Our Critical Care Advanced Practice Provider (CCAPP) fellows receive all their training at Children's Wisconsin. The 12-month curriculum is divided roughly into 10 months of CICU/PICU clinical work, 2 weeks of Anesthesia time, and 6 weeks of electives.

Each week the CCAPP fellow will work an average of 50 hours. Of this, 40 hours will be clinical, and 10 hours will be in educational activities. The majority of the fellow’s clinical time will be during the day Monday through Friday. Near the end of fellowship, as autonomy and experience warrant, the fellow will be expected to have limited clinical hours on nights for the purpose of learning various role expectations while covering an entire PICU unit with their preceptor.

CCPNP Fellowship

• CICU – 2 months total
• Trauma/Surgical PICU – 4 months
• Medical PICU – 4 months
• Anesthesiology – 2 weeks
• Elective Rotations (Max 2) – 6 weeks total
• Research/Educational time – 10 hours/week
• Clinical training – 40 hours/week

We consider mentorship during fellowship very important. Mentors offer unique guidance because they have been in your position and are using their experience for your benefit. Throughout the CCAPP fellowship training, you will work closely with the program directors, your preceptors, and faculty members who will offer advice, guidance and feedback along the way.

Throughout the 12-month fellowship, you will have reviews with the APP Fellowship Director, and your primary and secondary preceptors. These will be both formal and informal. Initially, the informal reviews will be frequent (every 1-2 weeks) and slowly become less frequent (every 3 months). Formal evaluations will occur every 3 months and feedback from other APPs, Critical Care physician attendings, medical fellows, and RNs will also be obtained to assist you with making progress toward program and your own individual goals.

During your research time, you will have an opportunity to meet with your project advisor(s) and team members. This is the time where you will have the opportunity to talk about your projects needs and obtain assistance in completing it prior to conclusion of fellowship. Based on your interest, you will be encouraged to meet up with several CCAPPs and faculty at MCW who have common goals. Ultimately, you and your team will highlight someone as your primary research mentor, who shares a similar research interest and will 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 CCAPP Fellow also has one APP or faculty as their go-to research resource throughout fellowship. They will be present at all fellowship research meetings and are dedicated to knowing specific details of your fellowship experience. Your Advisor’s goal is to ensure you are meeting all the criteria for fellowship completion and helps to keep your long-term goals in consideration.

During your educational time for your doctoral degree, you will have time to meet with the members of your doctoral program resource guide. This is the time where you will have the opportunity to talk about your educational, schooling, and Capstone project needs, as well as obtain assistance in working toward completion.

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

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
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.

Ever wonder what a day in the life of a Critical Care Advanced Practice Provider (CCAPP) Fellow is like at Children's Wisconsin?

CCAPP Fellowship

As a CCAPP fellow you will spend approximately 40 hours per week on service with direct supervision of your primary and secondary preceptor. You are also given 10 hours per week for an approved educational activity, either a project or time for doctoral degree classwork (pre-determined prior to starting fellowship program). The purpose of the one-year fellowship is to allow you to get comfortable in the PICU with the ability to incrementally increase the number and complexity of patients you will be caring for across all 3 of our Pediatric ICUs. These PICUs are divided into a Cardiac ICU (CICU), Trauma/Surgical ICU, and a Medical/Hem-Onc ICU. In addition, you are given 2 weeks’ time with Anesthesia Service and 6 weeks for elective rotations in 1-2 areas of your choosing for in-depth post-graduate training with a specific population of patients (available electives will be discussed during interview process).

You will spend 2 months in our third-floor CICU. We have a thriving cardiac program at Children's we perform a large volume of cardiac surgery. It is here that you will gain valuable 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 fourth floor is our Trauma/Surgical ICU, where you will spend a total of 4 months. Here you learn post-operative management of a variety of patient types including post-operative neurosurgery, general surgery and solid-organ transplant (predominately liver and kidney) patients. The fourth floor PICU provides you with some quick turnaround of surgical patients, intensive exposure to very sick traumatic brain injury 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.

