Pediatric Critical Care

Our fellows receive the majority of their training at Children's Wisconsin. Our 72-bed Pediatric Intensive Care Unit has approximately 2,000 admissions per year.

The 36-month curriculum is divided roughly into 16 months of clinical work and 20 months of research activities as follows:

The first year is conducted in four-week blocks. Clinical service during the second and third years is done one week at a time, which allows for increased time dedicated to your scholarly project and ongoing career development including the opportunity to attend classes scheduled at the Graduate School of Biomedical Sciences, programmatic development, allowance for increased blocks of time in the laboratory, etc.

First Year

• PICU – 25 weeks
• Anesthesiology – 8 weeks
• Research – 16 weeks
• Transport – 2 weeks
• Transport Medical Control – throughout the year
• In-house call frequency, average – Every fifth night
• Number of call nights/month – 5–6

Second Year

• PICU – 14 weeks
• Electives Available: bronchoscopy, neuro-critical care, procedural sedation, toxicology
• Research – 34 weeks
• Transport Medical Control – throughout the year
• In-house call frequency, average – Every fifth night
• Number of call nights/month – 5–6

Third Year

• PICU – 15 weeks
• Electives Available: bronchoscopy, neuro-critical care, procedural sedation, toxicology
• Research – 36 weeks
• Transport Medical Control – throughout the year
• In-house call frequency, average – Every sixth night
• Number of call nights/month – 4–5

Mentorship during fellowship is considered very important. Mentors offer unique guidance because they have been in your position and are using their experience for your benefit. Throughout the pediatric critical care fellowship training you will work closely with faculty members who will offer advice, guidance and feedback along the way.

Once you start your research rotation you will have scholarly meetings. This is a multidisciplinary meeting where you have the opportunity to talk about your interests and projects you would like to pursue. Based on your interest, you will be encouraged to meet up with several faculty at MCW who have common goals. Ultimately, you and your team will highlight someone as your primary research mentor. This is someone who shares a similar research interest who can offer guidance in the planning phase of your research project. They will help to keep your research project on track and will meet with you during your research time to collaborate on ideas and progress. Each Fellow also has one of the primary administration faculty as their go-to resource throughout fellowship. They will be present at faculty meetings as well as semi-annual reviews. Although all of the primary administration directors are involved with the progress of each Fellow, this is someone who is dedicated to knowing specific details of your fellowship experience. This is your Advisor who not only helps to ensure you are meeting all of the criteria for graduation but helps to keep your long-term goals in consideration.

In addition to practical clinical experience we provide other structured opportunities for learning, including:

Critical Care Section Conferences:

• Core Conference
  A foundational weekly conference including didactics and group discussions with multiple disciplines on core principles within basic and advanced pathophysiology, diagnostics and therapeutics.
  
  
• RESCQ Conference (Research, Ethics, Safety, Career Development and Quality Improvement)
  Weekly presentations/discussions on Research (such as: study design, statistics, databases, organization and interpretation of literature, manuscript writing and editing, oral and poster presentations, evidence-based medicine, journal club, and research in progress updates), Ethics (including: clinical, professional and research), Patient Safety Science, Career Development for Fellows (such as: work-life balance, career longevity, resiliency, how to choose a mentor, career selection panels) and Quality Improvement (including project updates, QI methodology, etc.)
  
  
• Code Conference
  A monthly multidisciplinary, faculty mentored/fellow- and advanced practice provider-led objective data-driven review and discussion of the previous month’s Code Blue Activations within the Pediatric Critical Care Unit.
  
  
• Neuro-Critical Care Conference
  A monthly multidisciplinary (critical care, neonatology, neurology, neurosurgery, neuroradiology, infectious disease and physical medicine and rehabilitation) case-based discussion focused on highlighted our shared Neuro-Critical Care patient population.
  
  
• Systems Improvement Conference
  A monthly, faculty mentored/fellow-led discussion focused on practice-based medicine, quality improvement, patient safety science and system-wide improvement opportunities within Pediatric Critical Care.

