Pediatric Critical Care Medicine Content Outline

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Pediatric Critical Care MedicineContent OutlineIn-Training, Certification, andMaintenance of Certification ExamsEffective for examinations administered November 1, 2020, and afterTHE AMERICAN BOARD of PEDIATRICS

Table of ContentsOverview . 1Development of the Pediatric Critical Care Medicine Content Outline . 1Content Domains . 1Universal Tasks . 1Development and Classification of Exam Questions . 2Exam Weights . 3Detailed Content Outline . 4Domain 1: Normal Organ System Development and Function, Anatomy and Physiology, Pharmacology, andPharmacokinetics . 4Domain 2: Common Conditions . 4Domain 3: Sedation and Analgesia . 5Domain 4: Organ Support Therapies and Monitoring . 6Domain 5: Procedures . 6Domain 6: End of Life . 7Domain 7: PICU Management and Coordination of Care . 7Domain 8: Professionalism, Leadership, Advocacy, and Education . 7Domain 9: Clinical Ethics . 7Domain 10: Core Knowledge in Scholarly Activities . 7

OverviewPCCM exam (in-training, initial certification, andmaintenance of certification) is classified according tothe content domain and subdomain to which it is mostclosely aligned. If an exam question does not align withone of the content subdomains, it is removed from thequestion pool and is not included on an exam.This content outline was developed to serve as theblueprint for the pediatric critical care medicine(PCCM) in-training, initial certification, andmaintenance of certification examinations. This outlineidentifies for all important stakeholders (eg,prospective candidates, diplomates, the public,training programs, professional associations) theknowledge areas being measured by these exams.Pediatric Critical Care Medicine Content Domains1. Normal Organ System Development andFunction, Anatomy and Physiology,Pharmacology, and Pharmacokinetics2. Common Conditions3. Sedation and Analgesia4. Organ Support Therapies and Monitoring5. Procedures6. End of Life7. PICU Management and Coordination of Care8. Professionalism, Leadership, Advocacy, andEducation9. Clinical Ethics10. Core Knowledge in Scholarly ActivitiesThis outline takes effect on November 1, 2020. Allpediatric critical care medicine (PCCM) examinationsadministered after this date will adhere to thespecifications within this outline.DEVELOPMENT OF THE PEDIATRIC CRITICAL CARE MEDICINECONTENT OUTLINEThe initial draft of this content outline was developed bya diverse, representative panel of practicing PCCMsubspecialists. The panel identified the knowledgerequired of PCCM subspecialists in clinical practice andcategorized that knowledge into content domains andsubdomains. All Board-certified PCCM subspecialists (N 2,535) were then invited to provide feedback via anonline survey. A total of 619 PCCM subspecialists (24%)rated the frequency and criticality of the contentdomains and subdomains. The survey also collectedopen-ended comments from respondents in order toidentify any important content areas that were notincluded in the initial draft.UNIVERSAL TASKSTo help ensure the clinical relevance of the PCCMexams, the practice analysis panel identified a set offour universal tasks that reflect the primary ways inwhich medical knowledge can be applied in clinicalpractice: (1) core science, physiology, andpathophysiology, (2) epidemiology and riskassessment, (3) diagnosis, testing, and monitoring,and (4) management and treatment. Each examquestion that falls within content domain 2 (commonconditions) is classified according to the universal taskto which it is most closely aligned. If a test questionwithin domain 2 does not align with one of theuniversal tasks, it is removed from the question pooland is not included on an exam. The universal tasksare described more fully below.The survey results were used to make final revisions tothe outline and to establish the exam weights (ie, thepercentage of exam questions associated with eachcontent domain). The content domains that were ratedas highly critical and frequently required in practicehave been weighted more heavily than the domainsrated as less critical and/or less frequently required.Establishing the exam weights in this manner helps toensure that the ABP’s PCCM exams are measuring thefull breadth of knowledge required for clinical practice,while also placing an appropriate amount of emphasison the content domains that were identified bypracticing subspecialists as being critically important.CONTENT DOMAINSThe knowledge for safe and effective practice as aPCCM subspecialist has been categorized into 10content domains, presented in the table below. A moredetailed breakdown of the knowledge within eachdomain is reflected in the detailed content outline,beginning on page 4. Each exam question included on a1

