Curriculum and Rotations Pediatric Critical Care Fellowship Curriculum Steve Tomek, MD, and Amanda Hall, MD, Fellow, providing care in the PICU General objectives include the development of: A strong fund of knowledge of pediatric critical care medicine Confidence to provide clinical care to critically ill children in a compassionate and ethical manner Technical proficiency with invasive diagnostic and therapeutic procedures necessary for providing critical care to children Management and interpersonal skills necessary to direct a pediatric intensive care unit and critical care program Teaching skills to effectively educate physicians, nurses, and other allied healthcare workers The ability to effectively utilize a team approach to both clinical and academic critical care medicine and to recognize the importance of such an approach Evaluation skills to critically review the medical literature as it relates to critical care medicine Research skills to further the body of knowledge in pediatric critical care medicine in clinical, laboratory, or translational research Rotations Rotations are scheduled in two-week to one-month blocks for the Pediatric Intensive Care Unit (PICU), and two-week to one-month blocks on the Pediatric Cardiac Intensive Care Unit (PCICU), depending on operating schedules. Trainees complete month-long formal rotations in anesthesiology and cardiothoracic (CT) surgery. We have also established rotations in sedation and a skill-building rotation in peripherally inserted central catheter (PICC) lines. Other rotations can be organized in consultation with the program director at the request of the fellow. Over three years of the pediatric critical care fellowship, fellows spend 14 months on PICU/PCICU service, one month in CT surgery, one month in anesthesiology, and 17 months in research, with three months of vacation. Clinical In order to balance the rigorous demands of medical intensivists, clinical training is spread across all three years of the pediatric critical care fellowship. Trainees benefit from in-house attendings and bedside teaching in the combined PICU/PCICU. Trainees focus on formulating diagnoses and learning the management principals of medical and complex surgical conditions under the supervision of the attending. They acquire a skill base to coordinate care for patients in the PICU/PCICU with other members of multidisciplinary teams, such as physicians, nurses, nurse practitioners, social workers, respiratory therapists, physical therapists, etc. After fulfilling mandatory, skill-based competency requirements, trainees begin to participate in the Pediatric Transport Program. As fellows progress in their pediatric critical care fellowship and demonstrate increasing competence, they earn increasing autonomy in the clinical setting. By the third year of fellowship, the attending intensivist supervises the trainee in an indirect fashion, as appropriate to each trainee’s strengths. The senior fellow completes a formalized rotation as an “attending” in which he/she directs rounds, supervises residents and junior fellows, and performs all of the activities of an attending physician, with the attending physician maintaining necessary, yet remote, supervision. At the completion of fellowship, our trainees demonstrate independent ability in patient care, complete a research project or scholarly activity, and expand upon any adopted roles as a clinician-educator or clinician-administrator. Fellows begin to teach residents and medical students during their first year of training. They also participate in the education of nursing and other staff. As training progresses, fellows acquire more teaching responsibilities for both groups. Second and third year fellows will complete rotations in PICC lines and on sedation service as skill-building modules. Research To support the development of their scholarly work, we provide increasing protected time for research during all three years of fellowship to address the requirements for ABP board certification. Many of our fellows have sufficiently progressed in their scholarly activity to present at a national conference during their second year of training. During the third year of training, each fellow completes his/her scholarly work product, obtaining signoff from their Scholarship Oversight Committee (SOC) members; this fulfills a major requirement for board eligibility. Didactic Educational activities provide trainees the forum to discuss the complex ethical, social, and other issues that occur in caring for seriously or terminally ill children, so that they may incorporate this knowledge into clinical practice.