Curriculum & Rotations

Pediatric Critical Care Fellowship Curriculum

General objectives include the development of:

• A strong fund of knowledge of pediatric critical care medicine
• Confidence to provide clinical care to critically ill children in a compassionate and ethical manner
• Technical proficiency with invasive diagnostic and therapeutic procedures necessary for providing critical care to children
• Management and interpersonal skills necessary to direct a pediatric intensive care unit and critical care program
• Teaching skills to effectively educate physicians, nurses, and other allied healthcare workers
• The ability to effectively utilize a team approach to both clinical and academic critical care medicine and to recognize the importance of such an approach
• Evaluation skills to critically review the medical literature as it relates to critical care medicine
• Research skills to further the body of knowledge in pediatric critical care medicine in clinical, laboratory, or translational research

Rotations

• Rotations are scheduled in two to four week blocks in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Care Center (PCCC).
• During their first year, trainees complete 4 week rotations in anesthesiology with our pediatric anesthesiology group and 4 weeks in cardiothoracic surgery, working primarily with the surgeons but with opportunities to work with the perfusionists as well.
• We have also established rotations in procedural sedation and a skill-building, including PICC placement, rotation with the Vascular Access Team (VAT), completed during the second or third year.
• Other rotations can be organized in consultation with the program director at the request of the fellow.
• Over the 3 years of the pediatric critical care fellowship (39 four week blocks), the fellows spend 18 blocks on clinical services, 18 blocks on research, and have 3 blocks (4 weeks/year) of vacation.
• Fellows attend PICU “bootcamps” during first year and again as an upper level fellow.

Conferences

• Further education is provided by a weekly division conference based on the critical care content requirements. Fellows provide a subset of these conferences, with additional sessions led by attendings from within the critical care division as well as content experts from outside the division.
• A second set of critical care division academic conferences  covers research, QA, and other related topics.
• Our ultrasound curriculum and communication curriculum are integrated into the clinical training and conference schedule. 
• In addition, the pediatrics department has a formal fellowship academic curriculum series that covers the full range of topics essential to all trainees, including core knowledge in scholarly activities but also with a focus on well-being and career guidance.

Clinical

In order to balance the rigorous demands of pediatric intensive care, clinical training is distributed across all three years of the pediatric critical care fellowship. Trainees benefit from in–house attendings 24/7 with bedside teaching during both service time and call in the PICU and PCCC, which are adjacent units. Fellows cover both units at night, with a resident in the PICU and an APP in the PCCC. Trainees focus on formulating diagnoses, learning the management principals of medical and complex surgical conditions, and performing procedures under the supervision of the attending.

They acquire a skill base to coordinate care for patients in the PICU and PCCC with other members of multidisciplinary teams, such as residents, nurses, advanced practitioners, pharmacists, respiratory therapists, physical and occupational therapists, social workers, etc. After fulfilling mandatory, skill-based competency requirements, trainees begin to participate in the Pediatric Transport Program.

As fellows progress in their pediatric critical care fellowship and demonstrate increasing competence, they expand their independent practice in both directing patient care and team leadership. The senior fellow completes a formalized rotation as an “attending” in which they perform all of the activities of an attending physician for the duration of the rotation, with the attending physician maintaining indirect supervision and, as they do for faculty colleagues, availability for patient care support as necessary. At the completion of fellowship, our trainees demonstrate high quality knowledge and skills in patient care, research, QA, education, and administration and are prepared to fulfill their career goals as a clinician, clinician-researcher, clinician-educator, or clinician-administrator.

Research

To support the development of their scholarly work, we provide the fellows with increasing protected time for research over the three years of fellowship. The scholarly activity will address the requirements for ABP board certification but more importantly lays the groundwork or builds on an established foundation of academic activity that the fellow may continue to pursue as faculty. Fellows are supported to attend a national meeting at least once during their fellowship with the goal of presenting their scholarly work. The full range of scholarly and research options are available, from bench to translational to clinical, informatics, and education research. Collaborations with departments across the undergraduate and graduate campuses are available, from the education and engineering schools to the Clinical and Translational Science Institute (CTSI). CTSI personnel, as well as research leadership within the department of pediatrics are available to review and advise on research projects in addition the each fellows Scholarly Oversight Committee (SOC), which they will form during the first year of fellowship.

Quality Assurance

Fellows identify a QA project during their first or second year of fellowship. The division has faculty invested in QA at the division and department level, and has actively pursued multiple QA initiatives over recent years, with significant progress across multiple metrics. Fellows may join ongoing projects or develop their own project. All trainees at the University of Rochester Medical Center complete the core Institute for HealthCare Improvement Basic Certificate in Quality and Safety, if not already completed during previous training.