Critical Care Medicine

The PICU at SickKids is a multidisciplinary, quaternary, closed ICU staffed by physicians and nurses, RTs, physiotherapists, nutritionists, pharmacists and other allied health professionals. Our historical contribution includes the pioneering work and early adoption, evaluation and refinement of extracorporeal support technologies for critically ill children (HFO, CRRT, ECMO, Berlin Heart and Novalung). 

We are recognized for excellent patient outcomes. Our care of patients with complex patho-physiology, such as congenital diaphragmatic hernia, is emulated around the world. We are leaders in the care of other complex patient populations including bone marrow and multi-organ transplantation. As the largest PICU in Canada, our patients are from within Ontario, across Canada and other countries. 

The CCCU at SickKids is the first critical care unit in Canada dedicated to the care of infants and children with heart disease. 

We provide comprehensive care to over 800 patients per year with a team of specialized physicians and nurses who are dedicated to care of neonates, infants and children with heart disease. Allied health professionals including respiratory therapists, pharmacists, nutritionists, physiotherapists and social workers are similarly aligned to support the needs of our patients. 

We support all segments of the Labatt Family Heart Centre including the Cardiovascular Surgery program, the Cardiac Diagnostic and Interventional Unit, the Cardiomyopathy and Heart Failure Program, Heart Transplant Service and the Pulmonary Hypertension Service. Our outcomes are amongst the best in the world for even the most complex patients and we strive to deliver this state-of-the-art care in a supportive family-centred environment. 

The Department of Critical Care Medicine at The Hospital for Sick Children is a multidisciplinary department with a 41-bed Intensive Care Unit (ICU). 

The University of Toronto Paediatric Critical Care Training Program is based within the Department of Critical Care Medicine at SickKids. The Paediatric Critical Care Program is accredited by the Royal College of Physicians and Surgeons of Canada. The department is staffed by a number of intensivists and all patients are admitted under the primary care of these physicians. 

Additionally, there are 15-20 full-time fellows/residents appointed for a period of at least one year, who have completed postgraduate training in either Anesthesia, Paediatrics or Paediatric Surgery.  There are also rotating residents assigned to the unit from Paediatrics, Anesthesia, Surgery and other subspecialty services.  

Physician leadership

Chief - Department of Critical Care Medicine
Dr. Steve Schwartz

Division Head - Paediatric Intensive Care Unit (PICU) 
Dr. Elaine Gilfoyle

Division Head - Cardiac Critical Care Unit (CCCU)  

Dr. Roxanne Kirsch

Residency Program & Fellowship Director

Dr. Briseida Mema

Research Director - Department of Critical Care Medicine & Acute Care Research Program 
Dr. Anne-Marie Guerguerian 

Staff physicians

• Dr. Gail Annich
• Dr. Haley Christian
• Dr. Alejandro Floh 
• Dr. Melany Gaetani
• Dr. Seth Gray
• Dr. Andrew Helmers 
• Dr. Lennox Huang 
• Dr. Roxanne Kirsch
• Dr. Nicole McKinnon 
• Dr. Briseida Mema 
• Dr. Haifa Mtaweh
• Dr. Christopher Parshuram 
• Dr. Luciana Rodriguez-Guerineau 
• Dr. Oshri Zaulan
• Dr. Olugbenga Akinkugbe
• Dr. Barney Scholefield
• Dr. Bhavikkumar Langanecha
• Dr. Rugambwa Michael Muhame

The clinical operations of the PICU and CCCU are led by a highly skilled and dedicated team of health care professionals. Operational accountability is provided by Jackie Hubbert, the Clinical Director of The Labatt Family Heart Centre and Critical Care Services. Two senior clinical managers are responsible for the day to day operations in Cardiac CCU Lakshmi Chockalingham and Paediatric ICU (Mary Chen). Overseeing budgets of over $10-million respectively and direct supervision of over 300 registered nurses (RNs) and clerical support staff, the operational managers work collaboratively within a team-based structure.  

The paediatric and cardiac teams consists of advanced practice nurses, educators, RRT educators/clinical specialists, clinical support nurses, charge RRTs, nurse practitioners, clinical nurse specialist and a quality manager.  

Our clinical team

• Karen Kinnear, RN, BScN, MBA - Vice President Clinical 
• Jackie Hubbert, RN, BScN, MBA - Clinical Director, The Labatt Family Heart Centre & PICU 
• Lakshmi Chockalingam - Senior Manager, CCCU 
• Mary Chen - Senior Manager Clinical Programs - PICU 
• Christina Sperling, RRT - Clinical Manager Respiratory Therapy 
• Karen Dryden-Palmer, RN, MN - Clinical Nurse Specialist 
• Cecilia Hyslop, RN - Advanced Practice Nurse Educator - CCCU 
• Leanne Davidson, RRT - Educator Respiratory Therapy – CCCU 
• Jason Macartney, RRT - ECLS & ECMO Program / Respiratory Therapist Educator 
• Sophie Joseph, 
Advanced Practice Nurse Educator PICU 
• Laura Buckley, PICU Nurse Specialist - Clinical Nurse Specialist  

Our frontline staff includes registered nurses (RNs) and registered respiratory therapists. The RNs and RRTs are an integral component of care delivery in both PICU and CCCU.  

