Critical Care Fellowship Training & Experience

*Research Months are call-free.

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, Anesthesia, and Sedation Service rotations. Coverage responsibilities will not exceed an average of every fourth night during these rotations.

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

1. Fellows will participate in the Sedation service for one month each during the first year of training. This service, run through the Division of Critical Care Medicine, provides conscious and deep sedation for painful procedures and diagnostic imaging throughout the hospital. Fellows will develop expertise in pre-sedation screening, the use of an array of sedative and analgesic medications, patient monitoring, and airway management techniques. All of this will take place under direct attending supervision. While on this rotation, fellows will take overnight call in the PICU.

2. Early 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.  

4. In the first year, one month is spent on the Transport Rotation.

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 lung transplantation. The fellow will work closely with one of 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 area.

Cardiology Rotation: During the month-long Cardiology Rotation, second year critical care fellows participate as part of the Nationwide Children's Perfusion Team, the Cardiac Anesthesia Team, and the Cardiology Consultation Team. The PCCM fellow on the Cardiology Rotation will further expand upon his or her medical knowledge and skill with pediatric cardiac patients by obtaining a greater depth of understanding of cardiac anatomy & disease pathophysiology; obtaining further skill with regard to cardiac bypass & ECMO; improving their basic echocardiography interpretation skills; and by exploring the unique hemodynamic differences in this population that make anesthesia & sedation challenging.

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 at Children’s Hospital of Philadelphia, 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.

Research Education

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

• The Research Institute is a separately incorporated subsidiary of Nationwide Children's Hospital whose mission is to conduct biomedical and behavioral research on the Nationwide Children's Hospital campus.

• Administratively, The Research Institute 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 Batelle Center for Mathematical Medicine, Vaccines and Immunity and Clinical and Translational Research. Each of these Centers encompasses research topics which are relevant to Pediatric Critical Care Medicine.

• The Research Institute 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 Research Institute 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 The Research Institute, 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:

• Research months are all call-free.

• First year trainees will receive an orientation to The 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 Research Institute 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 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

Twice-weekly acute care management seminars give way in the early part of the year to a series of weekly seminars on a broad array of topics with relevance to pediatric critical care medicine, given by experts in each field. Fellows are expected to organize and present at our twice-monthly journal club and monthly morbidity and mortality conferences. In addition, core competency lecture series are presented at Nationwide Children's Hospital and The Research Institute.