Critical Care Fellowship Training and Experience

*There is minimal call during research months

Vacation is taken during research months.

Clinical Training

During clinical service months in the PICU, fellows are expected to provide hands-on patient care, as well as supervise and direct patient care provided by residents. By the end of the first year of training, the fellow will have gained experience in the recognition, triage, and management of a wide variety of acute illnesses, and will have gained skill in the performance of invasive procedures. Though the second and third years are skewed toward research time, clinical time will be dedicated to the honing of clinical skills with emphasis on plan-making and team leadership.

The beginning of the first year includes a comprehensive orientation program, a unique week-long hands-on course in extracorporeal membrane oxygenation (ECMO) support, and participation in a national “boot camp” with simulation and team-building exercises to facilitate a smooth transition into fellowship.

Fellows will provide overnight ICU coverage during the PICU and Anesthesia rotations. Coverage responsibilities will not exceed an average of every fourth night during these rotations.

Three other clinical rotations serve to round out the PCCM fellow’s clinical education:

1. In the first year, fellows will have one month that is a combination of Transport Medicine (two weeks), and Procedural Sedation education and training (two weeks). During Transport shifts fellows will spend time with the hospital’s Transport team, participating in both ground and air transport of critically ill patients. During sedation shifts fellows will learn to perform procedural sedation both in the PICU and with Anesthesia in the Nationwide Children’s Procedure Center.

2. In the first year, one month is spent on the Anesthesia service, gaining experience with airway management and vascular access in the operating room.

3. A total of four months will be spent on the Cardiothoracic ICU service during the three-year fellowship.  

Cardiothoracic Intensive Care: The Cardiothoracic ICU rotation is designed to allow the fellow to have a focused experience in the management of critically ill medical and surgical cardiac patients and thoracic surgery patients, including children with heart and/or lung transplantation. The fellow will work closely with our cardiac intensivists and attend focused didactic sessions offered by the Division of Cardiology. In-house call consists of coverage of ONLY the children in the Cardiothoracic intensive care unit.

Fellows are exposed to Point of Care Ultrasound throughout their fellowship. There is an annual POCUS bootcamp with Anesthesia and PEM fellows that includes didactic and hands on practice using live pediatric and young adult models to learn the role of Point of Care Ultrasound in procedures as well as in assessment of the heart, lungs and abdomen. A longitudinal PICU specific curriculum includes didactic lectures and hands on practice throughout the fellowship.

Electives: Fellows in their third year have two months of flexible Elective time that can be tailored to individual fellows’ needs as they progress toward junior faculty positions. These can be spent clinically, or as additional research months as circumstances dictate.  

Simulation

Teamwork and communication are paramount in the pediatric intensive care unit where intensivists must prioritize and coordinate care for critically ill patients with complex medical problems, often in a high stress environment. In situ simulation allows participants to experience a medical crisis in their actual work setting and learn from any mistakes without harm occurring to a patient.

Pediatric critical care fellows at Nationwide Children's Hospital have ample exposure to inter-professional teamwork training through monthly, code team leader simulation sessions where they experience a vast array of clinical scenarios. They gain procedural expertise via task trainers that are utilized for teaching skills such as advanced airway management, central line placement and chest tube insertion. First year critical care fellows also attend a multi-institutional, high-fidelity simulation "boot camp" training program, where they participate in numerous code scenarios with other critical care fellows from across the country: all with the purpose of improving their teamwork and communication skills, as well as their confidence in being a code team leader. First year fellows will also participate in an interdisciplinary “Difficult Airway Bootcamp” that relies heavily on high fidelity simulation.

Research Education

The cornerstone of the PCCM fellows’ research experience is the Abigail Wexner Research Institute (AWRI) at Nationwide Children's Hospital. Please see the AWRI website for more detailed information, but briefly: 

• Administratively, the AWRI is divided into Centers of Emphasis including Biobehavioral Health, Cardiovascular and Pulmonary Research, Childhood Cancer, Gene Therapy, Injury Research and Policy, Innovation in Pediatric Practice, Microbial Pathogenesis, Molecular and Human Genetics, Perinatal Research, the Battelle Center for Mathematical Medicine, Vaccines and Immunity, Clinical and Translational Research, Genomic Medicine and Child Health Equity and Outcomes Research. Each of these centers encompasses research topics which are relevant to Pediatric Critical Care Medicine.

• The AWRI also has core facilities which offer the following state-of-the-art services to researchers: Biostatistics, DNA Sequencing, Functional Genomics, High Throughput Genotyping and Sequencing, Morphology, Flow Cytometry, Clinical Research Services, Transgenic and Embryonic Stem Cell, and Viral Vector.

• The AWRI boasts more than 160 Principal Investigators, 1,000 employees and occupies more than 800,000 square feet of research space. Research faculty members also hold faculty appointments at The Ohio State University. Should a fellow’s area of interest lie outside the scope of AWRI, resources of the general university academic community can be made available.

Important PCCM Fellow Research Experience Aspects

Important aspects of the PCCM fellows’ research experience at Nationwide Children's Hospital include:

• The majority of research months are call-free.

• First year trainees will receive an orientation to the Abigail Wexner Research Institute and The Ohio State University academic communities including tours of relevant facilities and an overview of the ongoing research in each Center.

• We offer a comprehensive and highly structured mentor matching program, insuring that fellows are aware of (and take full advantage of) the diverse academic opportunities at Nationwide Children's Hospital.

• PCCM fellows have regular Scholarship Oversight Committees, with representation from senior clinical and basic scientists, providing research and career development guidance to augment that provided by individual research mentors.   

• The AWRI at Nationwide Children's Hospital offers an Institute-wide didactic research curriculum tailored specifically to clinical fellows.  This series teaches subjects related to research methodologies, principles of biostatistics, grantsmanship, and academic career development.

• PCCM fellows with an interest in developing a research-intensive career will be offered advanced training in scientific study design and execution, scientific communication and grantsmanship skills in their second and third years of fellowship as part of an Advanced Research Competency Curriculum tailored to individual fellows’ academic area(s) of interest.

• PCCM fellows will have the following academic goals during their fellowships:

  • First year: Selection of an area of interest; matching with an appropriate mentor; development of a hypothesis and research plan.

  • Second year: Research plan implementation with collection of data and preliminary data analyses; presentation of early findings at a minimum of one national meeting.

  • Third year: Completion of data collection and analyses; preparation of manuscript(s) for publication; presentation of findings at a minimum of two national meetings.

We expect the Pediatric Critical Care Medicine subspecialty trainees to become fully integrated into the research program of their chosen mentor and will have appropriate resources made available to them. Trainees will not be responsible for securing their own research funding. Competitive intramural seed grant funding is available, however, for trainees who wish to augment their research projects and gain experience with the grant writing process.

A variety of Masters-level degree programs including Masters of Public Health and Masters of Clinical Research are available through The Ohio State University.

Didactic Education

Fellows receive robust didactic education with a diversity of styles and presentations. In the beginning of the academic year, our twice weekly “Survival Series,” targeted to first-year fellows, focuses on the most common and high-yield PCCM topics. Fellows also enjoy 2 hours of protected conference time each week, on a broad array of topics relevant to critical care medicine, presented by both divisional faculty and experts in other fields. Additional educational offerings include Neurocritical Care Conference, Board Review Sessions, ED/PICU Conference, Journal Club, and Morbidity & Mortality Conferences. Fellows will gain experience in organizing and presenting journal clubs with a variety of topics and formats. Additionally, a GME-wide “fellows college” will cover topics relevant to all pediatric subspecialties, including wellness and resilience, time management, managing interpersonal conflict, and job search negotiations.