| Curriculum Overview
The pediatric critical care medicine (PCCM) training program at Children's Hospital of Pittsburgh (CHP) centers around a 71-bed multidisciplinary intensive care complex. Included is a 31-bed PICU, an 12-bed intermediate intensive care unit, a 20-bed NICU. and an 8-bed cardiac intensive care unit (CICU). Units are staffed by PCCM attendings and fellows from the PCCM division. Over 2,500 children are admitted to the PICU each year. Because CHP is the only pediatric hospital for a catchment area of approximately 2 million people, nearly all critically ill children from this tri-state region are admitted to this institution. As a consequence, fellows have an opportunity to study the care of children with the full range of life-threatening medical disorders, as well as those recovering from trauma, cardiothoracic, neurosurgical, craniofacial, and other major surgery. In addition, the hospital is an international center for liver, heart, and heart-lung transplantation. There is also an active program for neonatal and pediatric support with extracorporeal membrane oxygenation (ECMO).
Eleven full-time pediatric intensivists staff the PICU and three full-time pediatric intensivists staff the cardiac intensive care unit. Pediatric residents, anesthesiology fellows, emergency medicine residents, and adult-oriented critical care fellows work with 14 pediatric CCM fellows to provide patient care. They are assisted by an outstanding group of pediatric critical care nurses, respiratory therapists, and other support personnel. Fellows also spend time in cardiothoracic surgery and anesthesiology, and have a variety of electives available to them. Training typically is for three years, although some fellows may meet requirements for certification with two years of critical care medicine training after other subspecialty training.
Through clinical experience, fellows become thoroughly knowledgeable and competent in the management of infants, children and adolescents with single and multiple organ system failure, understanding theoretical and practical aspects of invasive and non-invasive monitoring and in the intricacies of cooperation with medical, surgical, and anesthesiology colleagues. They are expected to take call in-house approximately every fourth night l0 months a year. Fellows participate actively in the emergency transport system administered by the critical care faculty. Fellows receive all requests for medical transport to the hospital via transport dispatch. They provide detailed medical advice to referring physicians and serve as transport physician for the majority of unstable infants and children, and all pediatric ECMO referrals. Approximately 1000-1200 children are transported annually, 20-30 of those being ECMO referrals.
Research opportunities abound in the PICU at CHP and the University Medical Center of Pittsburgh. Fellows are expected to initiate a clinical or basic science research project during their first year. Fellows are expected to present their research at national academic conferences in their second and/or third years of fellowship. They are encouraged to take advantage of opportunities particularly in the areas of cardiopulmonary physiology, cellular mechanisms of cerebral injury, critical care related pharmacology, sepsis, and outcomes. In addition, several fellows have taken advantage of formal training in clinical research or public health through the School of Medicine's Clinical Research Training Program and the Graduate School of Public Health.
Fellowship begins with an intensive, one-month orientation program, where fellows receive hands-on simulation-based training, lectures, conferences, and detailed training in invasive procedures. In addition, a year-long series of daily lectures in critical care medicine is shared with the adult program. These include core knowledge didactic lectures evidence-based learning (Journal Club), and case-based learning (Professor Rounds, M&M). Material specific to pediatric critical care is provided by the CHP intensivists and other subspecialists. In addition, there is an active program in medical ethics oriented toward issues in pediatric intensive care.
Fellows completing this program can expect to be well trained in virtually all aspects of pediatric intensive care and well prepared to carry out research activities in an academic setting.
For further information, contact Tara Redwing, PCCM Fellowship Coordinator, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Room 6840 Main Tower, Pittsburgh, PA 15213, email: redwingt@upmc.edu, phone#412-692-6236, fax # 412-692-607
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