for each site are:
St. Paul’s Ian Lund
City Hospital - Jacelyn Larson
RUH Mateen Raazi (Anesthesiology Program Director)
During this time, the resident will be supervised by an Anesthesiologist and/or Anesthesiology Resident during each day in the O.R.
The resident is expected to read around cases and have an awareness of the basic anesthetic agents, develop familiarity with airway
assessment and management and refine some basic IV skills. The resident will be evaluated by the supervisor at the end of each day
with the daily evaluation log submitted to the Program Director. Should concerns be noted, the resident should be approached by the
Program Director for Anesthesiology or Site Coordinator to identify these concerns and be given an adequate chance to improve
performance.
CanMEDS Roles
CanMEDS Key Competencies
Methods to Achieve Competencies
Medical expert
• The resident will be expected to demonstrate knowledge
concerning airway assessment, and anatomic factors that put a
patient at risk. Levels of anesthetic risk, indications,
mechansim of action, contraindications of common anesthetic
drugs, procedural sedation, agents of use, monitoring.
• Procedures – the resident is expected to gain some
experience with intravenous insertion, airway management,
bag-mask ventilation, and intubation
• Selective reading
• Case discussion during procedures
• Anesthesiology rounds attended
during rotations
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Communicator
Collaborator
Manager
Health Advocate
Scholar
Professional
• The resident is expected to gain familiarity with intraoperative monitoring
• An ability to communicate with patient, parents and all
health care professionals in taking an adequate history, putting
parents and child at ease.
• Procedural anxiety
• Demonstrated ability to work as part of the O.R. team with
Anesthesiologists, Residents, Anesthesiology Assistants and
Nurses.
• Demonstrate an understanding of the indications for
procedural sedation and the various alternatives available.
Standard of monitoring during and post-procedure until preprocedural level of sedation is achieved
• Demonstrate efficiency and time management in patient
assessments
• Demonstrate recognition of our educational objectives and
attempts to achieve during rotation
• To advocate for children and demonstrating an appropriate
understanding of adequate pain management and anxiolysis
pre-procedure
• Participate in educational experiences and teaching during
the rotation
• Assume responsibility in carrying out assigned tasks
• Punctuality
• Understand medical/legal issues regarding consent for
anesthetic and procedural sedation
• Observing staff
• Faculty feedback of resident/patient
interaction
• Observing staff
• Faculty feedback of resident coworker interactions
• Case discussion during procedure
• Case discussion during procedure
• Lecturing
• Interacting with supervisor
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Child Psychiatry Rotation for Pediatric Residents
This rotation is for four to eight weeks, done during the R2, R3 or R4 years of pediatric residency.
•
•
•
•
The resident will be supervised by Child and Youth Psychiatrists during the rotation.
The resident will follow both in-patients (10% of the time) and out-patients (90% of the time).
The resident is expected to read around cases seen, as well as to review the progress of any in-patients daily.
The resident will be evaluated via the written resident evaluation form used by the Department of Pediatrics by his/her supervisor at
the end of the rotation (with feedback given at the mid-point if the resident’s performance is unsatisfactory) with respect to the areas
indicated in the table below.
CanMEDS
Roles
CanMEDS Key Competencies
Methods to achieve
competencies
Medical expert
The resident is expected:
• To appreciate the scope and learn some of the techniques of Child and Youth
Psychiatry, focusing especially on areas where pediatric and psychiatric interests
interface. Residents are expected to have seen at least two new cases a week
during their attachment, and to have followed at least two for a second visit. Most
residents exceed these numbers considerably.
• The resident is required to develop a diagnosis (DSM IVTR or equivalent) and to
present this to the consultant for discussion. The presentation is then recorded and
the notes checked, corrected and signed by the consultant.
• To develop differential diagnoses of psychiatric conditions, and treatment plans
for a variety of the common child psychiatric disorders. Four conditions make up
the majority of child psychiatry consultations - anxiety disorder, substance abuse
(nicotine, alcohol, etc), mood disorders, and behavioural disorders (oppositional
and ADHD). Experience in eating disorders, conducts and psychotic disorder will
also occur, in a more limited fashion.
• Clinical experience is
selected to ensure a broad
experience of child and
youth psychiatric
common problems.
Within these common
problems the resident will
further master the Mental
Status Exam for children
and for youth. The
resident is encouraged to
keep a log of cases and
indicate which
experiences are missing
as the rotation proceeds so
this can be corrected, if
possible.
41 | P a g e
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Communicator
• To become acquainted with psychiatric interviewing of children, youth and
family, focusing on biopsycho-social-developmental issues.
• To record detailed notes on cases seen and develop a letter to be sent to the
referring physician describing the condition, explanations given, and where
appropriate, alternative forms of therapy proposed.
Collaborator
• To prepare selected subjects for presentation at tutorial, seminars and rounds
settings. Subject tutorials are arranged weekly, and are on areas of the resident's
choice, but cover common problems and syndromes in depth. Case tutorials are
conducted around cases. Reading seminars allow the pediatric resident to discuss
material with nursing and psychiatric resident staff on a weekly basis. Attendance
is mandatory at Pediatric Psychiatric Grand Rounds and Clinical Case Rounds
twice monthly (weekly Grand Rounds are 40% child and youth; 60% adult)
• To coordinate aspects of child and youth psychiatric care, making referrals to
other services, as necessary.
• Prevent psychological and/or psychiatric disturbances in children by recognizing
risk factors or warning signs, and dealing with these problems with the help of the
child and youth Psychiatrist.
• To learn more about child and youth mental health resources which support
children and their families with severe illness or behavioral disturbance so that
advocacy for individual children can occur to agencies.
Manager
Health Advocate
Scholar
• To approach learning about child psychiatry from an evidence-based approach
which will involve literature reviews to answer basic questions about individual
patient care.
• Some residents will take advantage of the opportunities for small research
projects available in the Service, with an opportunity to pursue these as the chance
arises. (This is an elective part of the rotation, but has shown residents some of the
• Learn interviewing
techniques from the text
(Simmonds, J. Ed.4) and
by observing the
consultant doing the
interview. Interviewing is
then conducted in front of
the consultant and solo
interviewing is not
permitted until the
consultant is satisfied
with the resident’s
performance.
• Attend these team
sessions; be prepared to
discuss your cases.
• Reviewing patient
progress with staff, and
coordinating the patient’s
care.
• Observe child and youth
psychiatrist as an
advocate and contribute to
treatment planning
• Utilizes the internet for
Medline searches in order
to find and read the
relevant articles.
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Professional
difficulties and issues involved in the conducting of research.) The project is
evaluated as part of the resident's general involvement and interest in the subject.
• Demonstrates responsibility towards patient care in performing consults,
attending clinics, and mastering skills
• Discussing issues with
the supervisor.
