Pediatric Critical Care

Our fellows receive the majority of their training at Children's Hospital of Wisconsin. Our 72-bed Pediatric Intensive Care Unit admitted 3019 patients in 2012. Critical Care providers also responded to 121 Code Blue events, 221 Rapid Response Team calls, and handled 1100 transports in 2012.

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 classes scheduled at the Graduate School of Biomedical Sciences or blocks of time in the laboratory.

First Year

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

Second Year

• PICU – 14 weeks
• Anesthesiology – NA
• Pulmonology – 4 weeks
• Transport – NA
• Transport Medical Control – NA
• Research – 34 weeks
• In-house call frequency, average – Every fifth
• Number of call nights/month – 5–6

Third Year

• PICU – 14 weeks
• Anesthesiology – NA
• Pulmonology – NA
• Transport – NA
• Transport Medical Control – 2 weeks
• Research – 36 weeks
• In-house call frequency, average – Every sixth-seventh
• 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 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 mentor 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.

Fellows in our program are involved in a variety of administrative activities, including scheduling, recruitment, coordination of core curriculum series, resident education, QI leadership, transport scheduling, and committee participation.

Second and third-year fellows participate on Critical Care committees, and have the opportunity to be involved in budget discussions.

Through our Joint Fellowship Curriculum, fellows also receive training in interviewing, contract negotiation, career development, and other administrative leadership topics.

Quality Improvement
First-year fellows complete the Patient Safety and Quality Improvement online courses through the Institute for Healthcare Improvement Open Course. Each group of fellows then puts their knowledge into practice by designing and completing a multi-disciplinary quality improvement project during the second and third years of fellowship.

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

Critical Care Section Conferences:

Research Conference
Weekly presentations on study design, statistics, databases, organization and interpretation of literature, manuscript writing and editing, research ethics, oral and poster presentations, evidence-based medicine, and research in progress.

Clinical Didactics Conference
Weekly lectures from multiple disciplines on basic and advanced pathophysiology, state-of-the-art diagnostics and therapeutics, and new programs.

Morbidity & Mortality
Monthly fellow-led review of the previous month's census in the critical care units.

Additional Conferences:

Cardiac Cath Conference
Weekly multidisciplinary review of upcoming cardiothoracic surgery procedures, presented by cardiologists and surgeons.

CV Journal Club
Monthly review and discussion of current literature on a topic in cardiology, CV surgery, anesthesia, or ICU management.

CV Case Review
Monthly case-based review of management.

Joint Fellowship Curriculum
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.

Academic Research Conference
Weekly presentation of current research by pediatrics faculty.

Pediatric Grand Rounds
Weekly lecture for staff physicians, trainees, and students.

Trauma Grand Rounds
Monthly lecture on trauma-related topics.

Other Conferences and Meetings:

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.

Fellows' Meeting
Monthly forum to discuss issues relevant to the fellowship with the Pediatric Critical Care Fellowship Director.

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.

Core Curriculum
Weekly didactic conference covering the core topics in pediatric critical care medicine. Speakers include faculty from within the division as well as outside the division.

Bedside Professor's Rounds
Case-based discussion with fellows and local "experts," occurs in the PICU twice per month.

Cardiac ICU Lecture Series
Didactic conference focused on Cardiac Intensive Care issues, occurs twice per month.

Simulation Curriculum
Simulation is used to augment education in procedural skills during orientation. Simulation is also used at various points throughout the year to augment education on team work and specific clinical scenarios.

Our program will be accepting applications through ERAS. Please apply on the ERAS website. ERAS will start accepting applications for Pediatric Critical Care on July 15. We will access your application and contact you to make interview arrangements.

Apply

Ever wonder what a day in the life of a PICU Fellow is like at Children's Hospital of 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 CHW 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 CHW 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 as well as patients requiring ECMO support and patients on 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 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 BMT 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 as well as rapid response pages. These are opportunities 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.

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 multiplies 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 the first 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.

If 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. 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 year you will also spend 4 weeks doing a Pulmonary rotation. During this rotation you will have the opportunity to do bronchoscopies, learn more about PFTs, sleep studies, respiratory equipment and home ventilators. This time also helps you learn some intricacies of taking care of the complex trach-vent patients as an outpatient.

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 and finishing your scholarly project. Some of the fellows have completed multiple research projects during their fellowship. There is ample support for pursuing clinical or basic science research within and outside the division of critical care. In addition to the time spent working on the scholarly activities, each of us participate in administrative duties. Some fellows make the call schedules, others make the transport schedules. This involves a fair amount of coordination among the fellows, nurse practitioners and residency.

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 starting a bowel regimen in patients who are receiving continuous narcotic infusion. 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, 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.

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.

Our PICU has 72 beds, and is arranged on 3 floors of 24 beds each.
Fellows rotate through all three floors of the PICU and provide care for a wide variety of patients including medical, surgical, and cardiac patients. We use a wide variety of treatment modalities including high frequency oscillating ventilators, renal replacement therapy, ECMO, ventricular assist devices, and transplantation.

We are a Level 1 trauma center and provide care for burn patients.

Fellows become proficient at performing procedures such as intubation, central venous line placement, arterial line placement, and chest tube placement. Fellows may also obtain certification in bronchoscopy by performing and observing 50 bronchoscopies in children, including 25 in children less than one year of age.

Clinical opportunities outside of the PICU:

• Trauma team member
• Transport physician
• Code team leader

Electives are available in Global Health and Procedural Sedation. Moonlighting is also available with the CHW Transport Team in addition to the fellows’ required shifts.

Training in research is an integral part of the program, and fellows can work with any researcher in the Medical College community. In addition to the conferences described above, all second-year fellows are required to take a two-month course in Research Study Design. Interested fellows are encouraged to pursue Masters Degrees from the MCW Graduate School of Biomedical Sciences in their areas of academic concentration. Recent fellows have pursued degrees in Bioethics, Clinical and Translational Science, and Public Health. Tuition is paid by the department of Pediatrics as a taxable benefit. Accommodations for class work are made in the clinical schedules of second- and third-year fellows.

Opportunities for Scholarly Activity

ABP requirements:

• The fellow will participate in a structured core curriculum in scholarly activities.
• The fellow will engage in a scholarly project under the supervision of a Scholarship Oversight Committee.
• The fellow will complete one of the following specific work products approved by the SOC:
• Peer-reviewed publication in which the fellow played a substantial role
• An in-depth manuscript describing a completed project
• A thesis or dissertation written in 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

Opportunities available at MCW for fulfillment of requirements:

• Clinical research project
• Laboratory based research project
• Master’s Degree with thesis
• Extensive QI project
• Outcomes research project
• Public Policy Project

Additional scholarship/educational opportunities

• Teaching of residents and medical students in both formal and informal settings
• Clinical facilitator for Medical School Biochemistry course
• Resident ward teaching
• Preceptor for Medical School Bioethics and Palliative Medicine course
• Transport Education Sessions
• Nursing orientation
• Mock code leader
• PALS instructor
• ATLS instructor

The stipend levels are determined by the MCWAH Board of directors. Information about the stipend amounts can be found on the Graduate Medical Education Stipends page.

Visit the Graduate Medical Education website for information about all benefits we offer.