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    4.12.14 Training in Paediatric Intensive Care Medicine

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    Berry Bancin
    The Royal Children's Hospital in Melbourne operates a 24-bed pediatric intensive care unit that admits approximately 1,700 children annually. The unit cares for children with conditions such as cardiac disease, trauma, cancer, and respiratory illness. It also performs procedures like extracorporeal life support and provides temporary renal support. The unit trains registrars in pediatric intensive care medicine and provides a 2-year accredited training program. Trainees complete clinical work, participate in teaching activities, and are encouraged to undertake a research project during their fellowship.

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    4.12.14 Training in Paediatric Intensive Care Medicine

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    Berry Bancin
    11 views6 pages
    The Royal Children's Hospital in Melbourne operates a 24-bed pediatric intensive care unit that admits approximately 1,700 children annually. The unit cares for children with conditions such as cardiac disease, trauma, cancer, and respiratory illness. It also performs procedures like extracorporeal life support and provides temporary renal support. The unit trains registrars in pediatric intensive care medicine and provides a 2-year accredited training program. Trainees complete clinical work, participate in teaching activities, and are encouraged to undertake a research project during their fellowship.

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    The Royal Children's Hospital in Melbourne operates a 24-bed pediatric intensive care unit that admits approximately 1,700 children annually. The unit cares for children with conditions such as cardiac disease, trauma, cancer, and respiratory illness. It also performs procedures like extracorporeal life support and provides temporary renal support. The unit trains registrars in pediatric intensive care medicine and provides a 2-year accredited training program. Trainees complete clinical work, participate in teaching activities, and are encouraged to undertake a research project during their fellowship.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    11 views6 pages

    4.12.14 Training in Paediatric Intensive Care Medicine

    Uploaded by

    Berry Bancin
    The Royal Children's Hospital in Melbourne operates a 24-bed pediatric intensive care unit that admits approximately 1,700 children annually. The unit cares for children with conditions such as cardiac disease, trauma, cancer, and respiratory illness. It also performs procedures like extracorporeal life support and provides temporary renal support. The unit trains registrars in pediatric intensive care medicine and provides a 2-year accredited training program. Trainees complete clinical work, participate in teaching activities, and are encouraged to undertake a research project during their fellowship.

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    Paediatric Intensive Care Medicine at

    the Royal Children's Hospital, Melbourne


    Background
    The RCH PICU is a 24 bed tertiary intensive care unit that serves the state of
    Victoria, as well as southern New South Wales, and admits children from all around
    Australia. We admit approximately 1700 children annually, and care for children with
    cardiac disease, multi-organ failure, haematological and oncological disease, major
    trauma and severe respiratory disease. We provide extracorporeal life support for
    children with severe circulatory and / or pulmonary failure, and perform interstate
    retrievals of children on ECMO. In addition we provide temporary renal support
    (haemofiltration, haemodiafiltration, plasmafiltration) to approximately 100 children
    per year. Approximately 60% of our admissions require mechanical ventilation.
    RCH is the state centre for liver transplantation, and bone marrow transplantation.
    The Cardiac Surgical service at RCH performs more than 700 heart operations
    annually, of which approximately one quarter are in young infants. We care for all
    children from Victoria, South Australia and the Northern Territory requiring cardiac
    surgery, as well as infants with complex cardiac disease from other states. RCH is
    the national centre for paediatric heart transplantation, which incorporates long term
    ventricular assist device (VAD) support. The majority of Australian newborns
    requiring surgical palliation of hypoplastic left heart syndrome (20-30 per year),
    undergo their surgery at RCH.
    A distinction is made between Cardiac and General ICU patients, with separate
    medical teams responsible for their day to day care, but the unit runs as a single
    large, mixed PICU.
    RCH PICU runs the Medical Emergency Team (MET) for the hospital, as well as
    the Paediatric Emergency Transport System (PETS) for the state of Victoria. The
    PETS service annually receives over 1000 calls, and delivers approximately 500
    retrievals.
    There are eight full-time and six part-time consultants, working a split-shift rota.
    Two to three consultants are on day shifts (Cardiac, General, and ECLS) and one on
    the night shift.