• Is punctual.
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Developmental Pediatrics Rotation (Kinsmen Children’s Centre)
This rotation is for four to eight weeks, done during the R2, R3 or R4 years of pediatric residency.
•
•
•
•
The resident will be supervised by developmental specialist(s) during the rotation.
The resident will perform consults on in-patients (10% of the time) and out-patients at the Kinsmen Children’s Centre (80-90% of the
time) or on one of the travelling clinics (0-10%).
The resident is expected to read around cases seen, as well as to review the progress of any in-patients daily (if appropriate).
The resident will be evaluated by his/her supervisors at the end of the rotation (with additional feedback given at the mid-point) with
respect to the areas indicated in the table below.
CanMEDS
Roles
Medical expert
CanMEDS Key Competencies
The resident is expected to demonstrate:
• Knowledge of the normal stages in childhood development, plus an
understanding of the possible causes of developmental delay.
• An understanding of chronic care pediatrics with a developmental perspective.
The resident is expected to gain clinical skills history taking with emphasis on
developmental, neurological, and musculoskeletal issues. Documentation of
dysmorphology is also important.
• A general knowledge of the spectrum of disorders the pediatric resident will
encounter during the rotation:
a) Meningomyelocele and other spinal cord injuries.
b) The various muscular dystrophies.
c) The various inherited metabolic disorders.
d) An array of ill defined developmental delays and irregularities that children
experience.
e) Cerebral palsy and Erb’s palsy.
f) Children with both physical and cognitive impairments who have multiple
needs.
g) Intellectual disability and various syndromes which may include intellectual
disability.
h) Fetal Alcohol Spectrum Disorder.
Methods to achieve
competencies
• Discussing and reading
around cases.
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Communicator
Collaborator
Manager
Health Advocate
i) Autism Spectrum Disorder.
j) Acquired brain insults and injuries.
k) Amputations - congenital, traumatic, and surgical.
l) Children with deprivation and psycho-social disadvantages.
• The resident is expected to carry out the initial assessment, and after the family
has also been assessed by the appropriate disciplines, the recommendations for
management and treatment are drawn up as a team and discussed with the parents.
If therapy is indicated, arrangements for that are made by the disciplines involved.
• Medical reports at Kinsmen Children's Centre go to parents as well as referring
doctors.
• The pediatric resident will interact with, and be involved with, a number of
professional disciplines during their rotation. These include: Psychology,
Speech/Language Pathology, Physical Therapy, Occupational Therapy, Nursing,
Social Work, E.C.I.P., Developmental Therapists, Preschool Teachers and
Associates, Saskatchewan Prevention Institute, Secretaries.
• The Pediatric resident will also participate in multi-specialist clinics involving
Orthopedic Surgeons, Neurosurgeons, Respirologists and Pediatric Urologists.
• The ability to function as part of the developmental assessment team at our
Centre is crucial. The pediatric assessment is only one aspect of a team assessment
which may also involve nursing, physical therapy, occupational therapy,
speech/language pathology, psychology, social work, education, and/or
developmental therapy. He/she will participate in long term planning and
management of children with disabilities.
• The pediatric resident will have an opportunity during the rotation to become
familiar with the resources of the Saskatoon Region Early Childhood Intervention
Program.
• The Pediatric resident will have the opportunity to observe and participate in
therapeutic preschool programs for children primarily with physical disabilities.
• Other valuable resources the resident should become familiar with include: the
Saskatchewan Prevention Institute, Ministry of Social Services, Saskatchewan
Association for Community Living, Saskatchewan Abilities Council, S.P.A.R.C.,
C.N.I.B., Cognitive Disability Strategy, Autism Services,
• The resident must
discuss report distribution
with the parents. The first
several reports that the
resident does should be
read by the supervising
physician and needed
corrections made before
distribution.
• The resident will take
opportunities to
participate in assessments
by other health
professionals.
• Reviewing the necessity
of investigations with
staff.
• Case discussions with
staff, neurology clinic
nurses, social workers.
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Scholar
Professional
Provincial Health Department including SAIL and PARA programs, Community
Health including public health nurses/speech-language pathologists/early
childhood psychologists, Provincial E.C.I.P programs, Schools in Saskatoon and
around the province, various developmental centers.
• Ability to research the literature for up-to-date information on the assessment,
management and prognosis of children with developmental problems.
• Demonstrates responsibility in attending clinics and following-up patients.
• Utilizes Medline/
Pubmed searches and
other internet based
resources in order to find
and read the relevant
articles.
• Attendance at clinics
and timeliness in
completing consults.
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Infectious Diseases Rotation
This rotation is for four to eight weeks, done during the R2, R3 or R4 years of pediatric residency.
• The resident will be supervised by either a pediatric and/or an adult infectious diseases specialist during the rotation.
• The resident will perform pediatric infectious diseases consultations on in-patients (80% of the time) and out-patients (20% of the
time; typically Tuesday morning clinics). Residents will be notified of consults by the ID office or by the ward team members.
• The resident will be evaluated by his/her supervisors at the end of the rotation (with feedback given at the mid-point if the
resident’s performance is unsatisfactory).
• The resident is expected to read around cases, as well as to review (and study the relevance of) microbiological investigations on
their patients daily.
The areas in infectious disease that residents should concentrate, and will be evaluated on include:
CanMEDS Roles
CanMEDS Key Competencies
Methods to achieve
competencies
47 | P a g e
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CanMEDS Roles
CanMEDS Key Competencies
Methods to achieve
competencies
Medical expert
• A working differential diagnosis, investigation and management of the following
problems should be attained while on this rotation:
a) Fever in children, septic shock, and the concept of “occult bacteremia”.
b) Fever in immunocompromised children (neutropenic patients or patients with
HIV or congenital immunodeficiency disorders).
d) Focal infections of the:
1. Head and neck (tonsillopharyngitis and complications, otitis media and
complications, sinusitis and complications, periorbital cellulitis, cervical
adenopathy)
2. Lung (pneumonia, empyema, croup, bronchiolitis)
3. Heart (endocarditis, myocarditis)
4. CNS (meningitis, encephalitis, brain abscess)
5. GI (gastroenteritis syndromes – viral, bacterial, protozoal)
6. Renal (Urinary Tract Infections)
7. Skin (cellulitis, erysipelas, necrotizing fasciitis)
8. Bone and joints (osteomyelitis and complications, septic arthritis, toxic
synovitis)
• A working knowledge of, and the rational use (including IV to oral step-down
therapy) in children of:
a) Antibiotics (oral, intravenous, intrathecal)
b) Antivirals (acyclovir, ganciclovir, oseltamivir)
c) Antifungals (nystatin, fluconazole, caspofungin, voriconazole)
d) Antimycobacterials (rifampin/rifabutin, clarithromycin)
• Reading around cases
• Case discussions during
rounds
• “Chalk board” talks
Communicator
• Learning how to use the
Sandford and Nelson
guide on the use of
antimicrobial agents.