Universal Tasks for Pediatric Critical Care MedicineUniversal Task1. Core science, physiology, andpathophysiology2. Epidemiology and riskassessment3.Diagnosis, testing, andmonitoring4.Management and treatmentDescriptionUnderstanding and applying anatomy, physiology, and pathophysiology tothe care of critically ill children in an age-specific developmental contextRecognizing patterns of health and disease and understanding thevariables that influence those patterns, including risk factors, riskstratification, natural history, and conditions that affect outcomesUsing available information (eg, patient history, physical exam, laboratorytests, imaging, and other tests) to formulate differential diagnoses,choose appropriate tests, and monitor disease evolution, response totreatment, and complicationsFormulating a comprehensive management and/or treatment plan,including appropriate organ-supportive therapeutic modalities,consultation, and reevaluation, taking into account multiple options forcare, co-morbidities, organ system interactions, relevant pharmacology,and evolving clinical statusDEVELOPMENT AND CLASSIFICATION OF EXAM QUESTIONSSAMPLE QUESTIONAlthough the field of pediatric critical care medicine iscontinually evolving, the content domains andsubdomains within this outline should be viewed asbroad categories of knowledge that are likely to remainrelatively stable over time. The detailed knowledgewithin the content domains and subdomains, however,is likely to change as the field continues to advance.Because exam questions may assess a PCCMsubspecialist’s knowledge of a specific element within acontent domain/subdomain, it is the responsibility ofthe test taker to ensure that his or her knowledge withineach knowledge area is current and up to date.To illustrate how exam questions are classified, considerthe following sample question:A 13-year-old, 50-kg boy with Crohn disease who hasbeen following a prescribed regimen of dailycorticosteroid therapy is admitted to the intensive careunit (ICU) following a 3-hour laparotomy, during whichhe lost 500 mL of blood. Anesthetic agents includedisoflurane, 5 mg of morphine, and vecuronium; 3 mg ofneostigmine and 0.6 mg of glycopyrrolate wereadministered at the end of surgery. Intraoperatively, thepatient received 1000 mL of lactated Ringer solution andtwo 100-mg boluses of hydrocortisone. On admission tothe ICU, he is extubated and has the following vital signs:pulse rate 150/min, respiratory rate 18/min, and bloodpressure 80/45 mm Hg.To ensure all PCCM exam questions are current and upto date, the ABP follows a rigorous questiondevelopment and approval process. Each examquestion is written by a board-certified subspecialist.Questions that fall within content domain 2 (commonconditions) are also classified to a universal task.Which of the following is the most likely explanation forthese vital signs?Once a question has been written, it is then discussedand revised, if necessary, by the ABP’s PCCM Subboard,a large, diverse panel of practicing PCCM subspecialists.During the revision process, each question is alsoreviewed multiple times by a medical editor to ensureaccuracy and by ABP editors who standardize questionstyle, format, and terminology; correct grammar; andeliminate ambiguity and technical flaws, such as cues tothe answer.A.B.C.D.Acute adrenal insufficiencyGlycopyrrolate toxicityHypovolemiaResidual isoflurane effectCorrect answer C. HypovolemiaThe question above would be classified as shown below:Content2. Common ConditionsDomain/C. Cardiovascular system4. Shock states (hypovolemic,Subdomain*distributive, obstructive,cardiogenic, septic)Universal Task 3. Diagnosis, testing, andmonitoringOnce the subboard has approved a question, it isincluded in the question pool and is made available forfuture exams. All approved questions in the pool arereviewed periodically for accuracy, currency, andrelevance.2*Note: Content subdomain 2.C.4 can be found on page 4