    Training
    The RCH PICU provides training in general and cardiac intensive care to trainees in
    paediatric intensive care, paediatrics, anaesthesia, adult intensive care, paediatric
    cardiology and emergency medicine. The unit is one of only 3 in Australia to be fully
    accredited for 24 months training by the College of Intensive Care Medicine of
    Australia and New Zealand (CICM), and is one of the 4 centres to hold the annual
    CICM Fellowship examinations in Paediatric Intensive Care.
    We employ 25 registrars (Fellows) from Australia and overseas, including the UK,
    Mainland Europe, Canada, India and South-East Asia. Our registrars work a full
    shift system, and also provide continuous cover for emergency retrievals. There is no
    ‘minimum’ experience required for our registrars. Some have no previous training
    in PICU, and others are advanced trainees, or have even completed training, but
    wish to increase their experience prior to commencing a permanent post.
    The Senior Registrars
    The senior registrars are in general the most experienced in the registrar group. The
    roster generally includes two to three senior registrars on each shift. As well as
    taking part in patient care, the senior registrar(s) are expected to lead in
    resuscitations and emergencies; to deliver high-risk transports; to assist the
    consultant on service The senior registrars will also have the opportunity to conduct
    ward rounds, to liaise directly with referring medical teams and to assist and
    supervise junior registrars with procedures etc.., The SRs also play a major role in
    the organisational capacity within the unit like organising and running different
    aspects of the teaching programme, presentation in various departmental reviews
    (mortality and morbidity, cardiac arrest review, complex case review etc..,). Several
    of our SRs also are given an opportunity to provide senior on-call cover for ICU (with
    supervision) in accordance with the advanced training requirements of the CICM.

    The Junior Registrars


    Junior registrars are generally less experienced and are given 6 or 12 month
    placements in PICU and some are starting a career in PICU. Depending on training
    and experience, several JRs also are allocated more seniors role in the roster.
    Trainees considering training in PICU or those in other training programmes where
    experience in PICU training will be very useful for their future career are encouraged
    to apply.
    Teaching
    There are two formal teaching sessions per week, as well as informal
    bedside teaching when on clinical service. Teaching sessions include clinical case
    presentations, tutorials, lectures, technical and skill sessions, web based lectures,
    journal club, audit & research presentations, morbidity &mortality and ECLS reviews.
    Registrars are encouraged and expected to participate in these sessions, and
    to conduct them. They are expected to attend teaching when not on night shifts or
    annual leave.

    Research Projects
    All registrars are encouraged (and expected) to undertake a research or audit
    project during their fellowship at RCH. This can be a retrospective review, or a
    prospective study, or a case series. All projects will be supervised by a PICU
    consultant. We also encourage trainees to consider a formal research period, with
    Warwick Butt, Trevor Duke, or Johnny Millar, a view to a higher degree (MD or PhD).
    We have limited funding to enable research higher degrees.

    Mentorship
    ICU registrars are paired with a consultant mentor. The mentors and trainees
    should meet within 4 weeks of the trainee starting at RCH, and at 3-monthly
    intervals (or as often as required) thereafter. The purpose of the mentorship is to
    set goals at regular intervals during the fellowship; to discuss training or other
    issues; to assist in research projects; to complete any necessary documentation for
    the trainees ‘parent’ training programme; and to provide feedback as necessary.

    Enquiries and Applications


    It is rarely ‘too early’ to express an interest. We usually allocate posts between 18
    and 24 months ahead of the start date, though occasionally posts become
    available at shorter notice. For overseas applicants, the absolute minimum time
    that it takes for the visa and registration to be processed is 6 months, though we
    begin the process up to 12 months ahead of time whenever possible. If English is
    not your first language, you are required to pass the IELTS English language
    examination. A minimum score of 7 is required in each field. However experienced
    you are, you will not be able to work at RCH without this score. If you are
    considering applying to RCH, then it is well worth sitting the IELTS ahead of time,
    so that this doesn’t become a problem at the last minute.
    If you are interested in working as a registrar in RCH PICU, then please write to us,
    and send an up to date CV. It is important that we know your career intentions,
    your preferred start date, and what training you intend to do between the time of
    applying and starting.

    Enquiries
    For general enquiries regarding RCH intensive care please contact:
    Associate Professor Warwick Butt, Director of Intensive Care:
    warwick.butt@rch.org.au. For Enquiries regarding training opportunities and the
    Fellowship program, please contact Dr Siva Namachivayam, Director of Training:
    siva.namachivayam@rch.org.au
    Further details of the Fellowship training programme for intensive care trainees, are
    given in Appendix 1.

    Appendix 1
     Fellows spend a minimum of 6 and a maximum of 24 months in the PICU
    depending on individual training requirements.
     Fellowships are offered to applicants wishing to pursue careers in intensive
    care medicine from all over the world. RCH is committed to providing PICU
    training to overseas doctors who shall contribute to improved services in other
    countries.
     Many of the Australasian fellows are pursuing Fellowship of the CICM.
     There is a new intake of Fellows twice a year (February and August).

    Aims of training
    To provide the Fellow with:
     an individually tailored training programme appropriate to each Fellow’s
    experience and goals
     a sound theoretical knowledge base in normal physiology and
    pathophysiology of critical illness in children
     upto date knowledge of treatment and technologies used in paediatric
    Intensive care
     clinical experience in the resuscitation, assessment and treatment of critically
    ill children
     clinical experience in paediatric transport medicine
     the opportunity to perform clinical research relevant to the practice of
    Paediatric Intensive Care
    Fellowship Programme
    Induction and Orientation
    New trainees receive an induction period of 3 days, consisting of lectures and
    workshops to orientate them to the PICU and PETS. During this time they have
    no clinical duties.

