| Pediatric Critical
Care Fellowship
The pediatric CC fellowship, accredited
by the Pediatric Residency Review Committee, has two to three positions
available each year. Each trainee remains at least three years,
in accordance with the requirements of the American Board of Pediatrics.
Clinical responsibilities are provided by the Neuro, Pediatric,
and Intermediate ICUs at Children's Hospital of Pittsburgh.
About
Children’s
 Children’s
Hospital of Pittsburgh is the pediatric facility of the University
of Pittsburgh School of Medicine. The hospital is fully approved
and accredited, and is the only hospital within a radius of 125
miles entirely devoted to the care of infants and children.
Because the hospital serves a population of several
million in the greater Pittsburgh metropolitan and tri-state area
of Pennsylvania, Ohio, and West Virginia, the range of pediatric
illnesses seen is very broad. More than 13,000 children are admitted
and about 30,000 children visit the Emergency Department each year.
Approximately 400 cardiothoracic operations are performed annually,
including 250 to 300 using cardiopulmonary bypass. More than 300
major neurosurgical procedures and more than 2,000 major general
pediatric operations are performed each year. Altogether, 10,000
to 11,000 operations are performed annually. The hospital is a Level
1 Regional Resource Pediatric Trauma Center and treats injured children
from the entire region. In addition, it is an international center
for bone marrow and solid organ transplantation (including kidney,
liver, heart, lung and bowel). An active ECMO program serves both
neonates and older infants and children.
Intensive Care unit
The pediatric intensive care complex is a 59-bed
multidisciplinary facility consistently providing technologically
advance dare for patients with life-threatening illness or injury.
More than 2,500 patients from newborn through young adults are admitted
annually. Included in the complex is a 23-bed Pediatric Intensive
Care Unit (PICU), a 20-bed Neonatal Intensive Care Unit (NICU),
an eight-bed Intermediate Intensive Care Unit (IICU), and a state-of-the-art
eight-bed Cardiac Intensive Care Unit (CICU). Complete facilities
for physiologic monitoring are available at every bed in the complex.
Pediatric Critical Care Medicine (PCCM) subspecialty residents have
responsibility for all patients in the PICU, IICU, and CICU. Care
of patients in the NICU is limited to patients requiring ECMO.
 In
addition to physicians from the full range of medical and surgical
subspecialties, highly skilled pediatric nurses, respiratory therapists,
social workers, occupational and physical therapists, critical care
pharmacists and other professionals work closely with the PCCM physicians
to complete an effective multidisciplinary team.
The ICUs are located on the sixth floor of the
hospital’s Main Tower, adjacent to the operating room area.
This facilitates transfer of patients to and from surgery. The hospital
emergency laboratory is located within the ICU complex, and measurements
of arterial and capillary blood gases, co-oximetry, electrolytes,
and ionized calcium and hemoglobin are available within a few minutes
24 hours per day.
 The
PCCM Division provides medical direction for the Respiratory Therapy
Department. This group provides complete and continuous coverage
in the ICU, including sophisticated technical support for the conventional
and high-frequency ventilation, arterial blood gas sampling and
analysis, simple bedside pulmonary function testing and participation
in clinical research.
The PCCM division also is responsible for the
hospital’s specialized pediatric emergency Transport Team.
Along with experiences transport nurses and respiratory therapists,
Children’s Hospital physicians transport critically ill infants
and children from around the region and nation by ground ambulance,
helicopter, or fixed-wing aircraft.
The division also contributes to the success of
an active home ventilation program, providing support for pediatric
patients requiring chronic mechanical ventilation.
Subspecialty Residency
Duration
In compliance with the requirements of the American
Board of Pediatrics for certification in Pediatric Critical Care
Medicine, the following subspecialty residency (fellowship) duration
is required.
| Goal Requirements |
Subspecialty |
Residency |
| Pediatric Intensivist |
3 year pediatrics |
3 years |
| Pediatric intensivist with subspecialty emphasis |
3 year pediatricsplusintegrated/combined subspecialty training
in a related subspecialty (e.g. cardiology, pulmonology, etc.) |
4-5 years |
| |
or
3 years pediatricsplus3 years pediatric training in a related
subspecialty (e.g. cardiology, pulmonology, neonatology) |
2 years |
| Pediatric Cardiac Intensivist |
3 years pediatrics plus3 years pediatric intensive care of
pediatric cardiology |
1 year |
| Pediatric anesthesiologist/intensivist |
3 years pediatrics plus 2.5 year anesthesiology |
2 years |
Subspecialty residency training for physicians
with an interest in pediatric intensive care and previous training
in surgery, medicine or other specialties can be tailored to the
requirement of the specific primary specialty board. While often
only six to 12 months of subspecialty residency training is require,
a minimum two-year subspecialty residency is more customary and
consistent with the acquisition of skills needed to fully participate
in an academic pediatric ICU.
