A Day in the Life of a Third Year Fellow
Each day can be quite different for a third year PICU fellow here at Children’s Hospital of Wisconsin! Since the service time is only 14 weeks, there are 38 weeks out of the year to do a myriad of other activities. Most of that time is spent working on a scholarly activity. For some, it means going to a research lab and working on experiments. For others, it means coming to the office and working with statisticians reviewing data that has been collected for a clinical research study. For me, it means going to class. I am working on a master’s degree in bioethics as well as a qualitative research study. Thus I spend my time in the classroom, on the wards doing ethics consultation, in the office reviewing data I’ve collected for my project or in the library reading materials for class.
In addition to the time spent working on the scholarly activities, each of us participate in administrative duties. Each fellow spends time during the third year making the call and transport schedules. This involves a fair amount of coordination among the fellows, nurse practitioners and acute care specialists. In addition, each fellow has their own unique administrative duty for the year. For example, one fellow helps with the fellowship recruitment for the next year, meeting with applicants and answering questions by email. Another fellow makes the core conference schedule, coordinating the topics and speakers for each week’s conference. A third fellow runs the monthly fellow administrative meeting, where we review all relevant business and receive education regarding administrative topics such as billing and quality improvement.
Beyond the individual duties, all fellows participate in a quality improvement project. These projects typically start in the second year and continue through the rest of fellowship. One recent project focused on looking at how to enhance the transfer of patients and patient information when a patient either transfers critical care service providers or goes from the PICU to a general floor. We also completed a project looking at ways to diminish the costs, both fiscally and physically, surrounding lab orders in the PICU. We used a daily reminder sheet at each bedside to remind us to assess the frequency of lab draws such that we can minimize the blood loss to each patient and the financial costs associated with it. This project went so well that these reminder sheets are at each patient’s bedside today and help remind us not only of lab draw frequency, but also to review nutritional goals, discharge plans, pain and sedation goals and whether or not invasive tubes and lines are necessary for that patient.
Personal goals can also be achieved during the third year of fellowship. For example, some fellows spend additional time learning procedural sedation. Some fellows spend time doing international health, going abroad and working to help third world communities. Some fellows spend more time in the operating room, finessing procedural skills or performing bronchoscopies. Some fellows work on education curriculum, mock codes, teaching PALS (pediatric advanced life support) or ATLS (advanced trauma life support). We are very fortunate to have such flexibility to tailor the third year in the way we see fit.
Finally, the third year is a very special time for fellows while on service. The fellow now leads daily rounds, taking the lead with families and patients, as well as with consultants of other services. Leadership and autonomy are built during these times, when the fellow is acting as the attending (or as we affectionately call it, “pretending”). In addition, we have the opportunity to carry the “3939” pager, which is the admitting and transport pager. We learn to manage patients over the phone and to coordinate patient placement in the PICU.
Thus, as one can easily see, the third year of fellowship can be quite unique, depending on the interests of each individual fellow. The third year of fellowship is the time where you transition to becoming an attending. Yet there is still an array of other activities that make the third year one of the most exciting times of fellowship! There is tremendous growth and steady transition from being a fellow to becoming an attending.