A Day in the Life of a First Year Fellow
In our first year of fellowship we spend 26 weeks on service in the PICU, divided into six 4-week blocks and one 2-week block. A typical day on service involves arriving at the hospital just before 7 a.m. to print a patient list and check on labs. Sign out is at 7 a.m. every day where we hear about overnight events and new admissions from the on-call person. Then we see patients until 8 a.m. when we have radiology rounds and review x-rays as a team. On the 3rd floor (Cardiac ICU) we review films and overnight events with the cardiovascular surgeons and on the 4th and 5th floors (Surgical and Medical ICU) we review films with a radiologist. We generally start walking rounds at 8:30 a.m. and finish between 11 a.m. and noon. Every Monday and Wednesday at noon we have Research Conference and Core Curriculum Conference for the whole Critical Care section. Tuesday noon conferences alternate between Professors Rounds which is a didactic session for fellows, nurse practitioners and rotating residents and fellows that focuses on one particular topic or disease and we invite a basic scientist or clinician with expertise in that area, and cardiac-focused didactics. The afternoons are spent following up on patients’ clinical condition, admitting new patients, and documenting the daily progress notes in EPIC, our hospital's electronic health record. Evening sign-out starts around 4 p.m. and is usually complete by 5 p.m.
In our first year we have 7 calls per month. Night calls are a good time to walk around the unit and think about the patients’ pathophysiology and troubleshoot as needed. We become more comfortable as the year progresses and realize that help is only a few feet away.
For our non-service months we have the opportunity to broaden our clinical and practical knowledge base. We spend two 4-week blocks with anesthesia focusing on airway management and principles of anesthesia. Four 4-week blocks are dedicated for research where can we choose a faculty member to work with and begin thinking about our own project to work on. The multiple research blocks and the large number of faculty available to work with ensures that we will identify an area of interest and a faculty mentor early on. To aid us in our research project we have a Scholarship Oversight Committee comprised of a faculty member from outside the division, and several Critical Care faculty members. In our first year we also spend 2 weeks with the transport team to gain experience and comfort with the transport process. Finally, we have 22 vacation days during our first year that we can take during our non-PICU months.
We also have administrative responsibilities during our first year and become involved in committees in areas of our particular interest. We spend time teaching residents and give a lecture series on PICU topics that is case-driven and geared towards board topics. Each year the first year fellow class completes an online quality improvement curriculum and begins to collaborate to choose a quality improvement project which will be implemented over the next two years of fellowship. I enjoy sharing an office with my co-fellows since it gives us the opportunity to get to know each other and exchange ideas.
As one can see our first year is a busy time that allows us to have a great deal of clinical exposure. During the course of a year we grow in our roles as fellows and take on more responsibility and improve our leadership skills. Children’s Hospital of Wisconsin is a great place to learn and train.