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 – 26 weeks
• Anesthesiology – 8 weeks
• Research – 16 weeks
• Transport – 2 weeks
• Transport Medical Control – throughout the year
• In-house call frequency, average – Every fourth night
• Number of call nights/month – 6–7

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 – 14 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.

Ever wonder what a day in the life of a PICU Fellow is like at Children's Wisconsin? If so, take a look and see what a typical day is like in each of the three years of fellowship.

First Year Fellow
As a first-year fellow you spend most of your time on service and on call. This is the best way to get you more comfortable in the PICU and allow you to gain a large chunk of clinical experience at the beginning of your three years of fellowship. At Children's, we spend 26 weeks on service in our first year. During those 26 weeks you spend a similar amount of time on each of the 3 ICU floors.

The 3rd floor is our CICU and where you will spend 2.5 months your first year. We have a large and thriving cardiac program at Children's and, as a result, we do a large volume of cardiac surgery. Here you gain a lot of experience taking care of a variety of both pre- and post-operative patients with congenital heart disease, cardiac transplant patients, patients requiring ECMO support, and patients supported with various ventricular assist devices. As with the other floors, this is a true-multidisciplinary team as we round and discuss patients with the cardiologists and the cardiothoracic surgeons daily.

The 4th floor is our trauma/surgical ICU; here you learn post-operative management of a variety of patient types including post-operative neurosurgery patients, general surgery patients and solid-organ transplant (predominately liver and kidney) patients. You are also responsible for responding to trauma activations in the ER when on service on the 4th floor as these patients frequently are admitted to the PICU. As a critical care fellow, you play an integral role in the traumas that come into the hospital. You are in the trauma bay and expected to perform the primary survey, perform procedures that may be needed and assist in resuscitation. Traumas often provide a fast-paced multidisciplinary team experience to say the least. The 4th floor PICU provides you with some quick turnaround of surgical patients, intensive exposure to very sick TBI and transplant patients, and an opportunity to get to know the staff and fellows of the various surgical specialties as together you are a team co-managing the patients.

The 5th floor PICU is more of a medical PICU where you will see a wide variety of patients but specifically gain expertise in management of sepsis, critically ill bone-marrow transplant (BMT)/hematopoietic stem cell transplant (HSCT) patients and oncology patients. Here, you will also work with various subspecialists who will frequently be present on rounds providing a true multidisciplinary approach to patient care. As the fellow on the 5th floor, you are responsible for responding to hospital-wide code blue pages. This is an opportunity for you to help in stabilization of acutely ill patients on the general floor and assist in their transfer to the PICU if necessary.

While on call, you will be responsible for covering one of the three PICU floors. Nights on call provide increasing amounts of autonomy throughout your first year. It is reassuring to know that there is always one of your attendings in-house and readily available for patient care and educational opportunities. As a first-year fellow you are given priority for procedures as this is a time for you to begin learning and mastering routine procedural skills necessary in the PICU.

Two months are spent on an anesthesia rotation where you are able to learn and refine your airway management, central line placement and peripheral IV placement skills. You will gain a lot of experience with intubations, central lines, arterial lines and chest tubes and by the end of your first year will be able to supervise other providers (nurse practitioners and residents) with these procedures.

You will also spend two weeks with the transport team. This time is meant to introduce you to interfacility transport of patients. As a quaternary care facility with a multitude of world-renowned pediatric subspecialist, we care for a diverse patient population from a large catchment area. Most commonly, we serve patients from all over Wisconsin and the upper peninsula of Michigan. Importantly, as the largest pediatric hospital in Wisconsin, we have the good fortune to take care of a diverse patient population from a wide range of environments and backgrounds inclusive of urban and remote rural areas. During your 2 week transport rotation, you have the opportunity to travel with the transport team and may experience both ground and air (helicopter and fixed wing) transport to the various regions we serve. 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 triage/coordinate patient placement in the PICU; a skill that is critical within our chosen careers.

Overall your first year of PICU fellowship is an insanely busy time filled with a lot of clinical service and nights on call. At the end of the first year you will be amazed at how much your knowledge, comfort and confidence in caring for critically ill children grows exponentially over those 12 months.

Second Year Fellow
As a second year Pediatric Critical Care Fellow, you spend less time on clinical service in the PICU. You spend 14 weeks on service during your second year compared to 26 in the first year of fellowship. This year is essentially the most productive time of your fellowship. You can work on getting your research project moving and pursue other educational activities such as a Master’s degree from the Medical College of Wisconsin.

When on service, a typical day begins by meeting in the PICU at 7:00 am for sign-out from the on-call fellow. During rounds you have more autonomy and are expected to run rounds with the attending present. At noon we go to noon conference on Mondays, Tuesdays, and Wednesdays. There are also opportunities to attend other multidisciplinary conferences other days of the week, such as Neuro-Critical Care Conference, Code Review, Board Review, Stoke Conference, Cath Conference and others. After lunch/conference, it is back to the PICU for more work, new admissions, procedures or teaching. At 4:00 pm we sign-out the unit to the on-call team and adjourn for the day.

During your second and third year, there are elective rotations available. These rotations are meant to help you broaden your knowledge and skills. Currently, available rotations include Neuro-Critical Care, bronchoscopy, and procedural sedation. Past fellows have also taken the opportunity to spend extra time with the cardiology (cath lab, echo, EP, etc.), palliative care, toxicology and complex needs teams.

Third Year Fellow
Each day can be quite different for a third year PICU fellow here at Children’s Wisconsin! Since the service time is only 14 weeks, there are 38 weeks out of the year to do a myriad of other activities to advance your academic career and fund of medical knowledge. A good portion of this year is spent working and finishing your scholarly project. Some of the fellows have completed multiple research projects during their fellowship. There is ample support for pursuing clinical, translational, educational or basic science research, both within and outside of, the division of critical care. In addition to the time spent working on the scholarly activities, each of us participate in administrative duties. For example, some fellows serve as members of the Code Review Committee, others are members of PICQUIC (Pediatric ICU Quality Improvement Committee) or the Graduate Medical Education Committee (GMEC) while others are foundational members to other various clinical or academic committees. One of the great things about this year is you really get to experience the various academic/administrative opportunities that lie ahead following graduation.

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 standardizing extubation readiness, while a current project is focusing on implementing a modified approach to Near4Kids. Some other projects involved improving the costs surrounding lab orders, converting intravenous to oral medications as appropriate, etc.

Personal goals can also be achieved during the third year of fellowship. Some fellows work on education curriculum development, facilitating 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 a way to help us mold and grow the rest of our career!

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”).

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.

"'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 find immense value in the ability to work as a multidisciplinary group within the PICU. Our institution has many great minds and leaders in their respective fields. The opportunity to have an open and collegial discussion with other subspecialties regarding not only patient care but ongoing research and education has been instrumental in my growth and development as a fellow. There is a great respect for the fact that our hospital is a teaching institution on many levels and faculty take every opportunity to teach and mentor trainees.”

"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.”