Directing the resuscitation of a child is more than just being able to intubate or start an IV. Our curriculum provides residents with the opportunity to participate in resuscitations in a variety of settings including the CHOP and HUP NICUs, the PICU, and the ED. While there is always support for the residents’ role provided by more senior physicians, residents have the opportunity to learn to lead with clarity and skill in critical situations. PALS and NRP training are provided during Intern Orientation and residents are recertified in these courses during their third year of training.

In partnership with the Center for Simulation, Advanced Education and Innovation at CHOP, we provide a comprehensive simulation curriculum. In keeping with the Center’s philosophy, the vast majority of this education is done in situ where teams are actively engaged in providing care to patients. Likewise, many of our simulations are conducted as interdisciplinary exercises that include nursing and respiratory therapy colleagues as well. The Chief Residents oversee a curriculum of floor-based simulations as well as simulations designed for each year of training that occur during our Academic Half Days.  Debriefs occur after every simulation, allowing residents to receive feedback related to medical care, team dynamics, and communication.

Focused specialty-specific sessions are held in the Emergency Department, NICU, and PICU. This preparation allows residents to actively participate, under the direction of fellows and attending physicians, in resuscitations in all critical care settings (HUP delivery room, HUP and CHOP NICU, PICU and ED). Delivery room experience and resuscitations are an integral part of the Well-Baby Nursery and NICU rotations at the Hospital of the University of Pennsylvania (HUP). In addition, residents are active members of the hospital-wide Code Blue Team. Residents play important roles in these settings and gain experience that can be used regardless of the path their future career.

Procedural Education

Learning to competently and compassionately perform procedures is one of the most challenging skills to master in pediatric training. At CHOP, multiple approaches are used to gain competency in performing procedures including (but not limited to) the following procedures: bag-valve mask ventilation, peripheral intravenous line and umbilical line placement, phlebotomy, lumbar puncture, splinting, and suturing.

Workshops are conducted as early as Intern Orientation to enable our residents to begin to develop competence and confidence in the procedural skills residents need to master. Pediatric Advanced Life Support (PALS) and the Neonatal Resuscitation Program (NRP) are likewise offered during orientation, and basic, life–saving procedures such as bag-valve-mask ventilation, intraosseous access, and endotracheal intubation are performed on simulators during these courses. Additional dedicated sessions early in the first year include suture and splinting workshops provided by the Division of Emergency Medicine.

Formal procedure learning is incorporated into some rotations, namely the ED and ICU rotations, and residents interested in pursuing a procedurally-heavy career can opt to complete the Procedures elective. This experience provides residents with the opportunity to gain deeper experience in procedural skills while capitalizing on the wide variety of resources and teachers that the hospital can offer. Procedures taught include:

• Phlebotomy
• Intravenous line insertion
• Lumbar puncture
• Casting and splinting techniques
• Point-of-care ultrasound
• Advanced sedation practices

As part of these experiences, faculty from the Division of Emergency Medicine have served as preceptors for residents interested in learning how to use point-of-care ultrasonography to facilitate some of these procedures.