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Specific Objectives

MEDICAL EXPERT

Knowledge

• General understanding of cardiac embryology and its correlation with cardiac defects. Fetal molding in the normal and abnormal heart.
• Anatomy and pathophysiology of congenital heart disease.
• Symptoms, physical signs and diagnostic indicators of simple and complex congenital heart disease.
• Rationale of palliative and reparative operations.
• Principles of cardiopulmonary bypass and deep hypothermic circulatory arrest, their application in newborns, and their advantages and disadvantages.
• Diagnosis and management of peri-operative arrhythmias.
• Pharmacology of drugs used in pediatric cardiac patients.
• Post-operative cardiac pathophysiology, including the morbidity of surgical shunts, Fontan physiology and advantages of early reparative surgery.
• Post-operative cardiac adaptation, growth abnormality and neuro-psychiatric changes by clinic visits.
• Pacemakers and ECMO (extracorporeal membrane oxygenation) in childhood.
• Pathophysiology of pediatric cardiac and pulmonary transplantations, including transplant immunology, immuno-suppression and organ preservation for transplantation.

Technical Skills and Clinical Competence

• Interpretation of diagnostic tests, including cardiac catheterization, angiography, echocardiography and other imaging techniques.
• Correlation of the pre-operative investigation with the anatomy seen at operation.
• Pre- and post-operative management of pediatric cardiac surgical patients, including hemodynamic monitoring, ventilator and inotropic support, and management of postoperative complications.
• Skill to place arterial and venous lines, exposure of the heart and cannulation for cardiopulmonary bypass.
• Competence in repair of simple congenital lesions such as the patent ducts, coarctation of aorta and secundum atrial septal defect, and implantation of pacemaker in childhood.
• Experience in complex congenital heart disease, ECMO support, and pediatric heart and lung transplantations.

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COMMUNICATOR

As this is your only pediatric rotation and experience in pediatric surgery it is important for you to liase with the pediatric cardiologist and intensivist who take care of the patients.听

• Be able to communicate affectively with patients and their families with respect to medical conditions, including assessing operative risks for patients and families undergoing pediatric cardiac surgery. Realize the crucial importance of parent relationship and the importance clear explanations.听 It is suggested when discussing high-risk surgery that this should be done with attending staff.
• Be able to interact affectively with other health care professionals, realizing that pediatrics cardiac surgery is a team effort. Specifically you will need to be able to communicate and respond to anesthestist, intensivist, pediatric cardiologist and residents as well as nursing.听
• Be able to document the patient鈥檚 conditions and progress accurately with emphasis on relevant issues both in the daily notes as well as on rounds.
• Be able to perform history and physical examinations, legible notes including protocols and important complications, which may occur with the patient.

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COLLABORATOR

• Be able to appreciate each individual鈥檚 role in the care of the pediatric cardiac surgical patient.听 Clearly identify central role of the parent in the patient鈥檚 relationship with the health care team.
• Be able to contribute effectively to interdisciplinary team activities.
• Be able to consult appropriately other health care professionals and to consult freely during your pediatric cardiac surgical rotation.听

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MANAGER

• Be able to use information technology to optimise patient care.
• Be able to use health care resources cost effectively.
• Be able to work efficiently and affectively.

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HEALTH ADVOCATE

• Be able to educate and counsel patients and their families regarding important lifestyle for the safety of the patient.听 This would include aspects of nutrition and education regarding activities that could potentially cause harm e.g.; secure medication.听 Always use child restraints in the car, always use helmets on bicycles.听
• Be able to educate and counsel patients and specifically their families regarding some of the long-term consequences of congenital heart disease and the need for life long follow-up.听

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SCHOLAR

• Be able to critically appraise sources of medical information.
• Be able to educate parents and their families regarding their medical condition.
• Be able to teach medical students if needed as well as other residents and other health care professionals specifically regarding surgical aspects of cardiac surgery in the pediatric population.
• Be able and available to present at rounds and on other subjects or grand rounds at the discretion of the attending pediatric cardiac surgeon.听

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PROFESSIONAL

• Be able to apply knowledge of the professional codes and norms of the behaviour that govern the behaviour of physicians and clinical practice.
• Be able to recognize and resolve ethical issues as they arise in clinical practice.
• Be able to recognize and deal with unprofessional behaviour in clinical practices.
• Be able to recognize your own limitations in dealing with pediatric cardiac surgical patients and seek appropriate counselling and help.