Interprofessional team care occurs with pharmacy, dietitians, social work, physiotherapy, occupational therapy, child life, chaplaincy and other teams, throughout a child's visit - relative to the child’s specific needs.  

The Paediatric Critical Care Medicine Training Program at SickKids attracts individuals who might be at different stages on their journey but their destination is that of clinical and/or academic excellence with the goal of advancing the care of paediatric critically ill children globally. Our program seeks to foster the development of physicians towards clinical excellence and the advancement of the field of pediatric critical care medicine globally. Accordingly, we are looking for a cohort of trainees who are good clinicians and value teamwork and inter-professional practice. Our trainees have a natural desire for discovery, are imaginative and creative thinkers, active learners, and will make a positive impact by pushing the field of paediatric critical care medicine.

This program is an accredited program by the Royal College of Physicians and Surgeons of Canada (RCPSC) and is based within the Department of Critical Care Medicine at SickKids. We are part of the University of Toronto’s Interdepartmental Division of Critical Care Medicine (IDCCM), a large network of world-class intensivist educators, scientists and investigators across six university hospitals in the city. Clinical fellows in the program may choose to complete the RCPSC Subspecialty Examination Affiliate Program (SEAP) to join the Royal College as a Subspecialist Affiliate should they be appointed for a second year of training.

Read the program overview (PDF)

Read more about the application cycle (PDF)

Application timeline

Application reviews

July to August 2024
Selection Committee members review applications and short-list candidates for interview.

Selections & appointment

August to September 2024
Short-listed candidates are interviewed, final selections are made and offer letters will be sent to successful candidates

Application documentation requirements

• Updated Curriculum Vitae (CV)
• Copy of your Medical Degree (and notarized translation if applicable)
• Copy of your Specialty Certification (and notarized translation if applicable)
• Three Letters of Reference are required:
  • Letters must appear on official hospital/university letterhead (signed and dated) and submitted by the referee to our program by the application deadline
  • Letters must include the name and contact information for each of the three referees
  • Letters should comment on the following points:
    1. Clinical Skills/Ability
    2. Communication Skills
    3. Academic History
    4. Management/Administrative Skills
    5. Professionalism
• Please note that all foreign documents must be translated to English by a certified translator with a seal and stamp of approval to be accepted.

Apply now

Contact

Sydney March
Education Coordinator, Critical Care Medicine
The Hospital for Sick Children
Toronto, Ontario
Canada
ccm.fellowship@sickkids.ca

Paediatric Intensive Care Unit Nurse Orientation

Our mission is to provide safe and supportive interprofessional development. To be grounded by the principles of family-centred, evidence-based practice in content, method, design and in all learning relationships. To contribute to excellence in patient care and professional development utilizing principles of student focused learning. To contribute to scientific knowledge specifically related to professional staff development, educational strategies and knowledge transference. Paediatric care nursing and interprofessional education is a collaborative program founded on the philosophy of evidence based, interprofessional family-centred care. 

Goals 

• To provide a practice environment responsive to patient, family, professional team, community and organizational needs 
• To enhance the capacity for continuing education of the interdisciplinary team 
• To facilitate individual learners to achieve excellence in their professional practice and to meet their personal developmental objectives 
• To provide resources and support for the critical care of children outside of the critical care program and hospital 
• To maintain and enhance safe patient care 

Our continuing education programming includes preparation to deliver complex technological care, for example continuous renal replacement therapy and advanced expertise in areas of interest (ie trauma care). Leadership development and support in developing research skills are provided to interested staff through many unit-based, hospital and external programs. 

Orientation Program

Paediatric intensive care nursing orientations are coordinated so that foundational skills for practice and continued learning in the clinical area are developed in the first phase of learning. Specialty specific knowledge and preparation to care for individual patient populations is addressed within the second phase of orientation. Orientation education reflects the extensive depth and breadth of the different needs and illness experiences of the children and families in our care. 

