Critical Care Medicine Fellowship
The Pediatric Critical Care Medicine fellowship is a three year program. Clinical responsibilities in the first year will include seven to eight months on clinical rotation (PICU/Anesthesia/CICU). Later in the year, fellows will assume administrative fellow responsibilities, including team management and leadership exposure, triage, and consultative experiences. In addition, in the first year, two to three months are devoted to the exploration of the fellow’s research interests .
During the second year, fellows will spend four-five months on clinical service in the PIC/CICU, with the remainder of the time spent on research. The third year focuses upon completion of the research pursuits with the goal of organizing and presenting the results of the scientific inquiry for peer review. In addition, clinical service time will focus on the preparation of the senior fellow to become an independent practitioner and leader of a multidisciplinary care team.
About Our Units
Fellows spend the majority of clinical time rotating though the Pediatric Intensive Care Unit and the Cardiac Intensive Care Unit. In the fall of 2011, the CICU moved to newly renovated space, with the PICU expanding into the current CICU space.
The PICU is a 32 bed unit, which includes a neurocritical care area (four privdate rooms) as well as a positive/negative isolation area (an additional four private rooms). The PICU is home to a state-of-the-art audiovisual center, the Baier Media Room. The CICU, located contiguously with the PICU, is a 13 bed unit that includes ten private rooms and a three bed pod. The unit includes telemetry monitoring from the central nursing station, an echocardiography viewing area, and a team center.
Children’s has become a leader among children’s hospitals in research funding. The Children’s Research Institute (CRI) is the academic home for many of our institution’s leading researchers, and both clinical and lab-based research opportunities are available to our trainees. Additionally, our division participates in both CPCCRN (the Collaborative Pediatric Critical Care Research Network, a competitive NIH-funded clinical trials network) and PALISI (the Pediatric Acute Lung Injury and Sepsis Investigators, a multi-center research consortium). With the NIH located only a few miles from Children’s National, the opportunity exists for selected fellows to participate in research.
Each of our trainees is expected to complete a minimum of one scholarly project during the course of their fellowship, resulting in the submission of a manuscript to a peer-reviewed publication. In addition, our fellows are expected to present findings at a national meeting.
A crucial first step in this process is the formation of a mentoring relationship with a faculty member (either inside or outside of our division), followed by development of a research question and specific aims and formation of a Scholarship Oversight Committee (SOC). The SOC will meet regularly with the fellow throughout his or her training to monitor the progress of the project, provide guidance, and assure that the fellow is engaging in a meaningful and educational scholarly endeavor that will meet the requirements for board certification.
Some important components of our research training include:
- Fellow core curriculum education series and research seminar guide fellows in the development of research skills.
- Academic Services Assistance Program (ASAP), a Wednesday noon seminar open to all Children’s faculty and fellows, offers multiple sessions focused on the development of research skills. Examples include conferences in submitting successful IRB proposals, securing funding, and poster preparation.
- Regularly scheduled opportunities to present research work to the critical care faculty.
- Opportunity to take courses at the George Washington University at minimal cost, including working towards a master’s degree for selected fellows.
In the 2009-2010 academic year there were 2,300 admissions to our intensive care units, with more than 500 of those to the cardiac ICU. In the PICU the clinical team has three critical care medicine fellows as well as pediatric residents; in the CICU the team has two critical care fellows and one cardiology fellow. In both units, the physician staff is strongly supported by nursing, pharmacy, nutrition, respiratory therapy, social work, and case management. Our rounds are family centered, with family members invited and encouraged to be present for and participate in our daily work rounds. Rounds are led seven days a week by a critical care medicine faculty member. Fellows are supervised at all times by an on call attending.
A sample schedule is shown below, based on the current system of 13 four-week blocks per academic year.