Exam WeightsThe tables below indicate the exam weights (ie, the percentage of exam questions associated with each contentdomain and with each universal task) for the ABP’s PCCM in-training, initial certification, and maintenance ofcertification exams. Please note that the weights reflect the content of a typical exam and are approximate;actual content may vary.Content Domains1. Normal Organ System Development and Function, Anatomy and Physiology,Pharmacology, and Pharmacokinetics2. Common Conditions*A. Multi-organ dysfunction/failure and organ system interactionsB. Respiratory systemC. Cardiovascular systemD. Neurologic systemE. Inflammatory, immunologic, and infectious syndromes and diseasesF. Kidney disease, fluid, and electrolyte disturbancesG. Hematologic disorders and neoplasmsH. Endocrinologic and metabolic conditionsI. Hepatobiliary and gastrointestinal disease, and nutrition for critically illand injured childrenJ. TraumaK. Toxicologic illness and envenomationsL. Behavioral health/commonly encountered psychiatric conditions3. Sedation and Analgesia4. Organ Support Therapies and Monitoring5. Procedures6. End of Life7. PICU Management and Coordination of Care8. Professionalism, Leadership, Advocacy, and Education9. Clinical Ethics10. Core Knowledge in Scholarly .0%4.0%4.0%4.0%4.0%1.0%* Questions that fall within content domain 2 are also classified to a universal task (see below).Universal Tasks *1. Core science, physiology, and pathophysiology2. Epidemiology and risk assessment3. Diagnosis, testing, and monitoring4. Management and treatment* Universal task classifications and exam weights apply only to questions within content domain ight20.0%5.0%40.0%35.0%100%

Detailed Content OutlineDomain 1: Normal Organ System Development and Function, Anatomy and Physiology, Pharmacology, andPharmacokineticsA. Respiratory systemB. Cardiovascular systemC. Neurologic systemD. Inflammatory and immunologic response systemE. Kidney function and fluid/electrolyte homeostasisF. Hematologic systemG. Endocrinologic and metabolic systemsH. Hepatobiliary and gastrointestinal systemsI. Pharmacology and pharmacokineticsDomain 2: Common ConditionsThe questions in this domain will be classified to both a content subdomain and a universal task. The contentsubdomains reflect the common conditions that pediatric intensivists must know, and the universal tasksreflect the primary ways in which knowledge is applied in clinical practice.Universal TaskDescription1. Core science, physiology, andUnderstanding and applying anatomy, physiology, and pathophysiology topathophysiologythe care of critically ill children in an age-specific developmental context2. Epidemiology and riskRecognizing patterns of health and disease and understanding theassessmentvariables that influence those patterns, including risk factors, riskstratification, natural history, and conditions that affect outcomes3. Diagnosis, testing, andUsing available information (eg, patient history, physical exam, laboratorymonitoringtests, imaging, and other tests) to formulate differential diagnoses,choose appropriate tests, and monitor disease evolution, response totreatment, and complications4. Management and treatmentFormulating a comprehensive management and/or treatment plan,including appropriate organ-supportive therapeutic modalities,consultation, and reevaluation, taking into account multiple options forcare, co-morbidities, organ system interactions, relevant pharmacology,and evolving clinical statusA. Multi-organ dysfunction/failure and organ system interactionsB. Respiratory system1. Acute respiratory distress syndrome (ARDS)2. Upper respiratory tract disorders3. Lower respiratory tract disorders4. Pulmonary circulation (includes pulmonary hypertension)5. Disorders of gas exchange (including blood gas analysis)6. Other disorders of the respiratory system (eg, diaphragmatic dysfunction, central control ofrespiration)C. Cardiovascular system1. Congenital heart disease2. Acquired heart disease3. Rhythm disturbances4. Shock states (hypovolemic, distributive, obstructive, cardiogenic, septic)5. Cardiac arrestD. Neurologic system1. Acute CNS disorders2. Chronic CNS disorders4