Infrastructure for learning

Interprofessional Education Specialist

Clinical Orientation Support Nurse
Direct clinical practice supervision 
Consistent support and feedback to learners 
Interface with clinical staff regarding learner skills, assignment planning and shift to shift integration of learners 

Clinical Support Nurse role
Dedicated two per shift - clinical expert nurses 
Focuses on supporting clinical practice at the bedside 

Interprofessional education team members
Professional service team members, as well as experts from programs, which have their patients cared for in PICU are direct contributors to orientation content 
Role transition support is provided throughout orientation by the social worker and leadership team 

Preceptors

• Preceptors are matched to new staff at the completion of the classroom part of orientation 
• Preceptorship last for approximately 40 shifts. 
• They work closely beside the orientees in the same room
• They provide clinical guidance and supervision, support competency development, and negotiate supportive learning assignments with the unit leadership team. 

Orientation phases

Paediatric Nursing Orientation
New staff to the hospital attend general paediatric nursing classes 
Participate in lectures, workshops, skills training and evaluation 
Content includes basic line management, NG placement, pain scales, developmental care, diversity and family centered care 

PICU Orientation Framework
12 weeks in length, delivered in hospital 
Classroom learning with integrated clinical experiences. 
High fidelity simulation and competency-based evaluation 
Classroom learning is followed by an additional 8-12 weeks of supervised clinical learning with a preceptor. 

Student Program

We provide placement clinical support for undergraduate and graduate level learns from a number of educational institutions across Canada. 

For more information, please contact: 

Sophie Joseph 
Interprofessional Education Specialist 
The Hopsital for Sick Children (SickKids) 
555 University Ave 
RM 2849 
Toronto, ON 
M5G 1X8 
Canada 
Phone: 416-813-5055 
Fax: 416-813-7299 
email: sophie.joseph@sickkids.ca 

Cardiac Critical Care Nursing Orientation

“Learning is finding out what you already know. Doing is demonstrating that you know it. Teaching is reminding others that they know just as well as you. You are all learners, doers, and teachers.” Bach, (1977) in Illusions: The adventures of a reluctant messiah

Having a clinically competent and confident nursing staff caring for critically ill cardiac children and their families is essential and is dependent upon offering a comprehensive educational program in the Paediatric Cardiac Critical Care Unit.  

The Labatt Family Heart Centre, through its Avenues to Excellence, is committed to quality education and training. Initial and ongoing education is both valued and supported in Cardiac Critical Care. The nursing orientation program and ongoing training efforts are designed using adult learning principles and varied methods of teaching and learning. There is a wealth of knowledge shared and a collaborative approach to educational opportunities helps in achieving the goal of service excellence bringing us ever closer to the vision of Healthier Children. A Better World. Our quality educational program aims toward continuous quality improvement, optimizing patient safety, facilitating skill growth and leadership development, enhancing communication effectiveness and accountability. The critical care education is aimed at developing and retaining highly skilled and engaged nurses. 

The Cardiac Critical Care orientation program for new learners exposes them to an expert Interprofessional team who teaches the care and management of critically ill children. The layout of the Cardiac Critical Care orientation is designed to gradually prepare the newly hired nurse for this highly complex and technological environment.  
 
The goal is to prepare the new nurse for collaborative practice, partnering with other healthcare providers to deliver excellence in patient and family centred care. The duration of orientation is dependent on the orientees years of experience and considers their individual learning needs and styles. 

 Orientation
 
Orientation for “experienced” nurses consists of a three month 'core' orientation program, comprised of clinical and theoretical components. This is followed by eight weeks supported by a preceptor, role modeling the way.  
 
Orientation for “new graduate nurses” is a 12-month program.  It consists of the same three month 'core' orientation program, followed by a six-month clinical period spent with a preceptor (in a shared assignment) guiding their development. In the final three months, the learner is more independent in their practice and is coached as needed by their preceptor.   

Multimodal approach to learning

The multimodal approach to education facilitates learners at all levels, to understand the evidenced-based management of critically ill children and their families.  

The program includes:  

• Didactic sessions 
• Case studies 
• Self-directed learning 
• On-line learning 
• Rounds 
• Chapter reviews 
• Objective Structured Clinical Evaluations (OSCE’s) 
• Simulation training 

Clinical time throughout the first three months is interspersed between theoretical content, which enhances the integration and translation of knowledge.  Examples of theoretical content are:  

• Congenital heart disease 
• Advanced ECG interpretation 
• Cardiac physiology 
• Blood gas analysis 
• Respiratory physiology 
• Artificial airways 
• Ventilators and a great deal more

Ongoing training

Ongoing training of all nursing staff includes cardiac mandatory study days, OSCE evaluation, PALS training, “30 Minute Work-Out” skill based education, and support of conference attendance.  Attendance and participation at bedside patient care rounds, back rounds, ethics, research, and safety rounds, offer interprofessional health care providers with an excellent opportunity for collaborative practice by sharing their knowledge and experience. 