• Observing the
• An ability to communicate with patients, parents and fellow health care
professionals about the nature and outcome of infectious diseases; specifically an interactions of staff with
patients, parents and
ability to explain the rationale for the investigative and treatment plans.
health care professionals.
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CanMEDS Roles
Collaborator
Manager
Health Advocate
CanMEDS Key Competencies
• Ability to work with nurses, fellow physicians and other healthcare
professionals in:
1. Manage and contain the spread of infectious diseases (infection
control).
2. Manage infections in the outpatient setting.
o The resident should learn how to utilize the microbiology and virology
laboratory, including:
a) The sending of appropriate specimens for diagnostic purposes.
b) An understanding of and recognition of likely etiological species using the
(bacterial) Gram stain, and (mycobacterial) Auramine-Rhodamine stain.
c) The tests (PCR, culture and rapid tests) used to identify common bacterial
agents (pneumococcus, beta-hemolytic Streptococcus, Staphylococcus,
Haemophilus influenzae, Bordetella pertussis, and Gram-negative
Enterobacteriaceae), viruses (RSV, Adenovirus, Paraflu, Influ, EBV, CMV,
etc), fungi (Candida, Apergillus, etc) parasites (Giardia, Cryptosporidium,
Plasmodium, etc) that affect children.
d) The methodology for testing and interpretation of antibiotic sensitivities for
the common bacterial species affecting children.
• Acquiring knowledge of current childhood immunization practices (both active
and passive immunizing agents)
• Prophylactic regimens for the child traveling outside Canada with his/her
family.
• Advocating for publicly funded immunization programs.
• An awareness of infection control practices within the hospital and in the
community (e.g. daycare and household) settings in preventing the spread of
infectious diseases.
• An understanding of the importance of reporting communicable diseases to
public health authorities, so that appropriate prophylactic measures may be
carried out.
Methods to achieve
competencies
• Attending team meetings
to discuss patient issues;
talking with the relevant
consultants, support staff.
• Throughout the day,
interact with
Microbiology/Virology
labs, reviewing patients’
results; asking questions
of techs and
microbiologists.
• Read about the relevant
microbial agents in
texts.
• Friday bench rounds
• Consult the Canadian
Immunization Guide
2006 Edition.
• Refer to the hospital
infection control
manual.
• Know the list of
reportable diseases in
Sask.
49 | P a g e
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CanMEDS Roles
Scholar
Professional
CanMEDS Key Competencies
Methods to achieve
competencies
• Ability to review and assess the relevant current studies available regarding the
efficacy of antimicrobial therapies and immunization programs, in order to
develop an evidence-based practice for infectious diseases in children.
• To learn using appropriate resources how to alter antimicrobial agent doses in
the setting of renal or liver failure, and for adequate penetration across the
blood-brain-barrier.
• Able to use the
Sandford guide on
antimicrobial agents to
alter doses.
• Utilizes the internet for
Medline searches in
order to find and read
the relevant articles.
• Interacting with the
supervisor when dealing
with problem cases in a
timely manner.
• Demonstrates an understanding of professional responsibilities in carrying out
timely consultations on ill (septic) patients, and appropriate follow-up.
• Understands medico-legal issues and ethics in infectious diseases, especially
the need to respect the privacy of patients (keeping confidentiality as it relates
to HIV, etc).
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Nephrology rotation for Pediatric Residents
PREAMBLE:
1. Pediatric Nephrology will be a minimum of one month rotation at the Royal University Hospital combining inpatient care as
well as outpatient clinics to be held twice/week. The resident must do a minimum of ¾ weeks in the rotation.
2. Elective rotations may also be selected by senior residents provided there is enough space available.
3. At the end of the rotation the resident must be able to assess the following:
a)
b)
c)
Manage common pediatric renal problems including proteinuria, hematuria, urinary tract infections and
vesicoureteral reflux, hypertension, electrolyte fluid acerbate disturbances, acute and chronic renal failure,
nephrotic syndrome and nephritis.
Fulfillment of specific Can MEDS objectives (see appendix A) is also a requirement.
Objectives specific to the rotation or ones knowledge. The resident must demonstrate knowledge in the following:
1) Clinical presentation of acute and chronic glomerular disease and tubular interstitial disease.
2) Indications for and interpretation of common renal function tests.
3) Indications for and advantages of diagnostic imaging. Imaging used to assess the urogenital system: Nuclear
Medicine, ultrasound, voiding cystourethrogram, CT angios and renal angiograms.
4) Indications for renal biopsy
5) Pathophysiology and treatment of renal failure in hypertension.
6) The use, benefit, side affects and toxicity of immunosuppression medication, antihypertensive, diuretics, and
other medications used in the treatment of chronic renal failure.
4. SKILLS: The resident must be able to demonstrate the following skills:
1) Perform urinalysis and interpret results.
2) Perform blood pressure and interpret results.
3) Interpret blood work and identify electrolyte abnormalities.
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5. PROBLEMS: The following problems are expected to be assessed, diagnosed and managed by the resident at the end of the
rotation.
1)
2)
3)
4)
5)
6)
7)
CanMEDS
Roles
Medical expert /
clinical decision
maker
Hypertension
Hematuria
Proteinuria and nephrotic syndrome
Acute and chronic renal failure
Simple and complex urinary tract infections
Nephrolithiasis
Renal tubular acidosis and other acid based arrangements
CanMEDS Key Competencies
•
•
•
•
•
•
Communicator
•
•
•
•
•
Must recognize abnormal findings
Must recognize which children are ill and the urgency of each illness.
Must have a good understanding of general nephrology and pediatric
problems presenting to the pediatric nephrologist and how they are
managed
Must be able to obtain an accurate, focused history and a complete
focused physical exam
Must be able to formulate an appropriate differential diagnosis or
prioritized problem list
Must show reasonable application of the medical literature to patient
care
Must be able to discuss concerns with the pediatric nephrologist
Must be able to explain to the patient/ parent management plans and
their rationale for each individual patient
Must communicate effectively with consultants
Must communicate effectively with patients / parents so as to deal with
ail concerns
Must communicate effectively with all members of the pediatric
Methods to achieve
competencies
• Read around cases
• Read pertinent
nephrology articles
•
•
•
Observe staff interaction
with patients
Practice history and
physicals
Present a talk on a
pediatric nephrology
topic at rounds
52 | P a g e
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•
Collaborator
•
•
•
Manager
•
•
•
•
•
Health advocate
•
•
•
Scholar
•
•
•
nephrology team and other health care professionals
Must maintain complete and accurate medical records
Must be able to participate in the management of nephrology patients
Must be able to involve primary care physicians in continued care when
necessary
Must be able to interact communicate with other members of the
nephrology care team
•
Organize differential
diagnosis and
management plan after
assessing patients in
clinic
Must be able to balance education needs, patient care and outside
activities
Must be able to choose appropriate investigations and utilize healthcare
resources wisely.
