Critical Care

Children's Intensive Care Unit (CICU)

Overview

The KK Women’s and Children’s Hospital (KKH) is an 830-bedded tertiary referral centre that offers a full range of services for neonates, children and women.

The fellowship programme in paediatric critical care is administered by the Children’s Intensive Care Unit (CICU). This is a 12 months training with an option to extend another 12 months for advanced intensive care training. The Children’s Intensive Care Unit is a tertiary, multidisciplinary paediatric intensive care unit with the nursing capability to support 16 beds with about 1700 admissions a year. Both negative and positive pressure isolation beds are available. There are separate facilities for cardiac step down patients and an intermediate care area that supports both medical and surgical patients.

The unit operates in an open collaborative manner, with all patients being managed by the CICU team. There are seven senior staff, and they provide consultant coverage at all times. A medical officer and a registrar are always resident on the unit. The unit (and the hospital) provides tertiary subspecialty paediatric care to the whole of Singapore. In addition, a significant number of international patients seek medical care here. We have available the full spectrum of advanced CICU monitoring and therapeutic technologies, including high frequency oscillatory ventilation (HFOV), continuous renal replacement therapy (CRRT), therapeutic plasma exchange (TPE), extra-corporeal membrane oxygenation (ECMO) support, inhaled nitric oxide, cardiac output measurement, intracranial pressure and continuous EEG monitoring. There are also extensive opportunities to care for patients following
cardiac surgery.

Other services provided by the CICU team include:

• The Children's Hospital Emergency Transport Service
  This is operated in collaboration with the neonatal intensive care unit (NICU) to transfer critically ill patients. The service performs 80 to 100 missions a year.
• Paediatric Code Blue Team
  The CICU team leads the emergency resuscitation team for in-hospital paediatric arrests and assists the surgical team in responding to major trauma patients.
• HomeCare Service
  This is a multi-disciplinary team that facilitates the care of technology dependent children in their own home and participates in their outpatient management.
• Central Venous Access
  The CICU staff responds to referrals from other disciplines, inserting central venous catheters or peripherally inserted central catheters to facilitate administration of drugs, parenteral nutrition, autologous stem cell harvesting and chemotherapy.

Objectives

The objective of the paediatric critical care fellowship is to train physicians to develop the knowledge, skills and attitudes necessary to practice as a paediatric critical care specialist. After completing the paediatric critical care fellowship programme, fellows will be competent in:

• developing holistic approach skills to a critically ill child;
• organ system(s) failure therapy and extra-corporeal life support systems;
• pathophysiology of disease processes in children and neonates;
• providing supportive care of the critically ill patient;
• monitoring of the critically ill patient;
• cardiopulmonary resuscitation and crisis resource management;
• transportation of critically ill children;
• managing ethical and end-of-life issues associated with critical illness;
• managing brain death and organ donation;
• managing chronically ill and technology dependent children;
• maintaining professionalism, interpersonal, leadership and communication skills;
• technical skills;
• education and research.

Course Contents

There are several components to the formal education programme for ICU fellows. The paediatric critical care fellowship programme covers the following:

• fundamentals of paediatric critical care;
• paediatric critical care lectures;
• CICU Monday grand rounds;
• CICU grey case conference;
• mortality rounds;
• CICU journal club/research rounds;
• mock codes;
• workshops;
• within the CICU there are daily (Cardiology/Cardiothoracic Surgery and Radiology) and weekly (Infectious Diseases, Respiratory) teaching rounds conducted by the relevant specialist teams;
• attendance at teaching rounds and journal clubs organized by other disciplines in the hospital is
  strongly encouraged .

*Please refer to the assessment and evaluation guidelines for further information about the course contents.

Training Methods

Fellows will provide and co-ordinate care for all patients in the unit, supervising the resident medical officers and working alongside the registrars/senior residents. They will attend and conduct ward rounds, be available throughout the day for admissions and to assist in the delivery of care. There will be opportunities to learn and perform skills relevant to invasive procedures involving airway management, vascular access, resuscitation and
emergency management.