Additional Conferences:

• “Tuesday Conference” - A rotating schedule comprised of:

• PICU Bedside Rounds
  Case-based discussions with fellows and local "experts," occurs in the medical/surgical ICU twice per month
  
  
• CICU Bedside Rounds Lecture Series
  Case-based discussions with fellows and local "experts," occurs in the Cardiac ICU twice per month
  
  
• Fellow’s Simulation Lab
  These are monthly hands-on learning sessions focused on a fellow’s development of critical thinking skills including crisis resource management and awareness of situational and cognitive biases that we all hold in some regards. Additional multi-disciplinary simulation offerings occur throughout the year during in-situ mock codes and procedural workshops. First year fellows also receive funding (through a grant from the Wisconsin Dairy Cares Foundation) and service coverage to attend the National Fellowship Bootcamp where several of our faculty members and nurse practitioners are instructors!

• PICU Fellow Board Review
  A monthly, faculty mentored/fellow lead session comprised of a brief didactic followed by practice of sample questions from American Board of Pediatrics: Pediatric Critical Care Board Exam and an in-depth team discussion of answers. These sessions assist in not only building one’s fund of knowledge but also on solidifying test taking skills.
  
  
• Cardiac Cath Conference
  Weekly multidisciplinary review of upcoming cardiothoracic surgery procedures, presented by cardiologists and surgeons.
  
  
• Joint Fellowship Curriculum (JFC)
  A required monthly presentation of topics for academicians-in-training from all disciplines.
  
  
• Multidisciplinary Surgical Conference
  Bi-monthly fellow-led conference for critical care, general surgery, and anesthesiology.
  
  
• Pediatric Grand Rounds
  Weekly lecture for staff physicians, trainees, and students.
  
  
• Professor Rounds
  A weekly, interactive hospital-wide clinical case presentation conference presented by a senior pediatric resident. A beloved tradition at the Children’s Wisconsin!!
  
  
• Trauma Grand Rounds
  Monthly lecture on trauma-related topics.

Other Conferences and Meetings:

• Fellow Administrative Meeting
  Required monthly meeting directed by the Fellowship Director. The objective is to learn and practice administrative and leadership skills, focusing on issues that impact the fellowship.
  
  
• Lunch with the Leaders
  Informal meeting over lunch with the Fellowship Leaders (Program Director, Associate Program Directors and Fellowship Research Directors). Discussions vary from career development, to getting to know your team members and more!
  
  
• Other Committee Meetings
  Second- and third-year fellows may be appointed to a committee relevant to their clinical or research interests by the Section Chief or Fellowship Leaders.

OVERVIEW/THROUGHOUT FELLOWSHIP

• We have 3 multidisciplinary units:
  • West 3: The cardiac ICU where you will manage pre- and post-operative patients with congenital heart disease and complex airway malformations, patients with cardiac transplants, various ventricular assist devices, and ECMO (VV and VA).
  • West 4: Focused on trauma/surgical ICU care where you learn post-op management for variety of post-op patients with neurosurgery, general surgery, ENT, and solid organ transplant (predominantly liver and kidney)
  • West 5: Focused on sepsis and oncology including bone marrow transplant/hematopoietic stem cell transplant patients
• Work directly with residents and nurse practitioners in teams on each floor
• Respond to Code Blue alarms throughout the hospital and actively participate in the trauma bay resuscitation
• Develop skills in triaging admissions and transport patients through our “3939” pager
• Develop presentation skills through journal club, systems improvement conference, etc

TYPICAL DAY

• 7:00 am receive sign-out from the overnight team
• 12:00 pm conference mostly on Mondays, Tuesdays, and Wednesday
• Board review on some Fridays
• There are some other opportunities for conferences other days of the week
• 4:00 pm sign out to the overnight team

FIRST YEAR

• Get immersed in clinical care for gaining comfort and confidence in the PICU early
• Begin learning and mastering routine procedures: arterial lines, peripheral IVs, central venous lines, chest tube placement, and intubation both in the unit and on 2 months of anesthesia
• Travel with our transport team to various regions during a 2 week rotation

