Our Pediatric Critical Care fellowship is a three year fully accredited program by the Accreditation Council for Graduate Medical Education (ACGME) whose goals include: providing educational and clinical experience so that subspecialty residents will be proficient in their ability to care for and manage critically ill children; providing with research opportunities in any of a number of fields that may be of interest to subspecialty residents; and to encourage involvement in the education of pediatric residents and medical students, as well as other health care professionals. At the end of the fellowship, subspecialty residents would have gained necessary skills to be able to pursue a pediatric critical care career in any capacity, including academic medicine.
1. Patient Care: Fellows are expected to render patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. The program will provide fellows with the opportunity to master the knowledge and skills necessary to diagnose and manage pediatric patients with critical care diseases. Additionally, fellows will be trained in the selection, performance, and interpretation of diagnostic and therapeutic procedures used in the care of pediatric critical care medicine.
2. Medical Knowledge: Fellows are expected to acquire the knowledge about the established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences necessary to provide compassionate, appropriate, and effective patient care. This will include specific knowledge of development, anatomy, physiology, pathophysiology, and epidemiology of pediatric critical care diseases.
3. Practice-Based Learning and Improvement: Fellows are expected to participate in an ongoing process that involves the investigation and evaluation of their own patient care, appraisal and assimilation of scientific knowledge, and improvements in patient care. Fellows are expected to engage in Scholarly Activity as defined by the American Board of Pediatrics. The program will aid fellows in developing the knowledge and skills needed to engage in such activity.
4. Interpersonal and Communication Skills: Fellows are expected to demonstrate interpersonal and communication skills that will result in an effective information exchange and teaming with patients, patients’ families, and other health care professionals. The program will work with fellows to enhance their skills as educators of patients, families, and allied health care professionals.
5. Professionalism: Fellows are expected to demonstrate a high degree of professionalism as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
6. Systems-Based Practice: Fellows are expected to demonstrate an awareness of and responsiveness to the larger context and system of health care. They should demonstrate the ability to effectively call on system resources to provide care that is of optimal value.
The first year curriculum involves six months of clinical rotations in our joint, twenty-bed Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU) at Children’s Memorial Hermann Hospital and two months of pediatric anesthesia, which includes exposure to cardiovascular anesthesia and procedural sedation. Four months of research complete the remaining time in the first year, of which the goals include: identification of a research mentor, initiation of a research project, and establishment of a Scholarly Oversight Committee (SOC).
The second year curriculum includes five months of clinical rotations in the PICU and PCICU with increased autonomy and responsibility in patient care. Clinical responsibilities are reduced as compared to the first year to provide seven months of protected research time, which is usually aggregated in three- to four- month blocks. Further development of the fellow’s research project occupies most of the second year, including submission of a research proposal to the SOC, execution of a research project, and data collection, analysis, and interpretation. The progress of the fellow’s research project is closely monitored by the SOC, which is expected to meet biannually with the fellow.
The third year of the fellowship is largely devoted to research. Clinical responsibilities during the third year include two months in the PICU and PCICU as acting attending and two months of electives, depending on each fellow’s specific interests. Eight months of research are provided in the third year for continued data collection, analysis, and interpretation as well as the submission of a first-authored manuscript, reporting the fellow’s research findings, to a high impact, quality journal. The fellow is expected to meet biannually with the SOC in the third year.
Throughout the three-year curriculum, fellows participate in a broad variety of educational conferences, journal clubs, case conferences, research seminars, and quality-improvement conferences, within the Division of Pediatric Critical Care Medicine, the Department of Pediatrics and Children’s Memorial Hermann Hospital. The Department of Pediatrics Fellows’ Core Curriculum Conference Series provides a structured curriculum for all fellows in the Department of Pediatrics and addresses topics including, but not limited to, research design, grant writing, presentation and teaching skills, quality improvement initiatives, principles of evidence-based medicine, professionalism, and an assortment of other topics. Pediatric critical care medicine fellows also participate in teaching an Advanced Pediatric Life Support course, “mock codes,” and PICU nurses and respiratory therapists, and pediatric residents. All fellows complete an extracorporeal membrane oxygenation (ECMO) certification course in their first year. Fellows are expected to present their research at local, national, or international conferences and are given five days each year in order to participate in academic meetings.