Must understand the value and limitations of these
investigations
Demonstrate an ability to utilize information technology
effectively to assist in the management of patient care, learning
needs and other activities.
Must work efficiently and effectively within the healthcare team.
•
Study appropriate work
up for common
nephrology problems
Must recognize concerns and issues which patients / parents, have about
their kidney disease,
Must be able to advise on issues such as immunizations, dietary
restriction, and medication benefits or side effects
Must be able to advise patients on lifestyle and preventative strategies
when living with kidney disease
•
•
Observe inpatient care
Organize discharge of
patients from hospital
Must be able to identify areas of weakness and establish a
comprehensive continuing education strategy.
Must demonstrate an ability to critically evaluate medical literature
Must demonstrate ability to stimulate learning by educating patients,
fellow trainees and other health professionals
•
Utilize internet for
Medline searches and
relevant topics
Present a pediatric
nephrology topic at
Pediatric Nephrology
•
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Professional
•
•
Must act in an honest, compassionate, and ethical fashion
Must recognize self-limitations and act upon them to always optimize
patient care
•
Rounds
Observe nephrologist
interaction with patient
and family
Back to Table of Contents
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Neonatology Rotation for Pediatric Residents
This rotation is for eight weeks in each of the R1 and R2 years, and four-eight weeks in the senior (R3/4) years of pediatric residency.
•
•
•
•
•
The resident will be supervised by Neonatologists/Intensivist/NNP/NPM Resident during the rotation.
The overall objective of the neonatal rotation is to prepare Pediatric residents to become proficient in the initial care of high risk and
normal newborns by the end of residency training.
The resident will perform perinatal consults on the obstetrics ward/case room/normal nursery and care for patients in the NICU.
The resident is expected to read around cases and to present at NICU rounds and present in critical care rounds.
The resident will be evaluated by his/her supervisors at the end of the rotation (with feedback given at the mid-point if the resident’s
performance is unsatisfactory) in the format of Can MEDS.
RESIDENT RESPONSIBILITIES:
1. On Call - First year residents are approximately on one-in-four call in the NICU initially buddied with NPM resident/NNP/senior
pediatric resident if available. Second, third and fourth year residents take call either in the PICU or as the ward supervisor, and are
available to assist the first year residents in managing emergency situations in NICU and to attend high risk deliveries, where
resuscitation of a critically ill newborn may be necessary. NICU calls are done in-hospital. It is the responsibility of the NICU
resident to inform the attending on call regarding consults, admissions or changes in the condition of patients under their care.
2. Daily Activities - Residents spend much of the rotation monitoring the progress of the babies in NICU, responding to their minute-byminute needs. The residents also perform antenatal consultations in consultation with the neonatologist-on-call when these are
requested by Obstetrics or the Normal Nursery to assess, advise and possibly admit babies to the NICU. Residents are expected to
arrive promptly by 08:00 hours to participate in hand-over rounds to allow their on-call colleagues to depart and attending rounds to
start in a timely fashion.
3. Parental Contact - Residents may speak to parents about the progress of their baby, but will find that the neonatologist always
arranges meetings where he/she gives feedback to the parents. Residents may obtain consents for special procedures: eg, blood
consent; but should not obtain consent for other specialties, for example – Surgery, Radiology, with regards to their procedures.
4. Deliveries - Residents attend high-risk deliveries in G400 with an RN to assist them. They are responsible for the baby's stabilization
and transport to NICU should that be necessary.
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5. Charting - The residents are responsible for writing doctor's orders, maintaining progress notes, and any charting related to
admissions or discharges/transfers (including the discharge summaries).
6. Rounds - The residents assigned to NICU are expected to participate fully in morning rounds for the entire Unit, also "sign-off"
rounds at 1630 when the Neonatologist and resident-on-call round in the unit to familiarize themselves with the babies. The principles
of the management of critically ill neonates are taught at the bed side during these rounds.
7. Presentations
Pediatric Academic Half-Day - weekly
Critical Care Rounds - once per week (Friday 12:15 p.m.) - NICU & PICU residents to alternate. Presentation of topics and
attendance is expected.
Pediatric Journal Club - once per month - the residents take turns presenting interesting papers which are critiqued
Perinatal Rounds – monthly - attendance while on NICU rotation is expected.
Occasionally (when asked) the residents will present inservices for the staff of NICU.
8. Procedures and skills - All residents working in the neonatal intensive care unit require completion of the NRP course successfully.
The following are some of the procedures the residents do:
a) Physical examination - on admission and discharge, but also "on-going" assessment throughout the baby's stay in NICU.
b) Interpretation of test results and consequent required action - blood work, X-rays, etc.
c) Administration of certain drugs.
d) Insertion and/or removal of umbilical arterial lines; peripheral arterial lines; percutaneous CVL’s/PICC lines; and chest tubes.
e) Performing bladder aspirates; lumbar punctures; transillumination; tracheostomy tube changes; exchange transfusions; intubations;
12 lead ECG (interpretation on "off" hours also); adjustment of ventilation parameters from bloodwork results.
f) Running resuscitation - "codes".
CanMEDS
Roles
CanMEDS Key Competencies
Methods to achieve
competencies
Medical expert
The resident will be expected to demonstrate knowledge in the following areas of
neonatal-perinatal medicine:
• Growth, development and nutritional requirements of the normal fetus and the
newborn.
• Disorders affecting all body systems of the fetus and newborn.
• The basic sciences applicable to the practice of neonatology including maternal
• Reading around cases.
• Case discussions during
work rounds and intensive
care presentations.
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physiological, biochemical, pharmacological and pathological influences on the
fetus, effect of maternal disease on the fetus and neonate, fetal physiology, fetal
development and nutrition, placental function, physiological and biochemical
adaptation to birth and extra uterine existence and physiology, biochemistry,
pharmacology and pathology development of the diseases of the fetus and
newborn. Psychology of pregnancy and maternal/infant interaction. Genetics,
psychomotor development and outcome, appropriate understanding of the
technical devices used in the care of the newborn, common problems requiring
surgical correction in the neonatal period.
• Knowledge and understanding of infection control during the perinatal period
and the nursery environment.
• In depth knowledge and understanding of principles of ventilatory management.
• To understand the complex ethical issues relating to perinatology.