The increased use of simulation provides students with a more realistic environment to enhance critical thinking and problem solving skills.  Insitu mock codes using high fidelity simulators in the unit, enhances retention of guidelines. E-CPR (ExtraCorporeal CPR) training exists, supporting resuscitation onto ECMO (extracorporeal membrane oxygenator).  This type of in the moment, insitu training helps prepare nurses and interprofessional team members for these critical and sudden events, hopefully enhancing patient outcomes. 
 
The Cardiac Critical Care Unit sees a broad spectrum of patients such as those with congenital and acquired heart disease, heart transplantation and those requiring advanced technology and life support – (eg. ECMO, Berlin Heart, Novalung and Continuous Renal Replacement Therapy). Subspecialty training in these areas is offered to experienced Cardiac Critical Care nurses; including competency assessment to help them provide the best possible care. 

Cardiac Critical Care has focused efforts on enhancing communication and leadership between all health-care team members.  Using the Crucial Confrontations framework by VitalSmarts, caregivers are encouraged to engage in communication that is respectful and at the same time holds people accountable for broken promises, violated expectations and bad behavior.  A program for training, and mentoring has been developed for interprofessional staff. 

SickKids in collaboration with George-Brown College is planning to provide a two-module program (Pediatric Cardiology Level 1 – Theory & Clinical; Pediatric Cardiology Level 2 – Theory & Clinical).  
 
This course is designed to provide interprofessional health-care team members with the knowledge, skills and competencies to care for the child and family with congenital and acquired heart disease across the lifespan. Each module consists of 125 hours theory and 120 hours clinical. Clinical hours can be completed concurrently with theory or up to three months post theoretical component completion. Learners will actively integrate theoretical knowledge with observational and hands on practice in a variety of paediatric cardiac settings, including: 

• inpatient and critical care unit 
• operating room 
• diagnostic interventional catheterization 
• cadaver laboratories 
• outpatient clinics 

In summary, enabling our people through the provision of quality cardiac critical care education, supports our goal of leadership in world class quality and service excellence.  Every effort in education is aimed at Healthier Children. A Better World.   

For more information, please contact: 

Cecilia Hyslop 
Cardiac Advanced Practice Nurse 
Critical Care Medicine 
The Hospital for Sick Children (SickKids) 
555 University Ave 
RM 2849 
Toronto, ON 
M5G 1X8 
Canada 
Phone: 416-813-6499 
Fax: 416-813-7299 
email: cecilia.hyslop@sickkids.ca 

Education Program

SickKids Paediatrics Critical Care Program is the primary training site for respiratory therapy students from The Michener Institute for Applied Health Sciences, Canadore College and St. Claire College. The Respiratory Therapy Department also provides in-house training in paediatric critical care for new respiratory therapists, inter-professional team members and paramedics. 

Registered Respiratory Therapists (RRT) are integral members of the Critical Care team providing cardio-respiratory support to acutely ill patients. They have specialized knowledge and skills in mechanical ventilation, oxygen therapy and airway management. Many of the RRTs also have advanced training in extracorporeal membrane oxygenation (ECMO) and other extracorporeal therapies such as the NOVA Lung and Continuous Renal Replacement Therapy (CRRT). 

RRTs joining the Critical Care Team undergo extensive training in paediatric cardio-respiratory care. The orientation typically includes two weeks of didactic and lab training, followed by four weeks of mentored shifts with an RRT, at the bedside.  After completing this time, new RRT staff are given the opportunity to provide feedback about their experience and then attend an additional lecture day to cover advanced topics and any outstanding issues.  

Ongoing education is coordinated by two Respiratory Therapy clinical specialists; one with a focus on the PICU and the other with a focus on the CCCU.The CCU is staffed with six RRTs, 24-hours per day, 365 days per year, with at least two of the six being Certified ECMO Specialists.  One Charge RRT takes on the leadership role per shift, maintaining communication with the Charge RN’s in both PICU and CCU, and ensuring the RRT team is supported throughout their shift.   Additionally, one member of the team is assigned to the Code Blue Team for their shift; providing hospital wide response to acute emergencies. 

RRTs are involved in a variety of initiatives within the CCU, including committee work, research, quality improvement, and implementation of best practices. The CCU RT Professional Practice Group (PPG) meets regularly to examine clinical practice and make recommendations for practice changes, new therapies or strengthening core services. 

For more information, please contact:

Leanne Davidson 
- Critical Care Respiratory Therapy Educator
 
Critical Care Medicine
 
The Hospital for Sick Children (SickKids)
 
555 University Ave
RM 2849
Toronto, ON  
M5G 1X8
 
Canada
 

Phone: 416-813-6486
 
Fax: 416-813-7299 

email: leanne.davidson@sickkids.ca