Program Goals
 The
purpose of the program is to assure excellent patient care while
providing subspecialty residents with the background to understand
the pathophysiology of acute, life-threatening disease, as well
as the physiology of advanced life support. It is also our goal
to provide research opportunities and training to prepare the resident
to embark on an academic career.
Over the course of three years, subspecialty residents
will have ample opportunity to develop both clinical and research
skills. In general, clinical responsibilities are greatest in the
first year and decrease over the subsequ3ent two years. Typical
assignment in the first year include six to eight months’
ICU service, one month anesthesiology, one month cardiothoracic
surgery, two months research or clinical electives and one month
meeting/vacation.
Expectations for the first year include:
- The acquisition of substantial cognitive and
technical skills required for the care of critically ill and injured
children
- Understanding theoretic and practical aspects
of invasive and noninvasive monitoring
- Cooperation and collaboration with physicians
from other specialties and professionals from other health care
disciplines
- Initiation of research efforts
- Development of an understanding of the ethical
principles, social factors and legal concerns relevant to providing
intensive care
 During
the second and third years, subspecialty residents will continue
to develop clinical skills, but will have more opportunity to teach
junior housestaff, participate in a lecture series on CCM topics
suitable for resident education, develop administrative skills and
focus on research. With the help of a faculty mentor, it is anticipated
that the subspecialty residents will become the principal investigators
of at least one clinical or laboratory study, and, in accordance
with requirements of the American Board of Pediatrics, become the
first author of a related publication.
The resources of the Safar Center for Resuscitation
Research are fully integrated into the division and available to
trainees. They provide extensive opportunity to study cellular and
molecular mechanisms of brain injury from trauma, ischemia and asphyxia.
In addition, opportunities within the division exist for studying
sepsis, multiorgan system failure, respiratory support of the critically
ill pediatric patients and outcomes research.
There are extensive and well-established opportunities
to collaborate with basic scientists from the University of Pittsburgh
(in laboratories immediately adjacent to the hospital) that offer
the subspecialty residents the opportunity to learn and apply current
cellular and molecular biology techniques to an enormous range of
disorders relevant to CCM. The facilities of the intensive care
complex itself, combined with clinical and investigational laboratories,
provide an excellent setting for clinical investigation.
Formal education
 All
subspecialty residents must have current certification in Basic
Life Support as well as Pediatric Advanced Life Support prior to
entering the program. Completion of Advance d Trauma Life Support
is also recommended prior to entering the program.
A core CCM lecture series is provided during the
summer months. Subsequently, PCCM lectures are given weekly the
division faculty and other medical and surgical faculty at Children’s
Hospital. An ethics-oriented case conference occurs monthly. A weekly
journal club provided an opportunity to review current literature,
as well as to learn appropriate study design, implemae3ntaiton and
data analysis. Daily lectures of the university-wide multidisciplinary
CCM training program also are open to pediatric subspecialty residents.
Weekly grand rounds in pediatrics, medicine, anesthesiology and
surgery and research seminars throughout the university complement
the subspecialty resident’s education. A visiting professor
program provides an opportunity to meet prominent members of the
field from other institutions.
Admission procedures
 Applicants
must have completed residency training in pediatrics, anesthesiology
or pediatric surgery. An application should be completed and submitted
promptly to the program director. The candidate is required to seek
letters of evaluation from at least three faculty members of prior
training programs. One letter should be from the department head
or training program director from each program in which the applicant
has trained and one from an intensivist. Information concerning
the applicant’s board eligibility or certification status
is required in one of these letters. If the applicant is a foreign
medical graduate, he/she must comply with the current Department
of Health and Human Services requirements regarding entry and eligibility
and must have already passed the ECMLE examination. A Pennsylvania
medical training license is required prior to the beginning date
by all trainees.
A visit to Children’s Hospital of Pittsburgh
is required of all applicants. It will be arranged after receipt
of the completed application. During the visit, candidates will
have an opportunity to meet the PCCM faculty and subspecialty residents,
and will participate in rounds and conferences.
Stipend and Fringe
Benefits
Subspecialty residency salaries are set by the
university at the PGY IV-VI levels. In 2001-2002, the PGY IV salary
was approximately $39,690. Fringe benefits include individual and
family plan health insurance, life insurance, long-term disability
insurance, accidental death and dismemberment insurance and individual
medical malpractice insurance. A small stipend is available to each
resident ton contribute to the cost of educational items such as
books, conferences and travel expenses.
Special housing is not available. However, numerous
apartment complexes are located near the campus and in other convenient
areas. In general, Pittsburgh is a safe and comfortable city of
neighborhoods with a modest cost of living when compared with most
major American Cities. |