- 8 clinical blocks (to include 2 weeks of anesthesia)
- 4 non-clinical blocks (to include 4 weeks of vacation)
- 1 orientation block (to include hospital and critical care orientation, buddy calls with senior fellows, supervised procedures, and a week-long ECMO course)
- 6 clinical blocks
- 7 non-clinical blocks (to include 4 weeks of vacation)
- 5 clinical blocks
- 8 non-clinical blocks (to include 4 weeks of vacation)
NOTE: Non-clinical blocks are used mainly to participate in scholarly activity, with the expectation that each fellow submit a manuscript for peer-reviewed publication prior to the completion of his/her training. Clinical responsibilities during these blocks are limited to 3 to 4 calls, with some of the blocks being completely call free. Fellows are free to use these blocks to participate in elective rotations, provided that progress towards completion of his or her scholarly activity is satisfactory.
A brief overview of our regularly scheduled learning opportunities are listed below.
CICU conference: organized and led by John Berger, MD, this twice monthly conference for the critical care and cardiology fellows focuses on the pathophysiology encountered in medical and surgical patients in the CICU; various formats are utilized, including pro-con debates and topic reviews based on recent literature
Core content review: a fellow-led session that is held twice per month; board review type questions are written by the fellow leader, based on a reading assignment from one of the major pediatric critical care textbooks
Core education/clinical skills: two to three sessions per month that cover the critical elements of the American Board of Pediatrics curriculum in critical care medicine over the course of training
Ethics rounds: quarterly, case-based seminar that is facilitated by members of the Children’s National Ethics Committee
Evidence based medicine journal club: this monthly conference organized and facilitated by faculty members Tessie October, MD, and Mike Spaeder, MD, includes an in depth analysis of a recent publication relevant to pediatric critical care; the articles are reviewed based on the principles formalized by JAMA, and the discussion includes a focused review of a key statistical concept
Fellow/faculty research in progress conference: semi-annual presentations by members of the division engaged in clinical or basic science research; this is a key opportunity for the fellows to gain experience in presenting their work and to get valuable feedback on the progress of their research (Each fellow is expected to present once/year.)
Fellow core curriculum: twice monthly two-hour seminar that utilizes a three-year curriculum to cover key topics in medical professionalism and career development, including quality improvement, mentoring, risk management, and promotion/advancement and key topics in research, such as study design and statistical concepts
Journal review: fellows are assigned journals to review on a rotating bases; and then briefly (3-5 minutes) present an article of interest to the group
Leadership and management in medicine: bimonthly seminar led by David Stockwell, MD, these sessions include topics related to professionalism, interpersonal skills, team leadership, and the business of medicine
Morbidity and Mortality: organized by Jen Schuette, MD, this monthly, two hour conference is a quality improvement focused and multidisciplinary discussion of all critical events occurring in the PICU and the CICU
PICU/ER conference: critical care and emergency medicine fellows alternate as session leaders, covering topics of interest to both groups utilizing various formats (case review, pro-con debate, journal club, etc.)
PICU case conference: held monthly, a PICU case is presented by the primary fellow, followed by a discussion of the differential diagnosis, appropriate work up, and potential therapeutic interventions; the discussion is guided by faculty
Simulation session: Lillian Su, MD, leads the fellows in a monthly session held in our hi-fidelity simulation lab focusing on clinical scenarios aimed at improving teamwork skills and expanding clinical knowledge
Wessel Rounds: one of our most popular sessions, this conference is open to trainees from both critical care and cardiology; David Wessel, MD, leads the fellows through a Socratic discussion of a topic or case in the CICU
White board sessions: led by Jen Schuette, MD, this is a semi-monthly interactive session to review physiologic principles by responding to questions individually on a white board
Faculty and Staff
Children’s Critical Care Faculty members are leaders in the field. Visit the Critical Care faculty page to meet the team and learn more about our Division.
Frequently Asked Questions
Q: What are the benefits?
In addition to salary, each fellow receives $1,000 per year for education expenditures (academic meetings, membership dues, textbooks, etc.). Fees for your medical license and any other required permits are covered by the division.
Please Note: The American Board of Pediatrics requires that you miss no more than 3 months during your training, to include vacation, sick leave, and any other absences you may need to take. If additional time is missed, it must be added to the end of your training period.
Q: Can I see the sample contract for this program?
There is a sample contract used by the program.