Specific skills that residents are expected to master in this rotation:
• Special competence in clinical assessment, detection and management of
critically ill newborn infants, techniques of infection control, techniques of
resuscitation, ventilatory support, continuous monitoring, temperature control,
general principles of critical care, general principles of post-operative care,
maternal, fetal and neonatal transport, procedures (see above).
Communicator
• Ability to communicate effectively and offer psychological support to parents of
critically ill newborns and members of the health care team.
• Observing staff counsel
patients and their families.
Collaborator
• Recognition of the need to function as a member in the health care team,
collaborating with the neonatal nurses, respiratory therapists, physiotherapists,
dietitians, social workers, pediatric surgeons, ophthalmologists, etc.
Manager
• Able to conduct an efficient problem-oriented approach to disorders
encountered in the NICU, utilizing appropriate tests as indicated - including xrays, CT scans, head ultrasound, metabolic screens, echocardiography, blood tests,
etc.
Health Advocate
• Able to secure medical and psychosocial resources for newborns during their
• Attending team
meetings; talking with the
relevant consultants,
support staff.
• Study the appropriate
work-ups for common
medical problems
encountered in premature
and full term infants in
the NICU.
• Attention to discharge
57 | P a g e
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stay in the NICU and after discharge home.
• Providing routine care for newborns, including antibiotic eye ointment for
prophylaxis against Chlamydia and gonorrhea, IM vitamin K to prevent
hemorrhagic disease, screening for metabolic diseases such as PKU,
hypothyroidism and galactosemia.
• Arranging appropriate follow-up with their pediatricians or family physicians,
and providing advice on infant nutrition, immunizations, and injury prevention.
planning and arranging
appropriate resources with
the social workers.
Scholar
• Motivated to the development of knowledge, and fulfilling the obligation of
continued self education and teaching.
• Able to research the literature on up-to-date aspects of neonatal medicine, plus
answering questions that parents have about the medical illnesses, progress and
long-term outcome of their newborns.
• Utilizes the internet for
Medline searches in order
to find and read the
relevant articles.
Professional
• Compassionate interest and overall understanding of the patient as a person,
sympathetic support of all members of the patients and family.
• Demonstrates responsibility in caring for and being available for the
resuscitation of critically ill newborns, timeliness when performing consults in
perinatology.
• Able to deal with ethical dilemmas in neonatology, including the difficulties that
arise when the patient’s prognosis is bleak or unknown.
• Attending ethics rounds
or case discussions.
• Observing interactions
between parents and the
neonatologist/NICU team.
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Emergency Room Rotation for Pediatric Residents
This rotation is for eight weeks during the R1 year, and four weeks during the R2, R3 and R4 years of pediatric residency.
•
•
•
•
The pediatric ER is located beside the adult ER at Royal University Hospital, ground floor level, and is open from 8 a.m. to midnight
daily. It caters to about 16,000 patients per year.
The resident will be supervised by ER/general pediatricians or a Pediatric Emergency Specialist.
Pediatric residents, Fam Med Residents and senior medical students rotate will be on duty on either shift (8 a.m. to 4 p.m. or 4 p.m.
until midnight). Pediatric emergencies between midnight and 8 a.m. are handled by the adult ER physician, with consultation to
Pediatrics as necessary.
The resident will be evaluated by his/her supervisors at the end of the rotation (with feedback given at the mid-point if the resident’s
performance is unsatisfactory).
The areas in the ER that residents should concentrate, and will be evaluated on include:
CanMEDS
Roles
Medical expert
CanMEDS Key Competencies
Communicator
• An ability to communicate with patients, parents and fellow health care
professionals about the investigative and treatment plans in an emergency room
setting, and the need for continuing if the child needs to be admitted to hospital.
• For severely ill children, an ability to empathize and comfort parents and family
members.
• To see and manage a wide variety of pediatric problems, both medical and
surgical in an emergency room setting. By the end of the rotation, residents should
have developed a differential diagnosis and learnt the management of children
with fever, poisoning, trauma and child abuse.
• To learn to organize priorities in resuscitating critically ill children and carrying
out appropriate investigations before transfer to an intensive care setting or to the
operating room.
• To gain the necessary skill in invasive procedures usually performed in an
emergency room setting (IVs, intubations, urinary catheterzation, suturing, etc).
Methods to achieve
competencies
• Reading around cases
• Case discussions during
shifts
• Mock codes or special
teaching sessions, where
available
• Observing the
interactions of staff with
patients, parents and
health care professionals.
• Residents should be
participating in
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Collaborator
Manager
• To understand the interaction between emergency room pediatricians and other
health care professionals in the community and in the hospital (including
obtaining or giving the right information, and giving any necessary medical advice
over the telephone).
• To carry out investigations and perform invasive procedures (including LPs,
central lines, intraosseous access, and intubations) only as are deemed necessary
and appropriate according to the presenting clinical problems.
• To determine when children need admission to hospital for acute care, and to
recognize when they can be safely discharged from the emergency room after
arranging appropriate consultation and follow-up.
Health Advocate
• To recognize the signs of possible child abuse/neglect, and to notify social
services in the event one is suspected or discovered.
• An awareness of infection control in the ER, in order to prevent the spread of
infectious diseases. Also, an understanding of the importance of reporting
communicable diseases to public health authorities, so that appropriate
prophylactic measures may be carried out.
• To communicate with the public at large about the logistics of providing
emergency care in the event of natural disasters.
Scholar
• To utilize critical appraisal when reviewing studies conducted in the ER in order
to develop evidence-based practices.
• To learn clinical pathways for patients coming through the ER, in order to
maximize efficiency and providing optimum care.
Professional
• Residents and students are expected to see patients in a timely manner, obtaining
the appropriate history and conducting a problem-oriented physical exam; they are
encouraged to prioritize their patients’ problems, recognize and attend more
interactions with patients,
parents and health care
professionals and receive
appropriate feedback.
• Feedback from
supervisor after
interacting with referring
physicians.
• Read and discuss with
Clinicians about which
recommended tests are
necessary or unnecessary
for specific problems in
Emergency texts and online resources.
• Read about child abuse
cases.
• Refer to the hospital
infection control manual.
• Know the list of
reportable diseases in
Sask.
• Utilizes the internet for
Medline searches in order
to find and read the
relevant articles.
• Students are encouraged
to be involved in Pediatric
Emergency Medicine
research as applicable.
• Review cases in a timely
manner as well as written
records with the
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rapidly to the critically ill patients.
• Understands medico-legal issues and ethics in the ER; the need to keep accurate
and concise emergency room records.
supervisors.
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PICU rotation for Pediatric Residents
This rotation is for eight weeks in the R2 year, and an additional 4-8 weeks in the senior (R3/4) years of pediatric residency.
•
•
•
•
The resident will be supervised by pediatric intensivists during the rotations.
The resident will perform PICU consults in the ER and on the general pediatrics ward, and care for patients in the PICU.