E.F.G.H.I.J.K.L.3. Peripheral nervous system disorders (including neuromuscular)4. Neurologic and neuropsychiatric complications of critical illnessInflammatory, immunologic, and infectious syndromes and diseases1. Sepsis and related conditions2. Infectious syndromes and diseases3. Transplant medicine4. Autoimmune and inflammatory conditions5. Primary and secondary immunodeficiencies6. Other immunologic conditions and infection-associated syndromes (rheumatic heart disease,anaphylaxis, toxic shock, etc)Kidney disease, fluid, and electrolyte disturbances1. Acute and chronic, primary and secondary kidney dysfunction2. Fluids and electrolytesHematologic disorders and neoplasms1. Hematologic disorders (includes coagulopathy, thrombosis, cytopenias, cell line abnormalities[quantitative and qualitative], etc)2. Neoplasms and complications (includes stem cell transplantation, tumor lysis syndrome,hyperleukocytosis, chemotherapies and their complications, etc)Endocrinologic and metabolic conditions1. Primary and secondary endocrinologic disorders (includes adrenal, thyroid, pituitary, pancreatic,parathyroid, etc)2. Primary and secondary metabolic disturbances (includes glucose homeostasis, inborn errors ofmetabolism, etc)Hepatobiliary and gastrointestinal disease, and nutrition for critically ill and injured children1. Hepatobiliary disease2. Gastrointestinal dysfunction3. Nutrition for critically ill and injured childrenTrauma1. Traumatic brain injury2. Penetrating injury, blunt injury3. Burn injury4. Environmental injury (includes heat stroke, lightning, etc)5. Child abuse6. Other (hanging, drowning, etc)Toxicologic illness and envenomations1. Toxidromes2. Envenomations3. Inhalation injury and hydrocarbon ingestionBehavioral health/commonly encountered psychiatric conditionsDomain 3: Sedation and AnalgesiaA. Different levels of sedation, potential complications, and steps for patient rescueB. Classes of anesthetics, sedatives, analgesics, and neuromuscular blocking agents, includingmechanisms of action, indications, duration of action, side effects, and contraindicationsC. Equipment and monitoring needed to provide safe and effective sedation during critical illness andfor procedural support5

Domain 4: Organ Support Therapies and MonitoringThe content subdomains listed below represent categories of organ support therapy and monitoringtechnologies. The questions in this domain may assess any of the following: (1) indications, contraindications,complications, and alternatives; (2) graphical output (normal and abnormal tracings) and interpretation,including radiologic studies; (3) foundational principles for device mechanics; (4) troubleshooting; or (5)common perturbationsA. Medical and mechanical support of failing organs1. Oxygen delivery systems, noninvasive ventilation, invasive mechanical ventilation2. Mechanical circulatory support devices, including ECMO and ventricular support3. Renal replacement therapyB. Monitoring modalities1. Invasive cardiorespiratory monitoring2. Noninvasive cardiorespiratory monitoring3. Invasive neurologic monitoring4. Noninvasive neurologic monitoringDomain 5: ProceduresThe questions associated with “Commonly performed procedures” (subdomain A) may assess any of thefollowing: (1) relevant anatomy and physiology, (2) indications and contraindications, (3) risks, (4) technicalaspects, or (5) complications. The questions associated with “Commonly assisted procedures” (subdomain B)may assess any of the following: (1) risks; (2) technical aspects, including positioning and monitoring of thepatient; or (3) potential complications.A. Commonly performed procedures1. Airway management (eg, airway adjuncts, bag-valve-mask ventilation, tracheal intubation,management of the difficult airway)2. Arterial catheterization3. Central venous catheterization4. Intraosseous cannulation5. Thoracentesis/thoracostomy tube placement6. Pericardiocentesis7. Abdominal paracentesis8. Defibrillation/cardioversion9. Cardiac pacingB. Commonly assisted procedures1. Flexible bronchoscopy2. Endoscopy of body viscera3. Bone marrow aspiration/bone marrow biopsy4. Plasmapheresis and other plasma-based therapies, and exchange blood transfusion5. Peritoneal dialysis6. Initiation of hemodialysis, including continuous renal replacement therapy (CRRT)7. Cricothyroidotomy8. Tracheostomy9. Intracranial pressure monitor placement10. ECMO cannulation6

Domain 6: End of LifeA. Defining and determining deathB. Pharmacologic and nonpharmacologic methods to manage pain/discomfort at the end of lifeC. Legal, ethical, and scientific practices during end-of-life care (eg, organ donation, terminalextubation)D. Advanced directives, assent as developmentally appropriate, and competence in deci

Universal Tasks for Pediatric Critical Care Medicine Universal Task Description 1. Core science, physiology, and pathophysiology Understanding and applying anatomy, physiology, and pathophysiology to the care of critically ill children in an age-specific developmental context 2. Epidemiology and risk assessment