    Clinical exposure and responsibilities


    During their training all fellows will spend equal time caring for cardiac and
    general
    ICU patients. PETS duties are shared between all fellows, and trainees will also
    spend some time at night on call specifically for PETS trips.
    Clinical responsibilities are all undertaken under direct supervision of a consultant
    intensivist, with increasing responsibility and autonomy being granted to more
    experienced trainees. Senior trainees (those with more than 2 years’ experience
    of PICU at RCH level) may be offered the opportunity to take first-call
    responsibility for the unit, in accordance with advanced training requirements of
    the CICM.

    Cardiac Intensive Care


     Assessment and initial management of a neonate or child with newly
    diagnosed congenital heart disease.
     Post-operative management of cardiac surgical patients, including cardiac
    transplantation.
     Medical management of heart failure and severe dysrhythmias.
     Initiation and ongoing management of VAD and ECMO for cardiac and
    respiratory disease.

    General Intensive Care


     Assessment, admission and initial management of critically ill children.
     Post-operative management of neurosurgical, orthopaedic, ENT, general
    surgical patients, liver and intestinal transplant recipients
     Central role in the RCH Trauma Team, responding to high-level trauma
    calls in the Emergency Department
     Providing advice, assessment and practical help to other clinical services
    within RCH.
    PICU Outreach
    The Paediatric Intensive Care unit also runs the Outreach service for RCH.
    Essentially this role encompasses the management of children with deteriorating
    illness or acute severe problems in the hospital in partnership with the bedcard unit.
    This could also be a consultation service wherein referrals are made by admitting
    units and ED. A senior registrar is usually rostered for outreach. The outreach doctor
    in partnership with PICU liaison nurse also reviews all children discharged from
    intensive care to the wards. He/she is also the ICU doctor attending MET calls and
    trauma calls in ED and very often the senior doctor leading resuscitations etc.., The
    other vital role of outreach doctor is to help with intra-hospital transfer of critically ill
    children. During night shifts, the outreach role (named “Night Hospital Lead – ICU”)
    helps coordinate ICU care delivery across ICU and RCH.

    PETS
    Handling telephone calls for advice from outside doctors and hospitals. Coordinating
    and undertaking transfer of critically ill children from referring centres in Victoria and
    neighbouring states.

    Teaching
     A core teaching programme runs annually and is delivered in 2-3 hour
    sessions each week. The curriculum is based on the knowledge required
    to pass the written component of the CICM fellowship examination.
     Weekly themed meetings discuss cases in a more interactive fashion.
    These rotate through the topics of Cardiac & General case presentations,
    ECMO, clinical Ethics, clinical Nutrition, PETS case discussion, clinical
    quality & safety meeting and morbidity & mortality. Trainees are required
    to present cases at these meetings, with the discussion chaired by a
    consultant intensivist or expert in that field.
     Trainees are also allocated to spend time in Anaesthesia where they gain
    experience in all aspects of airway management under the supervision of
    a Consultant Anaesthetist. This is tailored to the experience and
    requirements of individual trainees.
     The annual ECMO course runs over 5 days and is designed to train PICU
    senior nurses who wish to become ECMO specialists. Fellows training in
    PICU are encouraged to attend this and the twice yearly ECMO study
    days.
     Exclusive hands-on echocardiography experience is provided by
    consultant cardiologists in the ICU each week. In addition, trainees are
    encouraged to attend both the weekly Echocardiography Meeting and
    Cardiac Scheduling Conference in the Cardiology Department.

    Research
    Trainees spending 6 months or more undertake a research project under the
    supervision of a consultant intensivist. These range from simple retrospective
    reviews to designing and running clinical trials within the PICU, depending on
    available time and experience of the trainee.The PICU has strong links with the
    Murdoch Children’s Research Institute, the Australia and New Zealand Heart
    Research Centre and the University of Melbourne. A small number of senior trainees
    undertake a higher degree, performing research based in the PICU.

    Mentoring and Assessment


    Trainees are assigned a consultant mentor at the beginning of their period of
    training. At an initial meeting the trainee’s expectations and requirements are
    determined and a programme is devised to fulfil these. There are monthly meetings
    between trainees and mentors to ensure that these are being met.Trainees are
    assessed by each consultant every 3 months and their progress is discussed by the
    consultant group. The mentor then provides feedback to the trainee, and they devise
    an approach to any identified problems or deficiencies. The consultant mentor
    performs a formal 6 or 12 monthly appraisal for each trainee, depending on the
    period of training.

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