The resident is expected to read around cases and to present at PICU rounds.
The resident will be evaluated by his/her supervisors at the end of the rotation (with feedback given at the mid-point if the resident’s
performance is unsatisfactory) with respect to the areas indicated in the table below.
CanMEDS
Roles
Medical expert
CanMEDS Key Competencies
The goals of this rotation:
• To teach pediatric residents to recognize and manage organ system failure in
infants, children and adolescents. This is done by exposing them to the whole
cross section of disease, as well as accidental and surgical trauma which occur in
children. This exposure occurs under the direct supervision of the pediatric critical
care sub-specialists who are responsible for patients in the PICU. We expect the
residents to acquire the wherewithal to recognize organ system and multi organ
system failure and to plan therapy which is appropriate.
• To teach residents basic physiological and pathophysiological processes as they
relate to critically ill children. Residents should learn to prioritize the patients
needs and to intervene quickly when needed. This is accomplished by close
contact with the supervising intensivists both at the daily morning rounds as well
as throughout the day.
• Residents are also required to become certified in pediatric advanced life
support.
• Residents are encouraged to take the pre and post test and read the sources for
the SCCM online pediatric critical care course.
Specific skills that residents are expected to master in this rotation:
• To acquire the technical skills required in the management of organ system
failure. Examples include the establishment of intra-arterial line, establishment of
central venous access establishment of intrapleural tubes and endotracheal
Methods to achieve
competencies
• Reading around cases.
• Case discussions during
work rounds and while
work-up admissions to the
PICU.
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intubation. These skills are learned at the bedside under the direct supervision of
the pediatric intensivist. Some residents become more skilled than others but it has
been our experience that by the time residents have spent their four months in the
PICU, most of them are quite adept at these technical procedures.
• They must be able to resuscitate cardio respiratory failure including bag valve
mask supportive ventilation as well as securing the airway with endotracheal tube
placement for respiratory failure.
• they must be able to recognize perfusing and non perfusing cardiac rhythm
disturbances as well as utilize cardio - vasoactive mediations and cardioversion/
defibrillator to reverse pathologic process.
Communicator
• Ability to communicate effectively and offer psychological support to parents of
critically ill infants, children and adolescents. Communication skills are evaluated
by the supervising intensivist. There is essentially a one-to-one relationship
between the resident and attending intensivist for four months allowing for a close
working relationship. This close working relationship provides a good
opportunity for supervision, teaching and evaluation.
• Residents on the PICU service are required to prepare an in-depth one hour
seminar every second week. The seminar topic is based on a recent patient
exposure and is arrived at in consultation with the attending intensivist. The biweekly seminars presented by the residents are evaluated vis a vis clarity and
depth of thought process as well as for communication skills.
• Observing staff counsel
and interact with patients
and their families.
Collaborator
• Recognition of the need to function as a member in the health care team,
collaborating with the PICU nurses, respiratory therapists, physiotherapists,
dietitians, social workers, surgeons and pediatric subspecialists, etc.
Manager
• Able to conduct an efficient problem-oriented approach to multi-system
disorders encountered in the PICU, utilizing appropriate tests as indicated including x-rays, CT scans, blood tests, lumbar puncture for CSF profile, EEG and
assessing for brain death, etc.
• Attending team
meetings; talking with the
relevant consultants,
support staff.
• Study the appropriate
work-ups for common
medical problems
encountered in the PICU.
Health Advocate
• Able to secure medical and psychosocial resources for infants, children and
adolescents after their stay in the PICU.
• Arranging appropriate follow-up with their pediatricians or family physicians,
• Attention to discharge
planning and arranging
appropriate resources with
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and providing advice on nutrition, immunizations, and injury prevention.
the social workers.
Scholar
• Residents are expected to research up-to-date aspects of critical care for diseases
seen in children.
• Present and initially appraise a PCCM clinical question for fellow residents.
• Evaluation of intensive care knowledge and technical prowess is largely done by
the intensivist by interacting with the resident in the intensive care unit and to a
lesser extent, the emergency room. It also gives the resident an opportunity to
participate in various clinical investigative endeavors. Several but not all
residents have taken advantage of this opportunity which has resulted in
conference presentations and publications.
• Utilizes the internet for
Medline searches in order
to find and read the
relevant articles.
• Researching topics to be
presented.
Professional
• Compassionate in approaching the critically ill patients and their families.
• Demonstrates reliability and responsibility in caring for critically ill patients.
• Ability to deal with ethical dilemmas encountered in the PICU setting.
• Attending ethics rounds
or case discussions.
• Observing interactions
between parents and the
intensivist.
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Pediatric Neurology Rotation
This rotation is for eight to twelve weeks, done during the R2, R3 or R4 years of pediatric residency.
•
•
•
•
The resident will be supervised by pediatric neurologists during the rotation.
The resident will perform consults on in-patients (25-50% of the time) and out-patients (50-75% of the time).
The resident is expected to read around cases seen, as well as to review the progress of any in-patients daily.
The resident will be evaluated by his/her supervisors at the end of the rotation (with feedback given at the mid-point if the resident’s
performance is unsatisfactory) with respect to the areas indicated in the table below.
CanMEDS
Roles
Medical expert
CanMEDS Key Competencies
The resident is expected to demonstrate:
• An ability to perform a complete neurological and developmental history and
physical examination in children.
• A general knowledge of the list of topics below:
1) Seizures and their classification - Pediatric residents should have a full
understanding of epilepsy and all the epileptic syndromes (including febrile
seizures) of childhood, and an approach in investigating and treating such
conditions.
2) Childhood headache syndromes - especially learn how to sort out common and
classical migraine and the migraine variants, tension type headache and chronic
daily headache from the more ominous headaches of increased intracranial
pressure.
3) Neurocutaneous syndromes - malformations of the central nervous system and
neurocutaneous syndromes are all seen in the clinic and discussed.
4) Neuromuscular disorders with particular emphasis on muscular dystrophies the resident is required to attend the Muscular Dystrophy Clinic once a month,
where a large number of patients with a variety of muscular dystrophies, spinal
muscular atrophies, hereditary motor sensory neuropathies and structural
myopathies are followed. Residents will also be exposed to other aspects of
neuromuscular disease such as the floppy infant, neuromuscular junction
abnormalities, etc.
5) Neurodegenerative diseases and Cerebrovascular diseases.
Methods to achieve
competencies
• Reading around cases
• Case discussions during
clinic or while reviewing
the in-patients
• Observing and
participating in
performing procedures
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6) Neonatal neurology – including neonatal seizures, neonatal brain hemorrhage
and congenital malformations of the CNS.