The fellowship program provides extensive clinical experience in every aspect of pediatric critical care. Over 850 patients are admitted each year to our 20 beds combined Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU) located at state-of-the-art Children Memorial Hermann Hospital in Houston, Texas. The fellows are directly involved in the management of all critically ill medical and surgical patients, including supervising pediatric residents and working in a multidisciplinary environment with the pediatric surgical subspecialists. They get experience in performing all the critical care procedures with increased independence each year of fellowship. Fellows are exposed to advanced technologies available for monitoring respiratory, cardiovascular and neurological function including advanced respiratory mechanics monitoring and capnography for ventilated patients, invasive cardiac monitoring, and intracranial pressure monitoring. Highly specialized technologies are available including extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric respiratory and cardiac failure, high frequency oscillatory ventilation, inhaled nitric oxide, continuous bedside renal replacement therapy.
In addition to gaining expertise in the medical management of critical illnesses, fellows are actively involved in the management of critically ill pediatric surgical patients. All pediatric surgical subspecialties are represented in the Department of Pediatric Surgery including cardiovascular surgery, neurosurgery, general surgery, trauma, pediatric otolaryngology, orthopedics, solid organ transplant, and plastic surgery. Neonates with complex congenital heart disease are admitted post-operatively to the PCICU. Over 125 pediatric and neonatal open heart surgeries are currently being performed each year. Multidisciplinary rounds consisting of the cardiovascular surgeons, cardiologists, and pediatric critical care team facilitate the care of the cardiac patients within the PICU.
The faculty of the Division of Pediatric Critical Care Medicine is comprised of five full-time board certified/eligible pediatric intensivists with 24/7 in-house attending coverage. The PICU staff comprised of a broad range of healthcare professionals including highly skilled and specially trained critical care nurses and respiratory care practitioners, residents, medical students, social workers, physical and occupational therapists, chaplains, discharge planners, clinical nutritionists, and clinical pharmacists. All medical and surgical subspecialties are readily available to provide consultation as needed. Our PICU delivery model supports the entire team’s commitment to utilizing their specialized skills to meet our patients’ needs in a family-centered care environment.
o ensure our fellowship program leads to the development of well-rounded, pediatric critical care medicine physicians, all fellows are required to spend eighteen months of their thirty-six month fellowship pursuing a research project under the supervision of a mentor. Depending upon the fellow’s interest, a basic science, translational, or clinical research project can be undertaken with the appropriate mentor to fulfill this requirement. In addition, our fellowship program consists of intra- and extra-divisional curricula, which are designed to complement the individualized research training provided by the fellow’s mentor.
A. Goals of Research
- To assimilate new knowledge, concepts, and techniques in pediatric critical care medicine.
- To formulate clear and testable hypotheses from a body of information so as to be prepared to become an effective pediatric critical care physician.
- To engage in specific areas of scholarly activity to allow for the acquisition of skills in the critical analysis of the work of others.
- To advance research in pediatric critical care medicine.
B. Objectives of Research
- Engage in a project, under the supervision of a mentor, which allows the fellow to develop hypotheses or substantive scholarly exploration and analysis that requires critical thinking.
- Attain a basic understanding of the methods needed for the research project and submit a research protocol to the appropriate institutional committee for approval.
- Collect and analyze data, derive and defend conclusions, and place conclusions in the context of what is known or not known about a specific area of inquiry.
- Present work in oral and written form to a Scholarly Oversight Committee (see below) and submit a first-author manuscript to a relevant high-impact, quality journal for peer-review.
C. Research Timeline and Expectations
- The fellow is allotted eighteen months for research. The research project must be completed before the end of the third year of fellowship training. The project must be hypothesis-driven, achievable, and relevant to pediatric critical care medicine.
