Ooh Rah! (Virtual) Pediatric Critical Care Medicine Fellow Bootcamp (TILIF #5-7)

This weekend I was able to participate in a CoVid-modified version of a pediatric critical care (PCCM) Fellow Bootcamp, a first-year fellow right of passage that became yet another victim of the 2020 dumpster fire.

Normally, the new fellows from all across the country come together to one of 3 locations to learn/refresh themselves on the basics of pediatric code situations, resuscitation management, teamwork, and leadership skills. It's a crazy weekend of taking turns at being team leader while a fake patient is dying and then doing chest compressions under someone else's direction. Both mentally and physically exhausting.

This year, we were forced to stay at our home institutions, Zooming into group meetings to discuss cases and then running simulations on mannequins with our own co-fellows and attendings. It actually worked surprisingly well in most respects. What we lost in regards to learning to work with a rotating group of strangers (an important skill on code situations), we gained by learning to work with our actual colleagues. Turns out my co-fellow and attendings are pretty cool.

The biggest loss was meeting new future colleagues. Pediatric intensive care is a small world and we will see these folks throughout our careers both at our future hospitals and at conferences, meetings, etc. The usual highlight for the group that meets in St. Louis is a big party at a local program director's house with a pool. Ah well. This pandemic has caused so much heartbreak that my little troubles are nothing by comparison. Really wish I could have gone to that pool party though.

Lots of things learned from this weekend:

A good description of critical care doctors: Intensivists are like ducks swimming on the water - they appear very calm, but they are a flurry of activity below the surface.

Command the room. It needs to be clear who is leading the team so that at least one person knows what everyone else is doing. If you are short, grab a stool, because people naturally talk to the tallest person.

Automate repetitive tasks. If you're running a code, there are certain things that need to happen at regular intervals that are great for delegating to someone else. Examples are giving epinephrine or checking for a rhythm. It's much nicer to have someone ask if they should give another dose every 3 minutes. If that's their only job, then it's less likely to be missed.

For some things, there are many right answers. Shop around for your mentors' preferences and find an option that you are comfortable with to be your go-to. On the flip-side, also take note of choices that keep leading to poor outcomes, because sometimes an otherwise great mentor might be most comfortable with outdated modalities. 

Once you've tried the basics, don't forget to address the underlying cause of the situation, e.g. if the patient isn't breathing because they are seizing, you need to fix the seizures; if they are seizing because of their low blood sodium level, you need to fix that.

Then do it blindfolded.

This was one of the more fun things that managed to withstand the CoViD conversion. After practicing a bunch of codes, they then blindfold the leader. Then you are brought to the foot of the bed and need to lead your team through the resuscitation of a dying patient with your eyes blindfolded. You might think this would make things harder, but actually it's a great way to remind you to not focus in on any one thing and to delegate everything to your team so that you can be free to think.