7) Malignant diseases that affect the nervous system - residents are exposed once
a month to the Pediatric Neuro-Oncology Clinic which allows them to see a wide
variety of patients with pediatric brain tumours who have been treated with
surgery, radiation and chemotherapy. Residents are able to assess the benefits and
side effects of these therapies.
Communicator
• The ability to communicate with families and fellow health care professionals
regarding the plans for management of neurological diseases in children.
• Observing staff counsel
patients and their families,
and communication with
other health care
professionals.
• Attending team
meetings; talking with the
relevant consultants,
support staff.
Collaborator
• The resident will be an active participant in the multidisciplinary approach to
neurological diseases - including collaborating with nursing, physiotherapists,
occupational therapists, speech therapists, audiologists, and other pediatric
subspecialists.
Manager
• Residents should know the indications for, and be able to read radiological
investigations such as CT scans and MRI scans of the brain.
• A basic approach to EEG interpretations and understanding of the significance of
interictal and ictal EEG patterns will be taught.
• Understand the indications for performing lumbar punctures, myelography, brain
biopsy, muscle and nerve biopsy, intracranial pressure monitoring, arteriography,
x-rays of the skull, head ultrasound.
• Residents should also observe the performance and understand the utility of
nerve conduction studies, EMG's and evoked response testing.
• Reviewing the necessity
of investigations with
staff.
Health Advocate
• To support the child (and family) with static and progressive neurological
conditions; to empathize and help arrange respite care when needed in order to
alleviate the burden on the families.
• Case discussions with
staff, neurology clinic
nurses, social workers.
Scholar
• The resident will be expected to become familiar with pertinent literature
relating to childhood neurological and neuromuscular diseases, and become
experienced in critically evaluating such publications.
• Utilizes the internet for
Medline searches in order
to find and read the
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• To become familiar with the medications used to treat seizures and
neuromuscular disorders.
Professional
• Demonstrates responsibility in performing consults and attending clinics.
• Understand the concept and criteria for diagnosing brain death, and the
psychosocial ramifications of this diagnosis on family members.
relevant articles. Review
the pharmacology of
medications used in these
diseases.
• Punctuality in clinics,
doing timely consults on
in-patients, discussing
ethical issues with the
supervisor.
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Pediatric Rotation - Prince Albert - for one month:
Pediatric residents will spend one month with our pediatric service. The resident will be expected to attend the pediatric clinics that
run everyday. The pediatric resident will make themselves available for emergency consultations in the hospital. The pediatric resident
will attend high risk and/or preterm deliveries. The pediatric resident will round everyday on the inpatients both on the general
pediatric ward and in the special care baby unit (nursery).
Supervisors:
Dr. Ayaz Ramji
Dr. Duane Bulat
Dr. Peggy Lambos
Dr. Michelle DuRussel
Goals:
1)
Learn to manage a variety of consultative general pediatric problems in a regional centre.
2)
Learn to manage a small proportion of pediatric primary care in complex pediatric patients.
3)
Learn to assess and manage emergency consultations from the emergency room, walk-in clinics.
4)
Learn to assess and manage newborn infants that require resuscitation and ongoing care.
5)
Learn and appreciate the role of the support that is provided to the pediatricians here from the tertiary care centres.
Reading:
1)
20 Common Problems in Pediatrics by Bergman.
2)
Clinical Pediatric Neurology by Gerald M. Fenichel.
3)
Clinical Pediatric Dermatology by A.S. Paller and A. J. Mancini.
4)
Signs and Symptoms in Pediatrics by W.W. Tunnessen, Jr.
The pediatricians are part of a Childhood Development Team and the resident is expected to attend the multi-disciplinary forums that
occur. The resident can also attend optionally the assessments made by the various therapists on new referrals.
The pediatric resident can attend telehealth rounds on a weekly basis from RUH, Saskatoon.
The pediatric resident can attend departmental and hospital meetings to become familiar with the non-clinical roles of pediatricians.
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Educational Objectives for Social Paediatrics Rotation
•
•
•
•
•
•
The rotation is four weeks in duration; done either in 2nd or 3rd year of residency.
The resident will be supervised by a Paediatrician, at all times.
All clinics are based within one of 4 school-based clinics schools; rotation includes spending time with various other schoolbased staff; as well as attending case conferences.
The resident will be expected to learn about/ understand assess the following:
- common behavioural / mental health problems in infants/ children / adolescents
- the influence of the social determinants of health as it affects infants/ children/ youth; and families
- treatment modalities for specific mental health problems (eg ADHD) including medication options.
The resident will have the objectives of the rotation discussed at the beginning of the rotation, and feedback will be given
throughout the four weeks.
Evaluation will be done electronically at the end of rotation
CanMEDS
Roles
Medical expert
CanMEDS Key Competencies
•
Health care problems in infants/ children/ youth:
•
•
•
•
•
•
•
•
•
Understanding the impact of social determinants on health
Understanding the issues of poverty on the health of Indigenous
people
Impact of issues related to poverty on growth and development
Impact of exposure to violence and adverse childhood experiences
on the development of infants, children and youth
Impact of growing in foster care/ health care issues related to foster
care
Impact of poverty in adolescence
Street/incarcerated youth
Healthcare issues for immigrant/refuge families
‘Strength’ – based questioning (history-taking); Motivational
Interviewing
Methods to achieve
competencies
•
•
Read around cases
Discussion around
cases with
supervisor
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Communicator
•
School-based health as a means of providing access to care:
• School mental health: understanding disruptive behaviours,
ADHD, ODD, CD, Mood disorders, Anxiety, School-refusal,
learning disabilities, cognitive d/a
• Medical problems: asthma, eczema, obesity, adolescent
reproductive health etc
• Understanding and building resiliency in children and youth
• Understanding the issues related to racism, culture, ethnicity,
gender
• Understanding influences of history, politics and economics on
policies that affect health and well-being of communities and
populations
•
Sensitivity to communication needs of socially disadvantaged populations
with respect to:
•
•
•
•
•
Collaborator
•
Establishing trust/building relationships (understanding why
mistrust exists towards sectors such as health care, social services,
justice and law-enforcement)
Setting: need for flexibility (traditional settings may present a
barrier)
Approach: non-judgmental approach
Acknowledging lived experiences
Understanding the concept of cultural respect when communicating
and interacting with patients and families
Ability to function respectfully as a member of a multidisciplinary team;
•
Observing the
interaction of
supervising
Paediatrician with
patient and
families as well as
other team
members.
• The resident will
be observed doing
history and
physicals with
appropriate
feedback.
