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