- The initiation of a research project starts during the first year and includes the identification of a research mentor, a research project, and the establishment of Scholarly Oversight Committee. It is essential that the research mentor has the expertise to successfully oversee the fellow’s research project. To begin this process, the fellow will meet with the Associate Director of Research for the Division of Pediatric Critical Care Medicine within the first month of fellowship training. The research project and selection of a mentor requires approval of the Division Director, Fellowship Director, and Associate Director of Research.
- During the second year, the fellow is expected to submit a research proposal to his or her Scholarly Oversight Committee and begin the execution of his or her research project.
- During the third year, the fellow will continue data collection and subsequent analysis and submit a first-authored manuscript of his or her research for peer-review.
- These activities require active participation by the fellow and his or her mentor. The mentor(s) will be responsible for providing continuous feedback, which is essential for the trainee’s professional development.
D. Scholarly Oversight Committee
Each fellow must have a Scholarly Oversight Committee. The Scholarly Oversight Committee consist of three or more individuals, at least one of whom is based outside the fellow’s subspecialty discipline. The Fellowship Program Director may serve as a trainee’s mentor and participate in the activities of the Scholarly Oversight Committee, but only as an ex officio member. The Associate Director of Research for the Division can serve as a trainee’s mentor and a voting member of a trainee’s Scholarly Oversight Committee. For those trainees whose research falls outside of the expertise of the Associate Director of Research, the Associate Director of Research will serve as an ex officio member of the trainee’s Scholarly Oversight Committee.
The Scholarly Oversight Committee has several functions.
- Determine whether a specific activity is appropriate to meet the American Board of Pediatrics guidelines for scholarly activity.
- Determine a course of preparation beyond the core fellowship curriculum Evaluate the fellow’s progress as related to scholarly activity.
- Meet with the fellow early in the training period and every six months thereafter.
- Require the fellow to present and defend his or her scholarly research project.
- Advise the Fellowship Program Director and Associate Director of Research on the fellow’s progress and assess whether the fellow has satisfactorily met the guidelines associated with the requirement for active participation in scholarly activities.
- The final responsibility of the SOC is to review and approve the final scholarly “work product” of the fellow prior to submission to the ABP at the completion of training.
E. Work Product Report
Involvement in scholarly activities must result in the generation of a specific written “work product” as outlined by the ABP (www.abp.org). Examples of include, but are not limited to:
- A peer-reviewed publication in which a fellow played a substantial role
- An in-depth manuscript describing a completed project
- A thesis or dissertation written in connection with the pursuit of an advanced degree
- An extramural grant application that has either been accepted or favorably reviewed
- A progress report for projects of exceptional complexity, such as a multi-year clinical trial
The fellow’s SOC will be instrumental in guiding the fellow’s activity towards an acceptable product. It is the responsibility of each fellow to write their work product report and personal statement, as well as obtain approval from the SOC to be eligible to sit for the Subspecialty Board Examination.
F. Responsibility of Program Director
A written progress report by each trainee’s signed by all SOC members should be completed twice a year and forwarded to the fellowship program director.
The fellowship program director will keep documentation of each SOC meeting in the fellows file.
The fellowship director and the members of the fellow’s SOC are expected to monitor whether additional SOC meetings are necessary for fellows who need more help or may be changing their scholarly activity.
It is the responsibility of the training director to review the SOC documentation and clarify the responsibilities and outcomes for each fellow. The SOC and the Fellowship Program Director are both accountable for scholarly progress of individual fellows.
G. Verification of Scholarly Activity
Upon completion of fellowship training, the ABP requires verification from the training program director that the clinical and scholarly skills requirements have been met. This includes
- A comprehensive document (i.e. personal statement), written by the fellow, describing the scholarly activity that includes a description of his/her role in each aspect of the activity and how the scholarly activity relates to the trainee’s own career development plan.
- The actual “work product” of the scholarly activity as described above.
- Signature of the fellow, program director, and members of the Scholarship Oversight Committee on both the personal statement and work product of the fellow as described above