Fellows will present cases to consultants on daily rounds and are expected to participate in the call roster for nights and weekends. In addition, after suitable experience and training, fellows will be expected to participate in the other services offered by the unit as mentioned above.

The schedule of normal clinical work is usually a five-day week, starting at 8am. Fellows and Registrars usually do 5 to 7 in-house calls a month on average, covering for nights and weekends. During these calls they will have a medical officer resident on the unit as well.

Target Audience and Expected Competencies

• The preferred group of fellows to apply for this fellowship programme should have a recognized post-graduate degree in paediatrics, emergency medicine or anaesthesia and have significant experience in acute paediatric medicine. Some experience of paediatric critical care would be desirable.
• The paediatric critical care fellowship programme currently has 2 intakes in a year, commencing in January and July.
• To be eligible for this fellowship programme, interested applicants must:
  • be fluent in English;
  • be doctors from medical schools and if the medium of instruction is not in English then the applicant should have passed a recognized English proficiency test (e.g. TOEFL or IELTS);
  • have a valid registration with the Singapore Medical Council;
  • have current basic cardiac life support (BCLS) qualifications and have been credentialed in the administration of conscious sedation. It is expected that applicants have certification in Advanced Resuscitation in Children or its equivalent before start of their CICU fellowship.

Fellows will need to demonstrate their proficiencies based on the following competencies:

(A) Patient Care

• Fellows must provide patient care that is compassionate, appropriate and effective including the treatment of health problems and the promotion of health for children and all stages of illness
• Fellows must demonstrate their competence on elements to diagnose, treat health problems and evaluate patient care in the paediatric critical care setting

(B) Medical Knowledge

• Fellows must demonstrate medical knowledge of established and evolving biomedical, clinical, epidemiological, social-behavioral sciences and the application of medical knowledge to patient care.
• Fellows must demonstrate and apply their medical knowledge on the following elements:
  • scientific method of problem solving and evidence-based decision making skills;
  • diagnosing and managing common paediatric critical care issues;
  • data collection and interpretation of results central to paediatric critical care including appropriate indications for and use of screening tests/procedures for patients;
  • anatomy, physiology, pharmacology, pathology and molecular biology related to paediatric critical care;
  • surgical procedures employed in relation to the paediatric critical care patient.

(C) Practice-Based Learning and Improvement

• Fellows must demonstrate their ability to investigate and evaluate evidence, both in appraisal and assimilation of scientific evidence required for patient care in current and evolving practice settings, including diagnosing and treating health problems and promotion of health
• Fellows must demonstrate life-long learning skills and continuous self-assessment based on reflection and feedback required for patient care in current and evolving health care settings
• Fellows must demonstrate teaching and learning skills and perform research to contribute to medical education of health professionals

(D) Interpersonal and Communication Skills

• Fellows must demonstrate interpersonal and communication skills necessary for effective exchange of information and demonstrate the ability to collaborate with patients, their families and health professionals to provide quality patient care

(E) Professionalism

• Fellows must demonstrate commitment and professional attributes adhering to ethical principles including:
  • compassion and empathy;
  • honour and integrity;
  • accountability and responsibility;
  • duty and service;
  • respect;
  • humility;
  • excellence and scholarship;
  • social responsibility.

(F) Systems-Based Practice

• Fellows must demonstrate an awareness and responsiveness to the larger context and system of health care and demonstrate effective use of resources in the system to provide optimal health care for patients

*Please refer to our current and past fellows in this fellowship programme.
Course Materials

Interested applicants will need to take note of the following information on areas related to course materials.

• Certificate of fellowship will be awarded upon completion of the fellowship programme
  (Please refer to table 2 on the critical care assessment and guidelines page)
• Course fee will be determined upon application
• Candidates should be self-funded or have funding from external sources/institutions

If you have any questions about the fellowship application process, please contact the:

Head of Children's Intensive Care Unit
Division of Medicine
KK Women’s and Children’s Hospital

The paediatric critical care fellowship programme is managed by the following experts.