SECOND YEAR

• Clinical time is significantly decreased to allow for time to focus on your research project
• Participate in a quality improvement project
• Gain more autonomy during your service weeks
• Twice monthly transport shifts where you may go by ground or air
• Serve as members of committees such as Code Review, Death Review, etc
• Get involved in activities that achieve personal goals and professional development such as facilitate mock codes, teach PALS (pediatric advance life support) or PFCCS (pediatric fundamental critical care support)
  
  THIRD YEAR

• Work on finishing your research project and/or completing additional projects
• Present your research at a conference
• Twice monthly transport shifts where you may go by ground or air
• Consider electives such as Neuro-Critical Care, bronchoscopy, procedural sedation, palliative care, or toxicology. Past fellows have also spent extra time with cardiology in cath lab, echo, or EP
• Supervise residents, NPs, and junior fellow’s procedures
• Transition to becoming an attending
• Continue to serve in committees and get involved in activities that achieve personal goals and professional development

Meet Our Faculty

"'Better than a thousand days of diligent study is one day with a great teacher.’ Without question, I can say that there are so many great teachers here at Children's that I think even an entire fellowship is a short time to learn from all of them.”

"I think that, in addition to our high volume and acuity exposure, we have unique experiences with our transport and trauma involvement."

"Training to become a pediatric intensivist at Children's has been a great adventure. One of the primary reasons that has made fellowship such a positive experience has been the leadership and support of the fellowship program. Being a critical care fellow comes with several challenges that go well beyond taking care of the critically ill child. While I knew I would receive excellent clinical experience here at Children's as the foundation of my training, the fellowship program has really helped me grow in ways that go beyond these clinical aspects. Areas of focus, such as professional development, mentoring, critical thinking, and work-life balance are not just discussions that get you through one day to the next but lessons that perpetually push me to grow in ways that are both unexpected and genuine. I am truly grateful to be the part of this process at Children's and feel better prepared to be a pediatric intensivist in more ways than I ever imagined because of it."

“The program here has such a wide variety of pathology among its patients as a fellow you feel prepared to care for all patients following your time here. The support from faculty in regard to clinical experience and research is the best, ultimately preparing you for nothing but success in future endeavors.”

“Working with faculty from different training backgrounds helps develop familiarity with different practices and management approaches.”

“The fellowship training has high patient volume, exposing you to a variety of disease processes and medical complexity. There are also multiple institutional affiliations, which create a wide array of research opportunities.”

“My favorite thing about the PICU fellowship program here at Children's is definitely the people I work with. It’s more like a family than anything. I consider myself extremely lucky to have such and amazing leadership, faculty, co-fellows, NPs and nurses.”

Milwaukee is one of the Midwest’s best-kept secrets and a prime location for the Medical College of Wisconsin’s main campus. A one-of-a-kind city with a vibrant and diverse culture, this charming, yet metropolitan must-see is just 90 minutes north of Chicago and nestled on the coast of Lake Michigan. Whether you’re catching a show at Summerfest, the world’s largest music festival, immersing yourself in the old world charm of the Historic Third Ward or taking in the sights and sounds of one of the many cafés, beer gardens or restaurants that line the city’s riverbank and shoreline, Milwaukee never disappoints. Find out why MCW students, faculty and employees take pride in calling Milwaukee home.

Where do the current fellows live?

• Brewer's Hill in downtown Milwaukee
• Wauwatosa
• Oak Creek
• Third Ward
• Brookfield
• Lower East Side

Favorite places fellows have visited in Wisconsin:

• Devil’s Lake near Madison
• Whetherby Cranberry Company
• Lakefront
• Summerfest
• Door County
• Two Rivers
• Wisconsin Dells
• Sunrise at Cave Point County Park
• Wisconsin State Parks

Favorite restaurants in Milwaukee:

• Odd Duck
• Elephant Cafe
• Ca’lucchenzo 
• Carnevor 
• La Masa 
• Anmol
• Stella Van Buren
• Celesta
• Amilinda
• Dorsia
• The Original
• Kin by Rice and Roll

MCW is a great choice for your work. And your life.

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