Critical Care Medicine | Fellowship Program
The Division of Pediatric Critical Care Medicine offers a Pediatric
Critical Care Fellowship accredited by the Accreditation Council for
Graduate Medical Education.
Clinical training is received at St. Louis Children's Hospital, a
nationally recognized pediatric quaternary referral center on the campus of
the Washington University Medical Center. St. Louis Children's Hospital
serves eastern and southern Missouri, central and southern Illinois,
northwestern Kentucky, western Indiana, as well as the broader national and
international communities.
The pediatric intensive care unit (PICU) at St. Louis Children's Hospital
is a 26-bed (expanding to 36 beds in 2007) regional and national referral
center, boasting active medical/surgical and cardiac services (~ 8000
patient days/year). The PICU is supported by all pediatric medical and
surgical specialties. In addition, the PICU supports an ECMO program, a
hemofiltration service and a busy solid organ transplant program (kidney,
liver, heart, lung), including the largest pediatric lung transplant
program in the world. PICU fellows and faculty also assist the pediatric
chief residents with critical care transports (~ 1500 transports annually,
making it one of the busiest pediatric transport services in the country).
Fellows have the opportunity to participate as members of the transport
team and are exposed to the management of a regional referral system.
Finally, St. Louis Children's Hospital has a busy Emergency Department (~
60,000 visits/year), including a Level 1 trauma center and the only
pediatric burn center in the region.
The faculty consists of ten physicians. All faculty have academic
appointments through the Washington University School of Medicine. Faculty
are all board certified in Pediatrics, and board eligible or board
certified in Pediatric Critical Care Medicine. In addition, some faculty
are also board certified in Anesthesia or Pediatric Cardiology. Pediatric
Critical Care faculty have diverse scholarly interests encompassing both
the clinical and basic sciences, in addition to their responsibilities for
patient care and education. Clinical research interests include pulmonary
hypertension, traumatic brain injury, quality/medical error reduction, the
epidemiology of critical illness in children and participation in a variety
of multi-center clinical trials in Pediatric Critical Care Medicine.
Faculty are heavily involved in the field at the national level, with
leadership roles in the Pediatric Cardiac Critical Care Society, the
American Board of Pediatrics Sub-board of Pediatric Critical Care Medicine,
the Society for Critical Care Medicine, the Pediatric Acute Lung Injury and
Sepsis Investigators network and the NACHRI/Virtual PICU consortium. In
addition, critical care faculty are carrying out fundamental basic
research, investigating the genetics of growth and regeneration,
cardiomyocyte metabolomics, and the pathobiology of invasive streptococcal
infections.
The primary objective of the Pediatric Critical Care Medicine program is to
prepare individuals for an academic career in Pediatric Critical Care
Medicine. Accordingly, the program's specific goal is to provide trainees
with the knowledge and basic experience to become:
- Accomplished clinicians, through:
- guided study of the pathophysiology of medical and surgical critical illness in infants and children
- learning of skills in diagnostic and therapeutic procedures used in the management of these patients
- development of the attitudes and communication skills appropriate to facilitate interaction with patients, families, physicians, nurses, and other health professionals
- Effective medical educators, through:
- contact with appropriate role models at the bedside and during didactic presentations
- critical commentary by faculty on didactic presentations and participation in conferences organized or led by the trainee
- carefully monitored supervision of residents and medical students
- Promising researchers in basic science and clinical investigation, through:
- supervised progression toward formulation of testable research hypothesis
- learning of proper experimental design and methodology
- development of skills for the effective presentation of research results
- Efficient administrators,
through supervised acquisition of experience in management and problem solving in a multidisciplinary pediatric intensive care unit
To fulfill its objectives, as outlined above, the Critical Care Program's
curriculum is designed to allow a gradual acquisition of both cognitive
knowledge and practical skills. Initially, the focus is on the basic
assessment and therapy of organ system dysfunction. Thereafter, fellows
are encouraged to develop increasing sophistication in their understanding
of disease processes and management, leading to independent decision-making
and the ability to supervise others. Based on this progression, fellows
receive increasing levels of responsibility in patient care, teaching, and
supervision of junior fellows, house staff and medical students, and
clinical administration during the three years of fellowship.
The first year is fully structured, almost entirely clinical, and designed
to provide the fellow with the necessary experience to become an excellent
clinician. Clinical rotations include:
-
Eight months of Pediatric Intensive Care Medicine (5 months
medical/surgical service, 3 months cardiac service). Fellows are
primarily responsible for all medical patients and co-manage all
surgical patients.
-
One month of Pediatric Anesthesiology early in the year, designed to
teach airway management, invasive monitoring and pharmacology.
-
One month of Cardiac Catheterization, designed to teach hemodynamics
and vascular access.
-
One month comprising Cardiology and Pulmonary Medicine with a specific
focus on the skills of echocardiography and bronchoscopy.
-
The remaining month is available for vacation and to begin the process
of selecting a scholarly project that will commence during the second
year.
Clinical rotations during the second and third years are generally limited
to three months, including rotations in the Pediatric Intensive Care unit
as well as electives. Elective rotations available during the second and
third years are designed to provide additional educational opportunities in
specific areas relevant to the care of critically ill children. At present,
they include Cardiothoracic Surgery, Nephrology, Adult Critical Care
Medicine, Advanced Anesthesiology and Adult Neuro-Intensive Care; others
are available depending on each fellow's specific interests.
The bulk of the fellow's time during years 2 and 3 is reserved for
research. Research is performed under the guidance of an experienced
principal investigator (mentor) in either the clinical or basic sciences.
Mentors may be selected from any department/program within Washington
University. Indeed, fellows are encouraged to look broadly when choosing a
research mentor and the program is highly supportive of initiatives
directed at the development of physician-scientists, such as the Pediatric
Scientist Development Program.
Along with the experience obtained from the various clinical rotations,
fellows are expected to base their development as clinicians on sound
knowledge of the biological processes that underlie critical illnesses, the
diagnostic and therapeutic methods of the subspecialty, and the processes
used in the critical evaluation of clinical information. To guide
acquisition of this knowledge, a clinical curriculum has been prepared. The
specific items in this curriculum will be covered in teaching conferences
within the Division of Pediatric Critical Care Medicine (Monday Clinical
Case conference, Wednesday fellow conference, Monday M&M [monthly]) or the
Department of Pediatrics (Tuesday fellow conference).
The Fellowship Program participates in the National Resident Matching Program for Critical Care Medicine. Applications are screened and selected applicants are invited to travel to St. Louis to meet with our faculty and fellows and tour the facilities.
Those wishing to be considered may
download the application form from this
site or request one from Tracey Erdman, Department of Pediatrics, Division
of Critical Care Medicine, Washington University School of Medicine, St.
Louis Children's Hospital, One Children's Place, Suite 5S20, St. Louis, MO
63110.
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