You will spend 4 months on the fifth floor, which is more of a medical PICU. On this floor, 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. You will also work with various subspecialists who will frequently be present on rounds providing a true multidisciplinary approach to patient care.

In addition, the CCAPP team functions in a Float role when assigned. The CCAPP Fellow will be assigned to this role from time to time with your preceptor. The “Float” is assigned to assist where needed on all three units by entering orders, admitting patients that arrive while the assigned team is rounding, and assisting with questions from nursing staff and consulting services so as to not disrupt the teams rounding. Additionally, in this role, you are responsible for attending any Rapid Response Team (RRT) pages with your preceptor.

In the last six months of this fellowship you will be expected to provide night-shift coverage on occasion with your preceptor. While on call, you will be responsible for covering one of the three PICU floors. Nights on call provide increasing amounts of autonomy. 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 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 weeks are spent on an Anesthesia rotation where you are able to learn and refine your airway management, central line placement, arterial line placement and peripheral IV placement skills.

You will also spend a total of six weeks with 1-2 elective rotations of your choosing where you will receive more in-depth training about specific patient populations. A few examples include Pulmonary, Hem-Onc, Neurocritical care, Cardiac, and Palliative. This is not an exhaustive list and specific elective rotations are dependent upon availability of that specialty program.

Lastly, an expectation of all CCAPP fellows is either the completion of a research, QI, or educational project over the course of the 1-year fellowship or entry/ongoing coursework toward a doctoral degree.

Overall your CCAPP fellowship is an extremely busy time filled with a clinical service and immense educational opportunities. Need a positive message here to finish this section.

“The Pediatric Critical Care APP fellowship has provided me with a well rounded opportunity for development of my clinical skills, critical thinking, and continued education. As a new graduate with limited ICU experience, it allowed dedicated time to broaden my knowledge base, while learning from a large group of providers with a variety of approaches. The Critical Care APPs set an incredible example as to what it means to be leaders in our field.”

Quotes from APP Preceptors/Mentors

“The fellowship is ideal for the candidate that wants to hone their decision-making skills while easing into the transition of being a provider.”

“Fellowship provides for a structured transition to the provider role with the flexibility to experience areas not traditionally found as a student such as anesthesia and interfacility transport.”

"Fellowship participants are motivated individuals that want to enrich their knowledge of the care of complex patients within a large academic facility. Being at a tertiary facility allows for clinical and rotational opportunities that are among the best in the country.”

• Minimum of 2 years RN experience in a pediatric setting
• Recent graduate of accredited acute care or critical care pediatric nurse practitioner program
• Ability to obtain PNCB acute care PNP certification within 6 months of entering PCCPNP fellowship program
• Current RN license through state of Wisconsin
• Eligibility for credentialing through Children's Wisconsin medical/dental staff
• Eligibility for credentialing through MCW credentialing department
• Current PALS certification
• 12 month commitment

• Comprehensive clinical training in all areas of pediatric critical care (medical, surgical, cardiac)
• Monthly simulation lab training
• Weekly didactic lecture series (by Critical Care Physicians, Fellows, and guest speakers)
• Other Specific Clinical Rotations Options:
  • Anesthesia
  • EDTC
  • Pulmonary
  • Cardiology
  • General Surgery/Trauma
  • Elective: requires approval of PCCNP fellowship director
• Stipend and standard MCW benefits for PNP
• Eligibility for partial tuition reimbursement for DNP Coursework

Designed to optimize educational experience including:

• Monday-Friday clinical with some weekend/night coverage as deemed appropriate for educational experience
• Protected time for weekly didactic educational sessions at MCW and Children's
• Protected time to pursue coursework for DNP or PhD at Marquette University if individual chooses to pursue DNP/PhD option while in fellowship program