• Feedback from
other professionals
will be relayed to
resident (eg. from
teachers, social
workers, etc)
• Attending case
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•
•
Manager
•
•
•
•
Health Advocate
•
•
Professional
•
•
•
•
particularly within the school
Paediatrician’s role in the care of a socially disadvantaged population
Understanding the dynamics between various sectors and community
organizations and the partnering of health with these respective
professionals
exposure to administrative duties
exposure to a community practice
ability to manage/co-ordinate a multidisciplinary case, across various
sectors
understanding community resources and deficits
the role of the paediatrician as an advocate for the patient, the family and
the community
understanding the need for advocacy across (and within) systems other
than Health Care that impact the health and well-being of marginalized
infants, children and youth (Social Services, Law Enforcement, Justice,
Education)
displays a sense of integrity, responsibility and a sense of ethics
demonstrates a concern for the welfare of the patient and their families
demonstrates a sensitivity to diversity
respectful of other cultures/ and all individuals
conferences and
observing the
Paediatrician and
having an
opportunity to
participate – direct
observation – after
which feedback
will be given.
• Co-ordinating the
patients care, and
being able to
prioritize what
needs to be done in
a timely manner.
• Direct observation
• Reading articles.
This is part of the
core reading
material provided
on this rotation on
a) the determinants
of health
b) the role of race,
ethnicity and
gender on health
• discussions around
barriers to
accessing health
care
• Attitude towards
families and
colleagues –
observed
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•
•
Scholar
•
•
capacity for independent learning; learning around cases
applying an evidenced-based approach to understanding the health needs
of a socially disadvantaged population
•
•
Punctuality
Following through
with duties
Utilize internet to
do searches
Reading relevant
articles
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Pediatric Surgery Objectives for Pediatric Residents
PREAMBLE
A rotation in Pediatric Surgery should give residents the opportunity to become
familiar with the unique needs of infants and children as surgical patients. Some of the surgical diseases encountered in children are
similar in their presentation, management and outcome with their adult counterparts; others are quite different. The fundamental
principles of surgical care, however, are similar to those that govern surgical practice in other age groups.
MEDICAL EXPERT
Knowledge: Basic Science and Anatomy
• The resident should have an awareness of human anatomy and normal
physiology involving the head & neck, chest, abdomen and inguinal region.
Knowledge: General Clinical
At the end of the rotation, the Pediatric resident should be able to:
• Demonstrate the unique communication skills necessary to obtain thorough, focused pediatric histories from children, parents
or other caregivers
• Elicit key physical signs in children despite potential poor compliance;
Knowledge: Specific Clinical Problems
At the end of the rotation, the Pediatric resident should be able to:
• Recognize the unique natural history of surgical diseases in children and use the information in reaching a diagnosis
• Recognize the heat regulation problems in infants and the need for careful environmental control during evaluation and
management;
• Recognize the limited host resistance and high risk of nosocomial infections in newborns, and the need for aseptic protocols to
minimize environmental hazards
• Recognize the need to individualize drug dosage and fluid administration on the basis of weight, and be able to calculate
expediently fluid and electrolyte requirements using standard formulas
• Recognize and accommodate for the altered physiological systems (such as immature hepatic and renal function) that affect
drug and anesthetic administration
• Predict the risk of apnea post anesthesia and post narcotic administration in small infants
• Appraise the place for nonoperative management of solid viscus injuries
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•
•
•
•
•
Diagnose and apply principles of initial care and care during transport in the following neonatal conditions whose definitive
management should only be undertaken in specialized pediatric facilities with qualified pediatric surgeons: congenital
diaphragmatic hernia, esophageal atresia / tracheoesophageal fistula, gastroschisis / omphalocele, intestinal atresia,
Hirschsprung's disease, imperforate anus, intestinal malrotation, major pulmonary parenchymal disease (congenital lobar
emphysema, CCAM, etc.)
Diagnose and refer the following problems that may be seen initially by a community physician but will almost always be best
managed in a specialized pediatric facility:
o congenital lesions of the lungs and mediastinum
o gastroesophageal reflux (surgical management)
o chest wall deformities (pectus excavatum and carinatum)
o solid tumors of childhood (e.g. neuroblastoma, Wilms' tumor, hepatoblastoma)
Diagnose and provide the initial management of several conditions which, while ideally managed in a special pediatric facility,
may demand initial (and occasionally definitive) management locally because of urgency or distance:
o incarcerated inguinal hernia in the neonate
o aspirated and ingested foreign bodies
o acute abdomen in the neonate or infant
o acute gastrointestinal bleeding
o blunt abdominal and thoracic trauma
Diagnose, evaluate and optionally treat the following conditions which can be managed by experienced general surgeons or
referred to a pediatric surgeon (depending on prior experience and local resources). The pediatrician may be consulted and
help in the diagnosis, management, and may recommend referral to a pediatric surgeon.:
o Head and Neck:
 acute & chronic lymphadenitis, thyroglossal duct cyst
 dermoid cyst, congenital torticollis,
 branchial cleft cyst and sinus,
 lymphangioma/hemolymphangioma, tongue tie
o Abdomen
 umbilical hernia, umbilical granuloma
 inguinal hernia, pyloric stenosis
 intussusception, Meckel's diverticulum, appendicitis
o Scrotum
 communicating hydrocele, undescended testicle
 torsion of testis & appendix testis, epididymitis
Formulate a clear plan for the evaluation of a child presenting with:
o bilious vomiting
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•
•
o non-bilious vomiting
o acute abdominal pain
o chronic abdominal pain
o constipation
o rectal bleeding
Predict common post-operative complications in children and initiate their treatment.
Apply pediatric trauma principles in the initial resuscitation and management of traumatized children.
COMMUNICATOR
Convey pertinent information from the history and physical examination in
different circumstances (over the phone, in written form, during ward rounds and
conferences).
COLLABORATOR
1. Be able to coordinate care involving many different team members, including
anesthesia, intensive care, diagnostic imaging, nursing, and laboratory facilities
2. Consults effectively with other physicians.
MANAGER
1. Recognize that many surgical problems, although conceptually and
technically within the realm of expertise of general surgeons, are more
appropriately managed where there are special pediatric facilities (special
pediatric expertise in anesthesia, intensive care, diagnostic imaging, nursing,
and laboratory facilities);
2. Is able to prioritize and manage multiple simultaneous clinical demands.
HEALTH ADVOCATE
1. The resident should be a trauma prevention and health improvement advocate
2. The resident should recognize and respond appropriately.
SCHOLAR
Value the critical need of ongoing systems of peer review, maintenance of competence, and evaluation of outcomes in the surgical
management of sick children.
PROFESSIONAL
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1. Appreciate the unique emotional and ethical issues surrounding the care of a
sick child and the need to involve parents, children's advocates and other health
care-givers in many difficult situations;
2. Be aware of the life-long significance of surgical management decisions in
children and their impact on quality of life
3. Appraise the ethics of research concerning children;
4. Appreciate the sometimes complicated issues surrounding informed consent and refusal of treatment in children, especially in
situations where “quality of life” is a major issue.
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